Adult Socioeconomic Position Research Articles

OP10 Effects of socio Economic Position in Childhood and Adulthood on Cardiometabolic Risk Factors: The Jerusalem Perinatal Family Follow-Up Study

BackgroundStudies indicate that Socio Economic Position (SEP) might be an important predictor of cardiometabolic disease mortality and morbidity; yet the importance of timing of the effect of SEP on cardiometabolic...

OP02 Socioeconomic Patterning of fat and lean mass in Later Life: Findings from a British Birth Cohort Study

BackgroundFat and lean mass have important implications for health and physical functioning. Studies have reported associations between low socioeconomic position (SEP) and high body mass index (BMI) in adulthood, but...

PS19 Lifetime Socioeconomic Inequalities in Physical and Cognitive Ageing

BackgroundThe maintenance of physical and cognitive function for the maximal period of time is a key component of healthy ageing, associated with continued independent living, better quality of life and...

OP41 Birth Size and Mortality in Breast Cancer Patients

BackgroundPrevious studies suggest that larger birth size is associated with a higher breast cancer incidence, but the few studies of birth measures and mortality in breast cancer cases have been...

Sociodemographic and socioeconomic differences in sleep duration and insomnia-related symptoms in Finnish adults

BackgroundPoor sleep tends to be patterned by sociodemographic and socioeconomic factors. The aim of this study was to examine the associations of sociodemographic and socioeconomic factors with sleep duration and insomnia-related symptoms across life course.MethodsWe used cross-sectional Health 2000 Survey (2000–2001) among a total of 5,578 adult Finns, aged 30–79 years, representative of adult Finnish population. Data about sociodemographic and socioeconomic circumstances, insomnia-related symptoms over the previous month as well as average sleep duration were collected by questionnaires. Multinomial logistic regression models were adjusted first for gender and age, second for sociodemographic factors, third additionally for socioeconomic factors, and fourth for all covariates and self-perceived health simultaneously.ResultsOn average 70% of Finnish adults slept 7–8 hours a day. Frequent insomnia-related symptoms were more prevalent among women (14%) than men (10%). Not being married, not having children, having low education, low income, being unemployed, and being a disability retiree were associated with frequent insomnia-related symptoms. Similar factors were associated with short and long sleep duration. However, childhood socioeconomic position was mostly unrelated to sleep in adulthood except parental education had some associations with short sleep duration.ConclusionsDisadvantaged socioeconomic position in adulthood, in particular income and employment status, is associated with poorer sleep. When promoting optimal sleep duration and better sleep quality, families with low incomes, unemployed people, and disability retirees should be targeted.

Associations between socioeconomic position and asthma: findings from a historical cohort

Understanding the association between asthma and socioeconomic position (SEP) is key to identify preventable exposures to prevent inequalities and lessen overall disease burden. We aim to assess the variation in asthma across SEP groups in a historical cohort before the rise in asthma prevalence. Male students participating in a health survey at Glasgow University from 1948 to 1968 (n = 11,274) completed medical history of bronchitis, asthma, hay fever, eczema/urticaria, and reported father’s occupation. A subsample responded to postal follow-up in adulthood (n = 4,101) that collected data on respiratory diseases, early life and adult SEP. Lower father’s occupational class was associated with higher odds of asthma only (asthma without eczema/urticaria or hay fever) (trend adjusted multinomial odds ratio (aMOR) = 1.23, 95 % CI 1.03–1.47) but with lower odds of asthma with atopy (asthma with eczema/urticaria or hay fever) (trend aMOR = 0.66, 95 % CI 0.52–0.83) and atopy alone (trend aMOR = 0.84, 95 % CI 0.75–0.93). Household amenities (<3), in early life was associated with higher odds of adult-onset asthma (onset > 30 years) (OR = 1.48, 95 % CI 1.07–2.05) though this association attenuated after adjusting for age. Adult SEP (household crowding, occupation, income and car ownership) was not associated with adult-onset asthma. Lower father’s occupational class in early life was associated with higher odds of asthma alone but lower odds of asthma with atopy in a cohort that preceded the 1960s rise in asthma prevalence. Different environmental exposures and/or disease awareness may explain this opposed socioeconomic patterning, but it is important to highlight that such patterning was already present before rises in the prevalence of asthma and atopy.

