Adult Socioeconomic Position Research Articles

P22 Childhood socioeconomic position and adult smoking: are childhood cognitive ability, psychosocial adjustment and parental involvement important?

BackgroundStudies have shown that childhood socioeconomic position (SEP) is related to smoking in adulthood, independent of adult SEP. Educational attainment partially mediates this association; however, previous studies suggest three childhood...

Commentary: Precarious employment: Adding a health inequalities perspective

This issue features a contribution on precarious employment in Germany, particularly as it affects the working poor. This is an issue with global relevance. The article outlines the scale of the issue in Germany and in Europe more generally, and goes on to propose further research needs as well as possible policy responses. I would reinforce the public health importance of precarious employment, and to complement Broding and coauthors wish to add a health inequalities perspective. In particular, the growing convergence of social epidemiology and occupational health perspectives on precarious employment points to policy and practice implications that extend those proposed by Broding et al Work is a central determinant of both health and health inequalities both promoting and detracting from health via several pathways.1'2 Paid work is beneficial in many ways, most apparently as a source of income a primary determinant of adult socio-economic position, and thus health. Work can also play a positive role in adult socialization; in the development of identity and self-esteem. Work extends possibilities for social connectedness, participation in social networks outside family and neighbourhood groups. The converse of these healthand well-being-enhancing aspects of work are also of concern with precarious employment. A qualitative Canadian study describes how precarious or 'intermittent' work often puts workers in conflict with their own values in terms of what work means to them. These workers

The effect of school performance upon marriage and long-term reproductive success in 10,000 Swedish males and females born 1915–1929

Humans are an exceptionally intelligent species, and the selective pressures which may have shaped these advanced cognitive powers are therefore of interest. This study investigates the fitness consequences of pre-reproductive school performance in a Swedish population-based cohort of 5244 males and 4863 females born 1915-1929. School performance was measured at around age 10 using three variables: mean school marks, being promoted/held back in school, and recognised learning difficulties. Our primary outcomes were probability of ever marrying, total number of children and total number of grandchildren. In males (but not females), poorer school performance predicted fewer children and grandchildren. This was primarily mediated via probability of marriage; mortality and fertility within marriage were not important mediating pathways. The effect of school performance upon marriage in males was independent of early-life social and biological characteristics, including birth weight for gestational age, preterm birth, family composition, and family socioeconomic position. The effect of school performance upon the probability of marriage in males was, however, largely mediated by adult socioeconomic position. This suggests that in general sexual selection for cognitive abilities per se did not play a major role in either males or females in this cohort. Adult socioeconomic position did not, however, fully explain the marriage disadvantage in males or (at marginal significance) females with particularly poor school performance. We conclude that school performance can affect long-term reproductive success. In this population, however, the effect is confined to males and is largely mediated by the increased probability of marriage which comes with their greater socioeconomic success.

Does the Age of Achieving Pubertal Landmarks Predict Cognition in Older Men? Guangzhou Biobank Cohort Study

Earlier pubertal maturation in women may be associated with better cognition. It is unclear whether or not this also occurs in men. We tested the hypothesis that earlier pubertal development in men was associated with better cognition in later adulthood in a developing Chinese population. Multivariable linear regression was used in cross-sectional study of 2463 older, Chinese men from the Guangzhou Biobank Cohort Study. Mean pubertal age was calculated as the mean of recalled ages of first nocturnal emission, voice breaking and pubarche. We assessed the association of mean pubertal age with delayed 10-word recall and mini-mental state examination (MMSE) scores. Adjusted for age and education, 1 year earlier mean pubertal age was associated with higher delayed 10-word recall (0.06 [95% confidence interval = 0.02-0.10]) and higher MMSE (0.08 [0.03-0.13]) scores. Additional adjustment for childhood and adulthood socio-economic position, sitting height, and leg length did not change the results. These preliminary findings suggest earlier maturation in men is associated with better cognitive function in later adulthood. Whether pubertal timing is a marker of earlier life exposures or reflects a biological relation between somatrophic and/or gonadotrophic hormones and cognitive development is unclear.

