Impact of socioeconomic, behavioral and clinical risk factors on mortality

J Public Health (Oxf). 2009 Jun;31(2):231-8. doi: 10.1093/pubmed/fdp015. Epub 2009 Mar 10.


This study investigates the relative contributions of socioeconomic status (SES), behavioral and clinical risk factors on mortality. The Third National Health and Nutrition Survey Linked Mortality File was used to examine the association of SES (race, insurance, education, income), behavioral (smoking, obesity, physical activity), and clinical (elevated blood pressure, triglyceride level, lipid levels, C-reactive protein (CRP)) risk factors with 6-12-year all-cause mortality. Respondents were stratified by known chronic diseases into one of the following categories: no chronic disease, non-cardiovascular chronic disease, cardiovascular disease, and diabetes. The overall weighted mortality rate was 9.5% with the highest mortality rate among diabetics. Race, insurance coverage, income, smoking status, inadequate physical activity, elevated blood pressure and elevated CRP were independently associated with mortality in the overall population. When stratified by chronic disease, SES factors remained associated with mortality, most strongly in the healthy population. Current smoking and inadequate physical activity were also associated with mortality across disease groups while clinical risk factors were less consistent. SES factors, health behaviors and clinical risk factors were all associated with mortality even when baseline health status and chronic diseases are taken into account. Efforts to reduce mortality will require a multi-faceted approach incorporating healthy behaviors and accessible health care systems in addition to clinical advances.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiovascular Diseases / mortality*
  • Cause of Death*
  • Diabetes Mellitus / mortality*
  • Female
  • Health Behavior*
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Risk Factors
  • Social Class*
  • United States / epidemiology