Cognitive ability in early adulthood is associated with later suicide and suicide attempt: the role of risk factors over the life course

Cognitive ability/intelligence quotient (IQ) in youth has previously been associated with subsequent completed and attempted suicide, but little is known about the mechanisms underlying the associations. This study aims to assess the roles of various risk factors over the life course in explaining the observed relationships. The present investigation is a cohort study based on data on IQ test performance and covariates, recorded on 49 321 Swedish men conscripted in 1969-1970, at ages 18-20 years. Information on suicides and hospital admissions for suicide attempt up to the age of 57 years, childhood and adult socio-economic position, and adult family formation, was obtained from linkage to national registers. Lower IQ was associated with increased risks of both suicide and suicide attempt during the 36 years of follow-up. The associations followed a dose-response pattern. They were attenuated by approximately 45% in models controlling for social background, mental ill-health, aspects of personality and behavior, adult socio-economic position and family formation. Based on one-unit decreases in IQ test performance on a nine-point scale, the hazard ratios between ages 35 and 57 years were: for suicide 1.19 [95% confidence interval (CI) 1.13-1.25], fully adjusted 1.10 (95% CI 1.04-1.18); and for suicide attempt 1.25 (95% CI 1.20-1.31), fully adjusted 1.14 (95% CI 1.09-1.20). Cognitive ability was found to be associated with subsequent completed and attempted suicide. The associations were attenuated by 45% after controlling for risk factors measured over the life course. Psychiatric diagnosis, maladjustment and aspects of personality in young adulthood, and social circumstances in later adulthood, contributed in attenuating the associations.

Childhood socioeconomic position, adult socioeconomic position and social mobility in relation to markers of adiposity in early adulthood: evidence of differential effects by gender in the 1978/79 Ribeirao Preto cohort study.

Background:Longitudinal studies drawn from high-income countries demonstrate long-term associations of early childhood socioeconomic deprivation with increased adiposity in adulthood. However, there are very few data from resource-poor countries where there are reasons to anticipate different gradients. Accordingly, we sought to characterise the nature of the socioeconomic status (SES)-adiposity association in Brazil.Methods:We use data from the Ribeirao Preto Cohort Study in Brazil in which 9067 newborns were recruited via their mothers in 1978/79 and one-in-three followed up in 2002/04 (23–25years). SES, based on family income (salaries, interest on savings, pensions and so on), was assessed at birth and early adulthood, and three different adiposity measures (body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR)) ascertained at follow-up. The association between childhood SES, adult SES and social mobility (defined as four permutations of SES in childhood and adulthood: low–low, low–high, high–low, high–high), and the adiposity measures was examined using linear regression.Results:There was evidence that the association between SES and the three markers of adiposity was modified by gender in both adulthood (P<0.02 for all outcomes) and childhood SES (P<0.02 for WC and WHR). Thus, in an unadjusted model, linear regression analyses showed that higher childhood SES was associated with lower adiposity in women (coefficient (95% confidence intervals) BMI: −1.49 (−2.29,−0.69); WC: −3.85 (−5.73,−1.97); WHR: −0.03 (−0.04,−0.02)). However, in men, higher childhood SES was related to higher adiposity (BMI: 1.03 (0.28,−1.78); WC: 3.15 (1.20, 5.09); WHR: 0.009 (−0.001, 0.019)) although statistical significance was not seen in all analyses. There was a suggestion that adult SES (but not adult health behaviours or birthweight) accounted for these relationships in women only. Upward mobility was associated with protection against greater adiposity in women but not men.Conclusion:In the present study, in men there was some evidence that both higher childhood and adulthood SES was related to a higher adiposity risk, while the reverse gradient was apparent in women.

