Do lifestyle behaviours explain socioeconomic differences in all-cause mortality, and fatal and non-fatal cardiovascular events? Evidence from middle aged men in France and Northern Ireland in the PRIME Study

Objective. To examine the contribution of lifestyle behaviours to the socioeconomic gradient in all-cause
mortality, and fatal and non-fatal cardiovascular events.
Method. 10,600 men aged 50–59 years examined in 1991–1994 in Northern Ireland (NI) and France and
followed annually for deaths and cardiovascular events for 10 years. Baseline smoking habit, physical activity,
and fruit, vegetable, and alcohol consumption were assessed.
Results. All lifestyle behaviours showed marked socioeconomic gradients for most indicators in NI and
France, with the exception of percentage of alcohol consumers in NI and frequency of alcohol consumption
in NI and France.
At 10 years, there were 544 deaths from any cause and 440 fatal and non-fatal cardiovascular events. After
adjustment for country and age, socioeconomic gradients were further adjusted for lifestyle behaviours.
For total mortality, the median residual contribution of lifestyle behaviours was 28% and for cardiovascular
incidence, 41%. When cardiovascular risk factors were considered in conjunction with lifestyle behaviours
these percentages increased to 38% and 67% respectively.
Conclusion. Lifestyle behaviours contribute to the gradient in mortality and cardiovascular incidence between socioeconomic groups, particularly for cardiovascular incidence, but a substantial proportion of
these differentials was not explained by lifestyle behaviours and cardiovascular risk factors.