Although links between premature mortality and smoking or alcohol are well known, a recent Chennai study of nearly 500,000 adults indicates that social inequality also plays a significant role in death rates.
A paper in Nature Health presents findings from a large prospective study of over 500,000 men and women aged 35 and older in Chennai. It examines the combined effects of education, adult socioeconomic status, smoking, and alcohol use on deaths before age 70.
One in 10 men and one in three women in the study had no schooling. Even among non-smokers and non-drinkers, those without education faced roughly three times the middle-age death rate (35–69 years) compared with those holding tertiary qualifications. Few women smoked or drank, yet men who both smoked and drank showed about double the middle-age mortality of those with neither habit. Men lacking schooling were three times more likely to smoke or drink than men with higher education, and these behaviors worsened social disparities in premature mortality.
Over 52,000 premature deaths occurred during follow-up. The study was conducted jointly by Chennai’s Epidemiological Research Centre and the University of Oxford. Lead Indian researcher Gajalakshmi Vendhan noted that education served as a proxy for social class, while other factors tied to schooling and mortality remain unclear. Caste, income, and healthcare access were not examined.
Vendhan added that beedi smoking carried higher risk than cigarette smoking at every education level. Although conducted in Chennai, the results likely apply across India and possibly Southeast Asia.
The findings suggest that lowering premature mortality in India requires more than discouraging smoking and drinking. Policies should promote health screenings after age 50, raise taxes on cigarettes and alcohol, and prioritize broad improvements in education.