Socioeconomic position and the incidence of type 2 diabetes: the ELSA study

We examined the associations between childhood and adult socioeconomic position (SEP) and incident diabetes in 7,432 individuals aged 50 or older from the English Longitudinal Study of Ageing (ELSA). We identified 174 and 189 cases of incident diabetes, in men and women, respectively, over 5.3 years of follow-up. Cox models were estimated. In women, childhood SEP, education, occupational class, income, wealth, and subjective social status (SSS) were related to incident diabetes. Occupational class, income, and SSS did not remain significantly related to incident diabetes after adjustment for individual sets of covariates (i.e. unhealthy behaviours, obesity, or psychosocial factors). Wealth (HR: 1.65, 95 % CI: 1.05, 2.60, poorest vs. wealthiest tertile) remained significantly related to incident diabetes after adjustment for all covariates, but education (HR: 1.46, 95 % CI: 0.92, 2.33, lowest vs. highest category) and childhood SEP (HR: 1.47, 95 % CI: 0.98, 2.19, lowest vs. highest category) did not. In men, only wealth and SSS were related to incident diabetes. SSS remained significantly related to incident diabetes after adjustment for all covariates (HR: 2.46, 95 % CI: 1.32, 4.68, lowest vs. highest category), but wealth did not (HR: 1.42, 95 % CI: 0.94, 2.15, poorest vs. wealthiest tertile). Additional adjustment for wealth did not greatly affect the association between incident diabetes and SSS in men. Incident diabetes in older women is associated with SEP from all life stages, while in older men only with current SEP. Psychosocial factors (in women), unhealthy behaviours, and obesity partly mediate these associations.

Life-course origins of social inequalities in adult immune cell markers of inflammation in a developing southern Chinese population: the Guangzhou Biobank Cohort Study.

BackgroundSocioeconomic position (SEP) throughout life is associated with cardiovascular disease, though the mechanisms linking these two are unclear. It is also unclear whether there are critical periods in the life course when exposure to better socioeconomic conditions confers advantages or whether SEP exposures accumulate across the whole life course. Inflammation may be a mechanism linking socioeconomic position (SEP) with cardiovascular disease. In a large sample of older residents of Guangzhou, in southern China, we examined the association of life course SEP with inflammation.MethodsIn baseline data on 9,981 adults (≥ 50 years old) from the Guangzhou Biobank Cohort Study (2006-08), we used multivariable linear regression and model fit to assess the associations of life course SEP at four stages (childhood, early adult, late adult and current) with white blood, granulocyte and lymphocyte cell counts.ResultsA model including SEP at all four life stages best explained the association of life course SEP with white blood and granulocyte cell count for men and women, with early adult SEP (education) making the largest contribution. A critical period model best explained the association of life course SEP with lymphocyte count, with sex-specific associations. Early adult SEP was negatively associated with lymphocytes for women.ConclusionsLow SEP throughout life may negatively impact late adult immune-inflammatory status. However, some aspects of immune-inflammatory status may be sensitive to earlier exposures, with sex-specific associations. The findings were compatible with the hypothesis that in a developing population, upregulation of the gonadotropic axis with economic development may obscure the normally protective effects of social advantage for men.

Risk factors for smoking in rural women.

This study examined the association between social, demographic, and psychologic factors and smoking status among Appalachian Ohio women. A secondary aim examined whether specific factors could be identified and segmented for future tailored treatment of tobacco dependence. A cross-sectional survey (n=570) obtained information about social, demographic, and psychologic factors and smoking. Logistic regression described associations between these characteristics and smoking status. Chi-square automatic interaction detection (CHAID) analyses identified subgroups at risk for smoking. Fifty-two percent never smoked, with 20.5% and 27.5% categorized as former and current smokers, respectively. Women with low adult socioeconomic position (SEP) were more likely to smoke (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.74-5.34) compared to high SEP women. Other factors associated with current smoking included age 31-50 (OR 2.30, 95% CI 1.22-4.33), age 18-30 (OR 3.29, 95% CI 1.72-5.34), Center for Epidemiologic Studies Depression scale (CES-D) score≥16 (OR 1.99, 95% CI 1.31-3.05), and first pregnancy at age<20 (OR 1.74, 95% CI 1.14-2.66). The prevalence of smoking was 50% among those with four or more risk factors compared to 10% for those reporting no risk factors. CHAID analyses identified low adult SEP and depressive symptoms as the combination of risk factors most strongly associated with smoking; 49.3% of women in this subgroup currently smoked. Low SEP in adulthood, maternal circumstances, and depressive symptoms are associated with current smoking. Tailored cessation interventions that address these risk factors should be developed and further evaluated in an attempt to reduce disparities in smoking prevalence among this vulnerable group of women.

