Low education linked to tripled premature mortality in India

In a prospective study of 500,810 adults aged 35 and older in Chennai, India, researchers evaluated how social inequality, smoking, and alcohol use relate to premature mortality before age 70. Participants were enrolled between 1998 and 2001 and monitored through 2020, with cause-specific mortality assessed by verbal autopsy. Among individuals initially free of chronic disease, having no schooling was associated with almost three times the mortality rate ratio of having over 11 years of education, even among non-smoking non-drinkers (rate ratio of 2.76 in men; 2.93 in women). Substantial mortality excesses appeared across all major disease categories. For men, lower education coincided with higher smoking and drinking rates. Adjusted for education, male smoking was linked to a rate ratio of 1.26 and drinking to 1.52; combined, they almost doubled mortality (rate ratio 1.89). Fewer than 0.1% of women smoked or drank.