Influence of Life-Course Socioeconomic Position on Incident Heart Failure in Blacks and Whites: The Atherosclerosis Risk in Communities Study

The influence of early-life socioeconomic position (SEP) on incident heart failure in blacks and whites is unknown. The authors examined the relation between early-life SEP and incident, hospitalized heart failure among middle-aged US participants (2,503 black and 8,519 white) in the Atherosclerosis Risk in Communities (ARIC) Study. Early-life SEP indicators assessed included parental education, occupation, and home ownership. From 1987 to 2004, 221 and 537 incident heart failure events were identified in blacks and whites, respectively. In Cox proportional hazards regression, early-life SEP was inversely related to incident heart failure after adjustment for age, gender, and study center (for blacks, hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.00, 1.95; for whites, HR = 1.32, 95% CI: 1.06, 1.64). Additional adjustment for young and mid-to-older adulthood SEP and established heart failure risk factors attenuated this association towards the null in both blacks and whites. Of the SEP measures, mid-to-older adulthood SEP showed the strongest association with incident heart failure in both blacks (HR = 1.32, 95% CI: 0.90, 1.96) and whites (HR = 1.39, 95% CI: 1.11, 1.75). SEP over the life course is related to the risk of incident heart failure, with SEP later in adulthood having a more prominent role than earlier SEP.

Socio-economic disadvantage from childhood to adulthood and locomotor function in old age: a lifecourse analysis of the Boyd Orr and Caerphilly prospective studies

BackgroundSocio-economic influences over a lifetime impact on health and may contribute to poor physical functioning in old age.MethodsThe authors examined the impact of both childhood and adulthood socio-economic factors on...

Is childhood meat eating associated with better later adulthood cognition in a developing population?

Inadequate childhood nutrition is associated with poor short-term academic and cognitive outcomes. Dietary supplementation with meat is associated with better cognitive outcome in children. Whether childhood nutrition has life long effects on cognitive function is unclear. We examined the association of childhood meat eating with adulthood cognitive function in southern China where the older population lived through significant hardship during their early years. Multivariable linear regression was used in a cross-sectional study of 20,086 Chinese men and women aged ≥ 50 years from the Guangzhou Biobank Cohort Study (phases 2 and 3) 2005–8. We assessed the association of childhood meat eating with delayed 10-word and immediate recall score. Adjusted for age, sex, education, childhood and adulthood socio-economic position and current physical activity, childhood meat eating almost daily, when compared to yearly or never childhood meat eating, was positively associated with delayed recall score (additional number of words recalled out of 10 = 0.22 [95% confidence interval = 0.11–0.31]). Similarly adjusted, childhood meat eating about once a month, about once a week and almost daily were positively associated with immediate recall score (additional number of words recalled out of 30 = 0.38 [0.23–0.54], 0.73 [0.56–0.89] and 0.76 [0.55–0.98] respectively). More frequent childhood meat eating was associated with better cognition through to old age. If confirmed, these results highlight the importance of adequate childhood nutrition and they also emphasise the childhood and adolescent antecedents of adult disease, with corresponding public health implications for healthy aging.

Childhood Hardship, Maternal Smoking, and Birth Outcomes

To determine the association between type, chronicity, and severity of childhood hardships and smoking status during pregnancy, preterm birth (PTB), and low birth weight (LBW). Prospective cohort study. The National Child Development Study, a nationally representative study of births in Great Britain in 1958. Four thousand eight-hundred sixty-five women with at least 1 singleton live birth. Hardship during childhood, indicated by several variables, including financial/structural hardship, lack of parental interest in education, family dysfunction, violence/mental health issues, and family structure. Smoking in pregnancy, LBW, and PTB. A consistent and graded association was seen between all types of childhood hardships and smoking status during pregnancy (odds ratio [OR] for 4 or more hardships, 2.02; 95% confidence interval [CI], 1.58-2.58; P < .001 for all comparisons). Most hardships were also associated with risk of LBW and PTB, with associations between number of hardships and both outcomes persisting after controlling for smoking status and adult social class (for LBW, OR, 1.51; 95% CI, 1.10-2.06; for PTB, OR, 1.44; 95% CI, 1.08-1.92). Childhood hardships have an enduring impact on future pregnancy outcomes, in part through their association with smoking during pregnancy and adult socioeconomic position.

Shift-work and cardiovascular disease

Shift-work and cardiovascular disease

Trajectories of neighborhood poverty and associations with subclinical atherosclerosis and associated risk factors: the multi-ethnic study of atherosclerosis.