Socioeconomic status and the development of depressive symptoms from childhood to adulthood: A longitudinal analysis across 27 years of follow-up in the Young Finns study

We examined two alternative hypotheses on the association between low socioeconomic status (SES) and depressive symptoms: social causation and health selection. The latent growth curve (LGC) approach was used to examine trajectories of change in depressive symptoms over a period of 15 years in a dataset (the Young Finns study) consisting of a nationally representative sample of adolescents and young adults (n = 1613). Depressive symptoms were examined at four examination phases between 1992 and 2007. SES was measured as parental SES childhood (baseline of the study in 1980) and as the participants own SES in 2007 when the participants had reached adulthood and were between 30 and 45 years of age. The level of depressive symptoms was associated (r = −.14) with a slower decrease in symptoms during follow-up. Lower age, male gender, higher parental occupational grade but not parental income and lower negative emotionality in childhood were associated with a lower level of depressive symptoms. Higher age was also associated with a slower decrease in depressive symptoms. A lower level of depression and faster decrease in depressive symptoms were associated with a higher socioeconomic position in adulthood. A similar pattern was found in the relationship between the level of depression and income in adulthood. We concluded that the effect of childhood SES on depressive symptoms diminishes over time, but a higher level of, and especially faster decline of, depressive symptoms predicts the adulthood occupational SES gradient.

Socioeconomic pathways to depressive symptoms in adulthood: Evidence from the National Longitudinal Survey of Youth 1979

The existence of a direct effect of early socioeconomic position (SEP) on adult mental health outcomes net of adult SEP is still debated. This question demands the explicit modeling of pathways linking early SEP to adult SEP and mental health. In light of this background, we pursue two objectives in this study. First, we examine whether depressive symptoms in adulthood can be fit in a trajectory featuring both an intercept, or baseline range of depressive symptoms that varied between individuals, and a slope describing the average evolution of depressive symptoms over the years. Second, we estimate the direct and indirect pathways linking early SEP, respondents' education and adult household income, with a particular focus on whether early SEP retains a significant direct effect on the trajectory of depressive symptoms once adult SEP is entered into the pathway model. Drawing from 29 years of cohort data from the National Longitudinal Survey of Youth 1979, a survey that has been following a national probability sample of American civilian and military youth (Zagorsky and White, 1999), we used structural equation models to estimate the pathways between parents' education, respondent's education, and latent growth curves of household income and depressive symptoms. We found that the effect of parents' education was entirely mediated by respondent's education. In turn, the effect of respondent's education was largely mediated by household income. In conclusion, our findings showed that the socioeconomic attainment process that is rooted in parents' education and leads to respondent's education and then to household income is a crucial pathway for adult mental health. These results suggest that increasing educational opportunities may be an effective policy to break the intergenerational transmission of low socioeconomic status and poor mental health.

Childhood and Adult Socioeconomic Position, Cumulative Lead Levels, and Pessimism in Later Life: The VA Normative Aging Study

Pessimism, a general tendency toward negative expectancies, is a risk factor for depression and also heart disease, stroke, and reduced cancer survival. There is evidence that individuals with higher lead exposure have poorer health. However, low socioeconomic status (SES) is linked with higher lead levels and greater pessimism, and it is unclear whether lead influences psychological functioning independently of other social factors. The authors considered interrelations among childhood and adult SES, lead levels, and psychological functioning in data collected on 412 Boston area men between 1991 and 2002 in a subgroup of the VA Normative Aging Study. Pessimism was measured by using the Life Orientation Test. Cumulative (tibia) lead was measured by x-ray fluorescence. Structural equation modeling was used to quantify the relations as mediated by childhood and adult SES, controlling for age, health behaviors, and health status. An interquartile range increase in lead quartile was associated with a 0.37 increase in pessimism score (P < 0.05). Low childhood and adult SES were related to higher tibia lead levels, and both were also independently associated with higher pessimism. Lead maintained an independent association with pessimism even after childhood and adult SES were considered. Results demonstrate an interrelated role of lead burden and SES over the life course in relation to psychological functioning in older age.

