Estimated Deaths Attributable to Social Factors in the United States

Sandro Galea, MD, DrPH; Melissa Tracy, MPH; Katherine J. Hoggatt, PhD; Charles DiMaggio, PhD; Adam Karpati, MD, MPH


Am J Public Health. 2011;101(8):1456-1465. 

In This Article


Table 3 provides the summary RR estimates and corresponding 95% CIs derived from meta-analyses of the relations between each social factor and adult all-cause mortality. RRs for mortality associated with low education and poverty were higher for individuals aged 25 to 64 years than they were for those aged 65 years or older; for example, the RR was 1.75 (95% CI=1.51, 2.04) for poor versus nonpoor individuals aged 25 to 64 years, but the RR was 1.40 (95% CI=1.37, 1.43) for poor versus non-poor individuals aged 65 years or older. Adverse levels for all social factors considered were associated with increasedmortality, although the RR of mortality for low education among those aged 65 years or older was not statistically significant (RR=1.23; 95% CI=0.86, 1.76).

Table 3 also shows the population-attributable fraction for each social factor. These fractions ranged from 1.7% for area-level poverty to 11.5% for less than a high school education among those aged 25 to 64 years. From these population-attributable fraction estimates and mortality data, we estimated that approximately 245000 deaths in the United States in 2000 were attributable to low education, 133000 to poverty, 162000 to low social support, 39000 to area-level poverty, 119000 to income inequality, and 176000 to racial segregation.

Our sensitivity analyses showed that the summary RR estimates varied in magnitude but not direction depending on the choice of cutpoints and categories for the exposure. Among those aged 25 to 64 years, summary RR estimates for the relation between low education and mortality ranged from 1.17 to 2.45, those for poverty ranged from 1.20 to 2.39, and those for low social support ranged from 1.08 to 1.54. For area-level poverty, summary RR estimates ranged from 1.10 to 1.15, those for income inequality ranged from 1.14 to 1.32, and those for racial segregation ranged from 1.47 to 2.54. Complete results of the sensitivity analyses are available from the authors upon request.


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