{
  "abstract": "Background Although socioeconomic inequality in mortality has long been a public health focus, the associations of area-level socioeconomic status (SES) and individual-level factors with mortality have not been well investigated, especially in China with rapid industrial development.Methods In this nationwide, population-based, prospective cohort study, adults aged over 40 from 29 counties were included in the China Cardiometabolic Disease and Cancer Cohort study. The composite area deprivation index of area-level SES was generated from national census data and categorised into tertiles. Cox proportional hazards models were fitted to calculate HRs and 95% CIs for area-level SES with the risk of mortality, and comprehensive individual socioeconomic, lifestyle, and metabolic factors were examined as potential mediators.Results A total of 174 004 participants were included. During a median follow-up of 10.1 years, low area-level SES was associated with 34% increased risk of all-cause mortality (95% CI 1.27 to 1.42), 76% increased risk of cardiovascular disease (CVD) mortality (95% CI 1.59 to 1.94) and 13% increased risk of non-CVD mortality (95% CI 1.05 to 1.21) compared with high area-level SES. The association between area-level SES and all-cause mortality was partly mediated by individual socioeconomic, lifestyle and metabolic factors, contributing 3.8%, 20.7% and 8.9%, respectively. Furthermore, individuals with low area-level SES and low individual SES, unhealthy lifestyles, or poor metabolic status had the highest risk of mortality.Conclusions Significant area-level socioeconomic inequalities in mortality exist in China. Comprehensive interventions targeting both area-level circumstances and individual socioeconomic, lifestyle and metabolic factors were key strategies to reduce these inequalities.",
  "authors": [
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Qiuyu Cao"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Mian Li"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Ruizhi Zheng"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Hong Lin"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Yu Xu"
    },
    {
      "affiliations": [
        "China Development Research Foundation, Beijing, China"
      ],
      "name": "Zhicheng Wang"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China"
      ],
      "name": "Guijun Qin"
    },
    {
      "affiliations": [
        "Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China"
      ],
      "name": "Li Yan"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Min Xu"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Tiange Wang"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Yuhong Chen"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Shuangyuan Wang"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Zhiyun Zhao"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Jie Zheng"
    },
    {
      "affiliations": [
        "Dalian Municipal Central Hospital, Dalian, China"
      ],
      "name": "Zhengnan Gao"
    },
    {
      "affiliations": [
        "Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"
      ],
      "name": "Tianshu Zeng"
    },
    {
      "affiliations": [
        "Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China"
      ],
      "name": "Ruying Hu"
    },
    {
      "affiliations": [
        "Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"
      ],
      "name": "Xuefeng Yu"
    },
    {
      "affiliations": [
        "Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China"
      ],
      "name": "Gang Chen"
    },
    {
      "affiliations": [
        "Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China"
      ],
      "name": "Qing Su"
    },
    {
      "affiliations": [
        "Chinese People’s Liberation Army General Hospital, Beijing, China"
      ],
      "name": "Yiming Mu"
    },
    {
      "affiliations": [
        "Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"
      ],
      "name": "Lulu Chen"
    },
    {
      "affiliations": [
        "The First Hospital of Lanzhou University, Lanzhou, China"
      ],
      "name": "Xulei Tang"
    },
    {
      "affiliations": [
        "The Affiliated Hospital of Southwest Medical University, Luzhou, China"
      ],
      "name": "Qin Wan"
    },
    {
      "affiliations": [
        "The First Hospital of Jilin University, Changchun, China"
      ],
      "name": "Guixia Wang"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"
      ],
      "name": "Feixia Shen"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Guangxi Medical University, Nanning, China"
      ],
      "name": "Zuojie Luo"
    },
    {
      "affiliations": [
        "First Affiliated Hospital of Guangxi Medical University, Nanning, China"
      ],
      "name": "Yingfen Qin"
    },
    {
      "affiliations": [
        "Qilu Hospital of Shandong University, Jinan, China"
      ],
      "name": "Li Chen"
    },
    {
      "affiliations": [
        "Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China"
      ],
      "name": "Yanan Huo"
    },
    {
      "affiliations": [
        "Second Affiliated Hospital of Harbin Medical University, Harbin, China"
      ],
      "name": "Qiang Li"
    },
    {
      "affiliations": [
        "Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China"
      ],
      "name": "Zhen Ye"
    },
    {
      "affiliations": [
        "Central Hospital of Shanghai, Shanghai, China"
      ],
      "name": "Yinfei Zhang"
    },
    {
      "affiliations": [
        "Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China"
      ],
      "name": "Chao Liu"
    },
    {
      "affiliations": [
        "First Affiliated Hospital of Anhui Medical University, Hefei, China"
      ],
      "name": "Youmin Wang"
    },
    {
      "affiliations": [
        "Karamay Municipal People’s Hospital, Xinjiang, China"
      ],
      "name": "Shengli Wu"
    },
    {
      "affiliations": [
        "First Affiliated Hospital of Nanjing Medical University, Nanjing, China"
      ],
      "name": "Tao Yang"
    },
    {
      "affiliations": [
        "First Affiliated Hospital of Chongqing Medical University, Chongqing, China"
      ],
      "name": "Huacong Deng"
    },
    {
      "affiliations": [
        "Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China"
      ],
      "name": "Jiajun Zhao"
    },
    {
      "affiliations": [
        "Affiliated Hospital of Guiyang Medical College, Guiyang, China"
      ],
      "name": "Lixin Shi"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Ning Guang"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Yufang Bi"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Weiqing Wang"
    },
    {
      "affiliations": [
        "Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Jieli Lu"
    }
  ],
  "title": "Associations of area-level socioeconomic status and individual factors with mortality in China: a nationwide prospective cohort study",
  "uid": "6392835f-6046-5c25-8686-a2092983c0ca"
}