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Socioeconomic trajectories across the life course and risk of total and cause-specific mortality: prospective findings from the Moli-sani Study
  1. Marialaura Bonaccio1,
  2. Augusto Di Castelnuovo2,
  3. Simona Costanzo1,
  4. Amalia De Curtis1,
  5. Mariarosaria Persichillo1,
  6. Chiara Cerletti1,
  7. Maria Benedetta Donati1,
  8. Giovanni de Gaetano1,
  9. Licia Iacoviello1,3
  10. on behalf of the Moli-sani Study investigators
  1. 1 Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
  2. 2 Cardiocentro, Mediterranea, Napoli, Italy
  3. 3 Medicine and Surgery, Centre for Research in EPIdemiology and preventive MEDicine (EPIMED), University of Insubria, Varese, Italy
  1. Correspondence to Marialaura Bonaccio, Epidemiology and Prevention, IRCCS Neuromed, Pozzilli 86077, Italy; marialaura.bonaccio{at}


Background A life course approach has been suggested as the most appropriate to establish the total impact of socioeconomic status (SES) on adult health outcomes; however, such an approach has been poorly used within Mediterranean populations. We aimed to examine the SES trajectories from childhood to adulthood associated with mortality risk in a large general population-based cohort and to test potential pathways (eg, inflammation) underlying such associations.

Methods Longitudinal analyses on 22 194 subjects recruited in the Moli-sani Study, Italy (2005–2010). Low and high SES in childhood, educational attainment (low/high) and SES during adulthood (measured by a score including material resources and dichotomised as low/high) were used to define overall trajectories.

Results Over 8.3 years of follow-up, 1155 deaths occurred. In the group with poor childhood SES, an upward trajectory in both educational and material circumstances was associated with lower risk of all-cause death (HR=0.64; 95% CI 0.47 to 0.87), as opposed to subjects who remained stably low (low education and adulthood SES). Subjects with high childhood SES, but not educational achievement, were at increased risk of total and cardiovascular disease (CVD) death, although reporting higher material SES in adult life, as compared with the stably high SES group (HR=1.44; 1.02 to 2.02 and HR=1.90; 1.10 to 3.28, respectively). Inflammatory markers marginally accounted for such associations.

Conclusion For individuals with low SES in early life, an educational and material upward trajectory over the life course was associated with lower mortality risk. In the high SES childhood group, lack of a higher educational attainment appeared to be unfavourably associated with survival.

  • socioeconomic status
  • inflammation
  • life course
  • socioeconomic trajectories
  • cumulative socioeconomic disadvantage
  • mortality

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  • Collaborators Steering Committee: Licia Iacoviello*°(Chairperson), Giovanni de Gaetano* and Maria Benedetta Donati*.

    Scientific secretariat: Licia Iacoviello*° (Coordinator), Marialaura Bonaccio*, Americo Bonanni*, Chiara Cerletti*, Simona Costanzo*, Amalia De Curtis*, Giovanni de Gaetano*,Augusto Di Castelnuovo§, Maria Benedetta Donati*, Francesco Gianfagna*°,Mariarosaria Persichillo*, Teresa Di Prospero* (Secretary).

    Safety and Ethical Committee: Jos Vermylen (Catholic Univesity, Leuven, Belgio)(Chairperson), Ignacio De Paula Carrasco (Accademia Pontificia ProVita, Roma, Italy), Simona Giampaoli (Istituto Superiore di Sanità, Roma,Italy), Antonio Spagnuolo (Catholic University, Roma, Italy).

    External Event adjudicating Committee: Deodato Assanelli (Brescia, Italy), Vincenzo Centritto (Campobasso, Italy).

    Baseline and Follow-up data management: Simona Costanzo*(Coordinator), Marco Olivieri (Università del Molise, Campobasso, Italy).

    Informatics: Marco Olivieri (Università del Molise, Campobasso, Italy).

    Data Analysis: Augusto Di Castelnuovo§ (Coordinator), Marialaura Bonaccio*, Simona Costanzo*, Alessandro Gialluisi*, Francesco Gianfagna*°, Emilia Ruggiero*.

    Biobank and biomedical analyses: Amalia De Curtis* (Coordinator), Sara Magnacca*.

    Genetic analyses: Benedetta Izzi*(Coordinator), Francesco Gianfagna*°, Annalisa Marotta*, Fabrizia Noro*.

    Communication and Press Office:Americo Bonanni* (Coordinator), Francesca De Lucia (Associazione Cuore Sano,Campobasso, Italy).

    Recruitment staff: Mariarosaria Persichillo* (Coordinator), Francesca Bracone*, Francesca De Lucia (Associazione Cuore Sano, Campobasso, Italy), Salvatore Dudiez*, Livia Rago*.

    Follow-up Event adjudication: Livia Rago* (Coordinator), Simona Costanzo*, Amalia De Curtis*, Licia Iacoviello*°, Teresa Panzera*, Mariarosaria Persichillo*.

    Regional Health Institutions:Direzione Generale per la Salute - Regione Molise; Azienda Sanitaria Regionale del Molise (ASReM, Italy); Molise Dati Spa (Campobasso, Italy); Offices ofvital statistics of the Molise region.

    Hospitals: Presidi OspedalieriASReM: Ospedale A. Cardarelli – Campobasso, Ospedale F. Veneziale – Isernia,Ospedale San Timoteo - Termoli (CB), Ospedale Ss. Rosario - Venafro (IS),Ospedale Vietri – Larino (CB), Ospedale San Francesco Caracciolo - Agnone (IS);Casa di Cura Villa Maria - Campobasso; Fondazione di Ricerca e Cura GiovanniPaolo II - Campobasso; IRCCS Neuromed - Pozzilli (IS).

    * Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy

    °Department of Medicine and Surgery, University of Insubria, Varese, Italy

    § Mediterranea, Cardiocentro,Napoli, Italy

    Baseline Recruitment staff is available at

  • Contributors MB, LI and ADiC contributed to the conception and design of the work, and interpretation of data. SC, ADeC and MP managed data collection of the Moli-sani Study. MB and ADiC analysed the data. MB wrote the manuscript. CC, MBD, GdG and LI originally inspired the research and critically reviewed the manuscript.

  • Funding The enrolment phase of the Moli-sani Study was 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 Instrumentation Laboratory, Milan, Italy. Funders had no role in study design, collection, analysis and interpretation of data; in the writing of the manuscript and in the decision to submit the article for publication. Marialaura Bonaccio was supported by a Fondazione Umberto Veronesi Fellowship. Simona Costanzo was the recipient of a Fondazione Umberto Veronesi Travel Grant. All authors were and are independent from funders. The present analyses were partially supported by the Italian Ministry of Health 2013 (Young investigator grant to MB, number: GR-2013-02356060), the Italian Association for Cancer Research (A.I.R.C.) with grant AIRC "5x1000" to LI, Ref. n. 12237 and by BiomarCaRE (Biomarkers for Cardiovascular Risk Assessment in Europe): European Commission Seventh Framework Programme FP7/2007-2013 (HEALTH-F2-2011-278913).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.