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Interaction between education and income on the risk of all-cause mortality: prospective results from the MOLI-SANI study

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

To investigate the separate and inter-related associations of education and household income in relation to all-cause mortality.

Methods

Prospective study on 16,247 men and women (≥35 years), a sub-sample of the MOLI-SANI cohort that had been randomly recruited within an Italian general population. Both education and income were used as categorical variables. Hazard ratios (HR) were calculated by Cox-proportional hazard models.

Results

Over a median follow-up of 7.7 years (125,016 person-years), 694 deaths were ascertained. Either education (HR = 0.68; 95 % CI 0.51–0.91) or income (HR = 0.57; 0.42–0.77) was inversely associated with mortality. After simultaneous adjustment, the association of education appeared to be largely explained by income. A significant interaction between both variables was found (p = 0.0078). The inverse association with mortality was stronger when a higher income was combined with a higher educational level (HR = 0.59; 0.38–0.92 for the highest combination of the two indicators).

Conclusions

Either education or income was the predictor of mortality in a large sample of the Italian population. The two variables significantly interacted and the inverse association of income with mortality tended to be stronger within higher education groups.

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Acknowledgments

The MOLI-SANI research group thanks Drs. Vittorio Krogh and Sabina Sieri (Istituto Nazionale dei Tumori, Milan, Italy) for their contribution to dietary questionnaire analysis and interpretation, the Associazione Cuore Sano Onlus (Campobasso) for its financial support and the Azienda Sanitaria Regionale del Molise (ASReM, Campobasso, Italy), the Offices of vital statistics of the Molise region and the Molise Dati Spa (Campobasso, Italy) for their collaboration and support provided during the follow-up activities.

MOLI-SANI study Investigators: Steering Committee Licia Iacoviello (Neuromed, Pozzilli, Italy), Chairperson, Maria Benedetta Donati and Giovanni de Gaetano (Neuromed, Pozzilli, Italy). Safety and data monitoring Committee Jos Vermylen (Catholic University, Leuven, Belgio), Chairman, Ignacio De Paula Carrasco (Accademia Pontificia Pro Vita, Roma, Italy), Simona Giampaoli (Istituto Superiore di Sanità, Roma, Italy), Antonio Spagnuolo (Catholic University, Roma, Italy). Event adjudicating Committee Deodato Assanelli (Brescia, Italy), Vincenzo Centritto (Campobasso, Italy), Paola Muti (Hamilton, Ontario, Canada), Holger Schünemann (Hamilton, Ontario, Canada), Pasquale Spagnuolo and Dante Staniscia (Termoli, Italy). Scientific and organizing secretariat Francesco Zito (Coordinator), Americo Bonanni, Chiara Cerletti, Amalia De Curtis, Augusto Di Castelnuovo, Licia Iacoviello, Roberto Lorenzet, Antonio Mascioli, Marco Olivieri and Domenico Rotilio. Data management and analysis Augusto Di Castelnuovo (Coordinator), Marialaura Bonaccio, Simona Costanzo and Francesco Gianfagna. Informatics Marco Olivieri (Coordinator), Maurizio Giacci, Antonella Padulo and Dario Petraroia. Biobank and biomedical analyses Amalia De Curtis (Coordinator), Federico Marracino, Maria Spinelli, Christian Silvestri. Communication and Press Office Americo Bonanni (Coordinator), Marialaura Bonaccio and Francesca De Lucia. Moli-family Project Francesco Gianfagna, Branislav Vohnout. Recruitment staff Franco Zito (General Coordinator), Secretariat: Mariarosaria Persichillo (Coordinator), Angelita Verna, Maura Di Lillo, Irene Di Stefano, Blood sample: Agostino Pannichella, Antonio Rinaldo Vizzarri, Branislav Vohnout, Agnieszka Pampuch; Spirometry: Antonella Arcari (Coordinator), Daniela Barbato, Francesca Bracone, Simona Costanzo, Carmine Di Giorgio, Sara Magnacca, Simona Panebianco, Antonello Chiovitti, Federico Marracino, Sergio Caccamo, Vanesa Caruso; Electrocardiograms : Livia Rago (Coordinator), Daniela Cugino, Francesco Zito, Francesco Gianfagna, Alessandra Ferri, Concetta Castaldi, Marcella Mignogna; Tomasz Guszcz, Questionnaires: Romina di Giuseppe (Coordinator), Paola Barisciano, Lorena Buonaccorsi, Floriana Centritto, Antonella Cutrone, Francesca De Lucia, Francesca Fanelli, Iolanda Santimone, Anna Sciarretta, Maura Di Lillo, Isabella Sorella, Irene Di Stefano, Emanuela Plescia, Alessandra Molinaro and Christiana Cavone. Call Center Giovanna Galuppo, Maura Di Lillo, Concetta Castaldi, Dolores D’Angelo and Rosanna Ramacciato.

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Authors and Affiliations

  1. Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, IS, Italy

    Marialaura Bonaccio, Augusto Di Castelnuovo, Simona Costanzo, Mariarosaria Persichillo, Maria Benedetta Donati, Giovanni de Gaetano & Licia Iacoviello

Authors
  1. Marialaura Bonaccio
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  2. Augusto Di Castelnuovo
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  3. Simona Costanzo
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  4. Mariarosaria Persichillo
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  5. Maria Benedetta Donati
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  6. Giovanni de Gaetano
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  7. Licia Iacoviello
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Corresponding author

Correspondence to Marialaura Bonaccio.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The enrollment phase of the MOLI-SANI study was conducted at the Research Laboratories of the Catholic University in Campobasso (Italy) and supported by research Grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy)–Programma Triennale di Ricerca, Decreto no.1588 and IL LABORATORY, Milan, Italy. The present study was conducted within the framework of research Grants from the Fondazione Umberto Veronesi, Milan, Italy and the Centro Nazionale per la Prevenzione e il Controllo delle Malattie (Longitudinal cohorts, 2011), Ministry of Health, Italy. These funders had no role in study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. MB was supported by a Fondazione Umberto Veronesi Fellowship. All Authors were and are independent from funders.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

On behalf of the MOLI-SANI Study Investigators. MOLI-SANI study Investigators are listed in “Acknowledgments”.

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Bonaccio, M., Di Castelnuovo, A., Costanzo, S. et al. Interaction between education and income on the risk of all-cause mortality: prospective results from the MOLI-SANI study. Int J Public Health 61, 765–776 (2016). https://doi.org/10.1007/s00038-016-0822-z

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  • DOI: https://doi.org/10.1007/s00038-016-0822-z

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