在不同人口群体中报道了成年人死亡率的社会不平等现象，但是在墨西哥尚缺乏大规模前瞻性证据。我们旨在量化墨西哥城成年人的社会不平等（包括教育）与死亡率之间的关系。墨西哥城前瞻性研究在1998年至2004年间招募了15万名35岁及以上的成年人，来自墨西哥城的两个区。参与者在2021年1月1日前进行了因特定死亡原因的随访。Cox回归分析得出了35至74岁的教育与死亡风险比（RR），并在探索性分析中考察了生活方式和相关危险因素的介导效应。 在143,478名35至74岁的参与者中，教育与早期死亡之间存在明显的负相关关系。与拥有高等教育学历的参与者相比，在年龄和性别调整后，没有受过教育的人的死亡率约为两倍（RR 1·84，95% CI 1·71-1·98），相当于预期寿命短了约6年，而在未完成小学、完成小学和中学教育的参与者中，RR分别为1·78（1·67-1·90）、1·62（1·53-1·72）和1·34（1·25-1·42）。教育与肾脏疾病和急性糖尿病危机的死亡最为密切相关（无教育与高等教育相比，RR分别为3·65，95% CI 3·05-4·38和2·67，2·00-3·56），以及传染性疾病（2·67，2·00-3·56），但除癌症外，其他所有特定死因的死亡率都随教育水平降低而显著增加。生活方式因素（如吸烟、饮酒和休闲时间体育活动）及相关生理指标（如肥胖、糖尿病和血压）占据了教育与早期死亡相关性的四分之三。 在这个墨西哥人群中，成年人早期死亡存在显著的教育不平等现象，这些不平等现象似乎主要受生活方式和相关危险因素的影响。有效干预以减少这些危险因素可能会减少不平等现象，并对早期死亡产生重大影响。 本研究受到威康信托基金、墨西哥卫生部、墨西哥国家科学和技术委员会、英国癌症研究基金、英国心脏基金会和英国医学研究委员会人口健康研究单位的支持。 版权所有 © 2023作者。由Elsevier Ltd发表的Open Access文章，根据CC BY 4.0许可发布。版权所有，未经Elsevier Ltd授权，禁止复制。

Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City.The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors.Among 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1·84; 95% CI 1·71-1·98), equivalent to approximately 6 years lower life expectancy, with an RR of 1·78 (1·67-1·90) among participants with incomplete primary, 1·62 (1·53-1·72) with complete primary, and 1·34 (1·25-1·42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3·65; 95% CI 3·05-4·38 for no education vs tertiary education) and from infectious diseases (2·67; 2·00-3·56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality.In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality.Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.