ArticleThe Lancet. Public health2023
Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study.
Article in The Lancet. Public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Genetic estimation of causalities between educational attainment with common digestive tract diseases and the mediating pathways.BMC gastroenterology · 2024Pooled it
- Health inequalities in a middle-income country: a systematic review of the Costa Rican case.Frontiers in public health · 2024Pooled it
- Trajectories of physical activity patterns across the life course in Mexican adults: findings from the Mexico city prospective study.BMC public health · 2025Article
- Improving estimators of HIV mortality and retention in care by linking clinical cohort data with national registries in Mexico.BMC public health · 2025Article
- Association between lifestyle risk factors and mortality in the Mexico City prospective study.Scientific reports · 2025Article
- Prequalification of genome-based newborn screening for severe childhood genetic diseases through federated training based on purifying hyperselection.American journal of human genetics · 2024Article
- Education, urbanicity of residence, and cardiometabolic biomarkers among middle-aged and older populations in the US, Mexico, China, and India.SSM - population health · 2024Article
- The association between education and premature mortality in the Chinese population: a 10-year cohort study.The Lancet regional health. Western Pacific · 2024Article
- Do education, urbanization, and green growth promote life expectancy?Frontiers in public health · 2024Article
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Authors and funding
20 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundSocial inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City.
methodsThe Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors.
findingsAmong 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1·84; 95% CI 1·71-1·98), equivalent to approximately 6 years lower life expectancy, with an RR of 1·78 (1·67-1·90) among participants with incomplete primary, 1·62 (1·53-1·72) with complete primary, and 1·34 (1·25-1·42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3·65; 95% CI 3·05-4·38 for no education vs tertiary education) and from infectious diseases (2·67; 2·00-3·56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality.
interpretationIn this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality.
fundingWellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.
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