Annals of epidemiology · 2026
Contribution of lifestyle factors to sex differences in educational inequalities in life expectancy in selected European countries.
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Janssen Fanny, Zazueta-Borboa Daniel, Sizer Alison, Zengarini Nicolás, Martikainen Pekka
Аннотация
PURPOSE: Socio-economic inequalities in life expectancy are generally higher among men than among women. We formally estimated the contribution of smoking, alcohol, and obesity to the sex gap in educational inequalities in remaining life expectancy at age 30 (e30_ineq) in England and Wales (E&W), Finland and Italy (Turin), from 1992 to 2017.
METHODS: We compared the sex gap in e30_ineq (high versus low educated) with and without 'lifestyle-attributable mortality' (LAM) by extended cause-deletion lifetable calculations. We estimated LAM by multiplicatively aggregating estimates of smoking-, alcohol- and obesity-attributable mortality by educational level (low, middle, high), sex and five-year age groups (30 +).
RESULTS: Males experienced almost constantly higher e30_ineq than females. In 1992-2017, LAM contributed respectively 57%, 70%, and 92% to the observed sex gap of 1.1 years in E&W, 2.6 years in Finland, and 2.4 years in Italy (Turin), driven predominantly by smoking-attributable mortality. LAM, driven by alcohol-attributable mortality, determined the reversal from increase to decline in the sex difference in e30_ineq in Finland in 2007.
CONCLUSIONS: Smoking and excessive alcohol consumption, thus, largely determined the larger educational inequalities in e30 among men in all three countries, the observed country differences therein, and the time trends in the sex gap for Finland.
METHODS: We compared the sex gap in e30_ineq (high versus low educated) with and without 'lifestyle-attributable mortality' (LAM) by extended cause-deletion lifetable calculations. We estimated LAM by multiplicatively aggregating estimates of smoking-, alcohol- and obesity-attributable mortality by educational level (low, middle, high), sex and five-year age groups (30 +).
RESULTS: Males experienced almost constantly higher e30_ineq than females. In 1992-2017, LAM contributed respectively 57%, 70%, and 92% to the observed sex gap of 1.1 years in E&W, 2.6 years in Finland, and 2.4 years in Italy (Turin), driven predominantly by smoking-attributable mortality. LAM, driven by alcohol-attributable mortality, determined the reversal from increase to decline in the sex difference in e30_ineq in Finland in 2007.
CONCLUSIONS: Smoking and excessive alcohol consumption, thus, largely determined the larger educational inequalities in e30 among men in all three countries, the observed country differences therein, and the time trends in the sex gap for Finland.