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A study co-authored by researchers from Oxford Population Health has described a strong association between educational level and premature mortality in Cuba. Compared to those with a university education, men and women who had only completed primary education had a two-thirds higher risk of premature mortality. Overall, almost 30% of deaths in this study might have been avoided if all groups had the same mortality rate as those with a university education.

Lifestyle risk factors, including smoking, alcohol consumption, and obesity, were associated with one-third of the relationship between educational level and premature mortality in men and one-fifth of the relationship in women.

The Cuba Prospective Study comprises 146,556 adults from five provinces in Cuba. It is the largest prospective study to assess the impact of social inequalities on premature mortality in Cuba or in Latin America. Analyses involved 127,273 healthy participants (about half were women) aged between 35 and 74.

Cuba is a middle income country with universal healthcare and educational systems, and offers a unique opportunity to explore the effect of social inequalities on premature mortality.  Although Cuba’s social policies have not eliminated the impact of social inequality on premature mortality, its healthcare system is likely to have reduced some important disparities by ensuring equal access to healthcare for all of its citizens.

Understanding the relationship between educational level and premature death, and what lifestyle factors contribute to this relationship, can be used to inform policies that address health inequalities and population health. In particular, this study highlights the potential benefit of addressing smoking to both health inequalities and health overall.

Dr Stephanie Ross, lead author at Oxford Population Health, said ‘There is a strong educational gradient in premature mortality in Cuba, despite equitable access to both education and healthcare. If all adults had the death rates of the most educated, then there could be up to 30% (~13,000) fewer premature deaths in Cuba each year.’

Dr Nurys Armas Rojas, the lead author at National Institute of Cardiology and Cardiovascular Surgery in Cuba, said, ‘Smoking was the risk factor with the strongest effect on the relationship between educational level and all-cause mortality.’

Associate Professor Ben Lacey, senior author at Oxford Population Health added, ‘These results highlight the value of understanding the determinants of health inequalities, and although many major determinants lie outside the health system in Cuba, this study has identified the diseases and risk factors that require targeted public health interventions, particularly smoking.’

The full results of the study are published in The Lancet Public Health.