The authors used data from the Multi-Ethnic Study of Atherosclerosis and latent trajectory class modeling to determine patterns of neighborhood poverty over 20 years (1980-2000 residential history questionnaires were geocoded and linked to US Census data). Using these patterns, the authors examined 1) whether trajectories of neighborhood poverty were associated with differences in the amount of subclinical atherosclerosis (common carotid intimal-media thickness) and 2) associated risk factors (body mass index, hypertension, diabetes, current smoking) at baseline (January 2000-August 2002). The authors found evidence of 5 stable trajectory groups with differing levels of neighborhood poverty ( approximately 6%, 12%, 20%, 30%, and 45%) and 1 group with 29% poverty in 1980 and approximately 11% in 2000. Mostly for women, higher cumulative neighborhood poverty was generally significantly associated with worse cardiovascular outcomes. Trends generally persisted after adjustment for adulthood socioeconomic position and race/ethnicity, although they were no longer statistically significant. Among women who had moved during the 20 years, the long-term measure had stronger associations with outcomes (except smoking) than a single, contemporaneous measure. Results indicate that cumulative 20-year exposure to neighborhood poverty is associated with greater cardiovascular risk for women. In residentially mobile populations, single-point-in-time measures underestimate long-term effects.

Testing for racial/ethnic differences in the association between childhood socioeconomic position and adult adiposity.

We tested the association between 2 measures of childhood socioeconomic position (SEP) and adult body mass index (BMI), stratified by race and ethnicity. We used regression analyses to examine associations between adult BMI and 2 measures of childhood SEP (maternal education and whether the head of the child's household was working class), adjusted for a robust set of adult SEP measures, in a sample of 2068 adults from Los Angeles County, California. Maternal educational attainment was associated with a lower median adult BMI among Whites (8% decrease for high school diploma and 9% decrease for a college degree, compared with no high school diploma). A maternal high school diploma was associated with a 6% decrease in median adult BMI among Hispanics and an 11% decrease among Blacks. Our measure of childhood working-class status was not correlated with adult BMI. Our results suggest that childhood SEP is independently associated with adult BMI. However, our results also suggest that the effect may depend on which measures of SEP are used and that some aspects of childhood SEP may matter more for adult BMI than others.

Cancer risk in relationship to different indicators of adult socioeconomic position in Turin, Italy

To determine the magnitude of social inequalities in cancer incidence according to different socioeconomic indicators and to assess the independent role of each indicator. Data from the Turin Longitudinal Study and the Piedmont Cancer Registry (1985-1999) were used to analyse the relationship of cancer incidence with three dimensions of individual socioeconomic position (education, occupation, and material living conditions) and with an area-based deprivation index. Multivariate Poisson regression models were used to estimate both relative risks and relative indexes of inequality (RIIs). Results showed an independent role of all the socioeconomic indicators. The overall gradients of inequalities, expressed by the RIIs for total cancer incidence, varied from 9 to 26% among men; among women, we estimated a 22% protection at the bottom of the educational hierarchy, and a 12% gradient for decreasing ease of living conditions. For most cancer sites, socioeconomic position in early adult life was as important as later socioeconomic position, while the area-based deprivation index played only an additional role. Different socioeconomic indicators pinpoint to a series of specific risk factors that are related to specific phases of the life course. Individual level data, rather than ecological data, is preferred to accurately monitor social inequalities in cancer risk.

Analysis for the Impact of Adulthood and Childhood Socioeconomic Positions and Intergenerational Social Mobility on Adulthood Health

There are at least three conceptual models for the effects of the childhood social environment on adult health: the critical period model, the social mobility model, and the cumulative risk model. However, few studies have investigated all three different models within the same setting. This study aims to examine the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility over the life course on the health in adulthood based both on the critical period model and the social mobility model. This study was conducted on 9583 adults aged between 25 and 64 years old and they were the respondents to the Korea Welfare Panel Study (2006). A multivariate logistic regression analysis was carried out, using the critical period model and the social mobility model out of the life course approaches, to look into the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility on the health status in adulthood. Household income and occupation out of the adulthood socioeconomic position indicators had an independent influence on the adulthood health status. The childhood socioeconomic position indicators, except for the place of childhood residence, affected the adulthood health status even after adjustment for the adulthood socioeconomic position. The effect of intergenerational social mobility was also statistically significant even after adjusting for the adulthood socioeconomic position, but it became insignificant when the childhood socioeconomic position was additionally adjusted for. Adulthood health is indeed affected by both the childhood and adulthood socioeconomic positions as well as intergenerational social mobility. This result shows that a life course approach needs to be adopted when dealing with health issues.

