Educational disparities in mortality mediated by modifiable behavioral factors: Findings from the Japan...

Area of Science:

• Public Health
• Epidemiology
• Social Determinants of Health

Background:

• Educational attainment is a known social determinant of health.
• Disparities in mortality based on education exist globally.
• The role of behavioral factors in mediating these disparities requires further investigation, particularly in Asian populations.

Purpose of the Study:

• To investigate the association between educational level and overall/cause-specific mortality in Japan.
• To determine if modifiable behavioral factors mediate educational disparities in mortality.

Main Methods:

• A multi-center cohort study of 58,831 Japanese adults (Japan Multi-Institutional Collaborative Cohort Study).
• Participants were categorized by educational level (high school or lower, junior college, university or higher).
• Cox regression and causal mediation analysis were used to assess mortality risks and the impact of behaviors (smoking, alcohol, physical activity).

Main Results:

• Men with lower education (high school or less) had higher overall mortality (adjusted HR: 1.23) and risks for cancer and other causes.
• These disparities were most prominent in men aged 35-59.
• Smoking, alcohol, and physical inactivity mediated 11%, 9%, and 12% of the mortality gap, respectively. No significant disparities were found in women.

Conclusions:

• Significant educational disparities in mortality persist among younger Japanese men.
• Modifiable behaviors such as smoking, excessive alcohol consumption, and insufficient physical activity are key mediators of these disparities.