Abstract
BackgroundDisparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions. This study examined the association between parental income in childhood and several measures of morbidity in adulthood.MethodsWe used administrative data on seven complete Norwegian birth cohorts born in 1967–1973 (N = 429,886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 and 43, were taken from registry data on consultations at primary health care services based on diagnostic codes from the International Classification of Primary Care (ICPC-2) and hospitalizations and outpatient specialist consultations registered in the National Patient Registry (ICD-10).ResultsLow parental income during childhood was associated with a higher risk of being diagnosed with several chronic and pain-related disorders, as well as hospitalization, but not overall primary health care use. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7–9 percentage point difference). There were also differences for chronic disorders such as hypertension (8%, CI 7.9–8.5 versus 4%, CI 4.1–4.7) and diabetes (3.2%, CI 3.0–3.4 versus 1.4%, CI 1.2–1.6). There was no difference in consultations related to respiratory disorders (20.9%, CI 20.4–21.5 versus 19.7%, CI 19.2–20.3). Childhood characteristics (parental education, low birth weight, and parental marital status) and own adult characteristics (education and income) explained a large share of the association.ConclusionsChildren growing up at the bottom of the parental income distribution, compared to children in the top of the income distribution, had a two- to threefold increase in somatic and psychological disorders measured in adulthood. This shows that health inequalities by socioeconomic family background persist in a Scandinavian welfare-state context with universal access to health care.
Highlights
Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions
While a large body of research has documented the role of adult socioeconomic status in determining adult health [1, 3, 13], more recent research has focused on the importance of childhood factors for adult health
Few studies have compared these direct and indirect mechanisms for more than a few selected disorders. This study addresses these issues by analyzing population-wide administrative data on parental income across the entire childhood and a wide range of morbidity measures based on diagnoses from general practitioners, specialist health care, and hospitalizations in adulthood for seven complete birth cohorts in Norway (N = 429,886)
Summary
Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions. While a large body of research has documented the role of adult socioeconomic status in determining adult health [1, 3, 13], more recent research has focused on the importance of childhood factors for adult health. From these studies, evidence has accumulated that parental socioeconomic factors, childhood health, and residential context matters for later adult health and contribute to “the long arm of childhood” [14,15,16].
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