Association between intelligence and type-specific stroke: a population-based cohort study of early fatal and non-fatal stroke in one million Swedish men

BackgroundInverse associations between IQ and stroke have been reported in a few studies, but none have investigated subtypes of stroke, nor have they studied fatal and non-fatal stroke separately. Stroke...

Life-course socio-economic factors, skin colour and abdominal obesity in adulthood in a Brazilian birth cohort.

ObjectiveObesity is an increasingly prevalent nutritional disorder throughout the world. In particular, abdominal obesity is associated with cardiovascular and metabolic risk. The present study aimed to evaluate the effects of skin colour and life-course socio-economic indicators on waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) in young adults.DesignPopulation-based birth cohort study. Individuals born in 1982 in Pelotas (southern Brazil) were visited on a number of occasions from birth to age 23–24 years. A sample of the cohort was sought in 2006 and 972 individuals were located. The analysis was restricted to individuals with complete data available (442 males, 414 females).ResultsIn men, family income at birth and in 2004–5 were positively associated with WC and HC, but not with WHR. Regardless of current income, men born to wealthier families had larger WC and HC as adults. Skin colour was not associated with any of the outcomes. In women, early poverty was associated with smaller HC, and current poverty with larger WC. Poverty at any age thus led to higher WHR. Black women had larger WC and HC than white women, but there were no differences in WHR. All the associations were partially mediated by education and behavioural variables.ConclusionsThe effects of early socio-economic position on WC and HC persist even after adjustment for adult socio-economic position, highlighting the importance of interventions during the first years of life.

Associations between childhood socioeconomic position and adulthood obesity.

Childhood socioeconomic position (SEP) is inversely associated with cardiovascular disease and all-cause mortality. Obesity in adulthood may be a biologic mechanism. Objectives were to systematically review literature published between 1998 and 2008 that examined associations of childhood SEP with adulthood obesity. Five databases (Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science) were searched for studies from any country, in any language. Forty-eight publications based on 30 studies were identified. In age-adjusted analyses, inverse associations were found between childhood SEP and adulthood obesity in 70% (14 of 20) of studies in females and 27% (4 of 15) in males. In studies of females showing inverse associations between childhood SEP and adulthood obesity, typical effect sizes in age-adjusted analyses for the difference in body mass index between the highest and lowest SEP were 1.0-2.0 kg/m(2); for males, effect sizes were typically 0.2-0.5 kg/m(2). Analyses adjusted for age and adult SEP showed inverse associations in 47% (8 of 17) of studies in females and 14% (2 of 14) of studies in males. When other covariates were additionally adjusted for, inverse associations were found in 4 of 12 studies in females and 2 of 8 studies in males; effect sizes were typically reduced compared with analyses adjusted for age only. In summary, the findings suggest that childhood SEP is inversely related to adulthood obesity in females and not associated in males after adjustment for age. Adulthood SEP and other obesity risk factors may be the mechanisms responsible for the observed associations between childhood SEP and adulthood obesity.

Childhood Living Conditions, Socioeconomic Position in Adulthood, and Cognition in Later Life: Exploring the Associations

This study examined the association between childhood living conditions, socioeconomic position in adulthood, and cognition in later life. Two questions were addressed: Is there an association between childhood living conditions and late-life cognition, and if so, is the association modified or mediated by adult socioeconomic position? Nationally representative data of the Swedish population aged 77 years and older were obtained from the 1992 and 2002 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Cognition was assessed with an abbreviated version of the Mini-Mental State Examination scale. Childhood living conditions were assessed by self-reports of childhood living conditions. The results showed independent associations between conflicts in the household during childhood, father's social class, education, own social class in adulthood, and cognition in later life. Exposure to conflicts during childhood, having a father classified as a manual worker, low education, and/or being classified as a manual worker in adulthood was associated with lower levels of cognition in old age. There seemed to be no modifying effect of adult socioeconomic position on the association between childhood conditions and cognition in later life. This suggests the importance of childhood living conditions in maintaining cognitive function even in late life.

