Childhood socioeconomic status, adult socioeconomic status, and old-age health trajectories

Abstract

1. IntroductionThe current study uses a large population database linking information from over 75,000 persons across early, middle, and late life to establish how the combination of childhood and adult SES are associated with late-life long-term morbidity patterns. Socioeconomic status has long been seen as a crucial morbidity and mortality determinant (Adler et al. 2008; Antonovsky 1967; Bobak et al. 2000; Braveman et al. 2010; Chen, Yang, and Liu 2010; Hay 1988; Hayward et al. 2000; Kadushin 1964; Mackenbach et al. 2008; Marmot et al. 1991). The topic of SES and health has attracted growing attention in the United States, particularly as population health has improved overall while social class gradients in health have steepened (Elo 2009; White and Preston 1996). In an attempt to explain these divergent trends, research has focused on pathways that account for persistence in and expansion of health inequalities. Some of these include mediators such as stress, social support, and preventive as well as risk behaviors (Engdahl and Tambs 2010; House et al. 1990; Marmot and Siegrist 2004; Petrelli et al. 2006; Tang, Chen, and Krewski 2003).Some research suggests pathways can operate from early life onward, implicating both childhood and adult SES as determinants of health in old age (Elo and Preston 1997; Galobardes, Lynch, and Davey Smith 2004; Galobardes, Lynch, and Smith 2008; Galobardes, Smith, and Lynch 2006; Hayward and Gorman 2004; Luo and Waite 2005; Preston, Hill, and Drevenstedt 1998; Smith and Hanson Forthcoming). Pudrovska and Anikputa (2014) have identified models that explain links between early-life SES and later-life health. The critical period model assumes that early-life disadvantages result in long-term biological and irreversible scars that manifest over time, sometimes not revealing themselves until later in life (Hamil-Luker and O'rand 2007; Kuh and BenShlomo 1997). By contrast, the pathway model assumes that early life is important not because it is directly associated with late-life health but because it shapes later-life experiences. For instance, socioeconomic conditions in adulthood will be closely related to those experienced in early life, such that adult SES is a mediator between early-life SES and later-life health (Galobardes, Lynch, and Davey Smith 2004; Lawlor et al. 2006). The cumulative risk model argues that impacts of SES compound over the life course (Kahn and Pearlin 2006; Ross and Wu 1996). In this case, effects are independent and additive, meaning that SES at different stages of the life course is autonomously important and combines to create a net effect on later-life health. Finally, there is the social mobility model (Hallqvist et al. 2004). Social mobility contends that SES in adulthood can mitigate or reverse effects of early life. For instance, upward mobility might moderate or even reverse somewhat the negative impacts of low earlylife SES. Similarly, SES disadvantages later in life can outweigh benefits that might have been accrued due to earlier life advantages. Except for the critical period model, these arguments all suggest that someone born into a low SES family is not destined to endure poor health in late life, but rather that the health effects of early-life SES are malleable (Pudrovska and Anikputa 2014).The current study adds to the discourse in a number of ways. Testing for both childhood and adult SES effects requires measures that are consistent over generations and able to reflect relative transitions in status that take place across the life course. This study employs a broad SES indicator that is consistently and reliably measured across early and later life and allows for an assessment of relative SES position within generations. While most studies of early-life SES rely on retrospective information, the current study uses objective information obtained from vital and administrative records.Studies have consistently demonstrated an association between SES and mortality or morbidity, although few have examined effects of SES on morbidity as it develops and changes over the course of old age. …