Life-Course Socioeconomic Position and Incidence of Coronary Heart Disease

Cumulative exposure to socioeconomic disadvantage across the life course may be inversely associated with coronary heart disease (CHD); the mechanisms are not fully clear. An objective of this study was to determine whether cumulative life-course socioeconomic position (SEP) is associated with CHD incidence in a well-characterized US cohort that had directly assessed childhood and adulthood measures of SEP and prospectively measured CHD incidence. Furthermore, analyses aimed to evaluate whether adjustment for CHD risk factors reduces the association between cumulative life-course SEP and CHD. The authors examined 1,835 subjects who participated in the Framingham Heart Study Offspring Cohort from 1971 through 2003 (mean age, 35.0 years; 52.4% women). Childhood SEP was measured as father's education; adulthood SEP was assessed as own education and occupation. CHD incidence included myocardial infarction, coronary insufficiency, and coronary death. Cox proportional hazards analyses indicated that cumulative SEP was associated with incident CHD after adjustment for age and sex (hazard ratio = 1.82, 95% confidence interval: 1.17, 2.85 for low vs. high cumulative SEP score). Adjustment for CHD risk factors reduced that magnitude of association (hazard ratio = 1.29, 95% confidence interval: 0.78, 2.13). These findings underscore the potential importance of CHD prevention and treatment efforts for those whose backgrounds include low SEP throughout life.

Life-course socioeconomic positions and subclinical atherosclerosis in the multi-ethnic study of atherosclerosis

A major limitation of past work on the social patterning of atherosclerosis has been the reliance on measures of neighborhood or individual-level socioeconomic position (SEP) assessed at a single point in time in adulthood. Risk of chronic disease is thought to accumulate throughout the life-course, so the use of a measure for a single point in time may result in inaccurate estimates of the social patterning of subclinical disease. Using data from the US Multi-Ethnic Study of Atherosclerosis (MESA), we examined the relation between childhood SEP [CSEP] (father or caretaker's education), adulthood SEP [ASEP] (a summary score of income, education, and wealth), and 20-year average exposure to neighborhood poverty [NSEP] (residential addresses geocoded and linked to census data) and the prevalence of subclinical atherosclerosis, as assessed by common carotid intimal–medial thickness (IMT) in mid to late adulthood. Participants were 45–84 years of age at baseline and were sampled from six study sites in the United States. After adjustment for age, CSEP and ASEP were both inversely and independently associated with IMT in men. All three indicators CSEP, ASEP, and NSEP were inversely and independently associated with IMT in women. Associations were somewhat reduced after adjustment for cardiovascular risk factors, suggesting that these factors may play a mediating role. There was evidence of heterogeneity in effects of NSEP by gender, and in the effects of ASEP and NSEP by race/ethnicity. Our results contribute to the growing body of work that shows that SEP at multiple points in the life-course, and at the individual and neighborhood level, contributes to the development of atherosclerosis.

Pathways to obesity in a developing population: The Guangzhou Biobank Cohort Study

'Environmental mismatch' may contribute to obesity in rapidly developing societies, because poor early life conditions could increase the risk of obesity in a subsequently more socio-economically developed environment. In a recently developing population (from southern China) we examined the association of life-course socio-economic position (SEP) with obesity. In a cross-sectional study of 9998 adults from the Guangzhou Biobank Cohort Study (phase 2) examined in 2005-06, we used multivariable linear regression to assess the association of SEP at three life stages (proxied by parental possessions, education and longest held occupation) with obesity [body mass index (BMI) and waist-hip ratio (WHR)] in men and women. There was no evidence that socio-economic position trajectory had supra-additive effects on BMI or WHR. Instead in women, higher SEP at any life stage usually contributed to lower BMI and WHR; e.g. women with higher early adult SEP had lower BMI [-0.45; 95% confidence interval (CI) -0.71 to -0.19) and WHR (-0.02; 95% CI -0.02 to -0.012]. In contrast, in men, higher childhood SEP was associated with higher BMI (0.53; 95% CI 0.18 to 0.88) and WHR (0.01; 95% CI 0.003 to 0.02) as was high late adulthood SEP with BMI (0.36; 95% CI 0.07 to 0.64). This study provides little support for environmental mismatch over the life course increasing obesity in this rapidly transitioning southern Chinese population. However, our findings highlight different effects of the epidemiologic transition in men and women, perhaps with pre-adult exposures as a critical window for sex-specific effects.