Associations with early-life socio-economic position in adult DNA methylation

Disadvantaged socio-economic position (SEP) in childhood is associated with increased adult mortality and morbidity. We aimed to establish whether childhood SEP was associated with differential methylation of adult DNA. Forty adult males from the 1958 British Birth Cohort Study were selected from SEP extremes in both early childhood and mid-adulthood. We performed genome-wide methylation analysis on blood DNA taken at 45 years using MeDIP (methylated DNA immunoprecipitation). We mapped in triplicate the methylation state of promoters of approximately 20,000 genes and 400 microRNAs. Probe methylation scores were averaged across triplicates and differential methylation between groups of individuals was determined. Differentially methylated promoter sites of selected genes were validated using pyrosequencing of bisulfite-converted DNA. Variably methylated probes (9112 from n = 223,359 on the microarray) corresponded to 6176 gene promoters with at least one variable probe. Unsupervised hierarchical clustering of probes obtained from the 500 most variable promoters revealed a cluster enriched with high SEP individuals confirming that SEP differences contribute to overall epigenetic variation. Methylation levels for 1252 gene promoters were associated with childhood SEP vs 545 promoters for adulthood SEP. Functionally, associations with childhood SEP appear in promoters of genes enriched in key cell signalling pathways. The differentially methylated promoters associated with SEP cluster in megabase-sized regions of the genome. Adult blood DNA methylation profiles show more associations with childhood SEP than adult SEP. Organization of these associations across the genome suggests a well-defined epigenetic pattern linked to early socio-economic environment.

Socio-economic position over the life course and all-cause, circulatory diseases, and neoplasms mortality in adulthood and old age: Results from a Swedish birth cohort

ObjectiveTo compare alternative lifecourse models in predicting the effects of child and adult socio-economic position (SEP) upon adult mortality.DesignLife-long follow-up of a representative, population-based birth cohort (Uppsala Birth Cohort Study),...

Gender and life course occupational social class differences in trajectories of functional limitations in midlife: findings from the 1946 British birth cohort.

Older women and those of lower socioeconomic position (SEP) consistently constitute a larger portion of the disabled population than older men or those of higher SEP, yet no studies have examined when in the life course these differences emerge. Prevalence of self-reported limitations in the upper body (gripping or reaching) and lower body (walking or stair climbing) at 43 and 53 years were utilized from 1,530 men and 1,518 women from the British 1946 birth cohort. Generalized linear models with a binomial distribution were used to examine the effects of gender, childhood and adult SEP, and the differences in the SEP effects by gender on the prevalence of limitations at age 43 years and changes in prevalence from 43 to 53 years. For both genders, the prevalence of upper and lower body limitations were reported at 3%-5% at age 43 years. However, by age 53 years, women's upper body limitations had increased to 28% and lower body limitations to 21%, whereas men's limitations had only increased to 12% and 11%, respectively. Men and women whose father's occupation was manual or whose adult head of household occupation was manual had higher prevalence of both limitations compared with those with non-manual backgrounds. These differences widened with age, especially in women. The effect of adult SEP on the prevalence of limitations was stronger than that of childhood SEP and was partly mediated by educational attainment. Our findings provide the first evidence that prevention of disability in old age should begin early in midlife, especially for women from manual occupation households.

Childhood socioeconomic position, adult sense of coherence and tooth retention

To explore the role of sense of coherence (SOC) as a mediator in the relationship between childhood socioeconomic position (SEP) and tooth retention in adulthood. Data from 5401 dentate adults aged 30 and over who participated in the nationally representative Finnish Health 2000 Survey were analysed. Participants provided information on demographic characteristics (sex and age), childhood SEP (parental education), adulthood SEP (years of education and household income), the SOC scale and oral health-related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). They also had a clinical oral health examination. Structural equation modelling was used to test a model including adulthood SEP, SOC and oral health-related behaviours as mediators of the relationship between childhood SEP and tooth retention. Multigroup comparison was also conducted to test the hypothesized model within each sex and age group (<45 years, 45-59 years and 60+ years). The relationship between childhood SEP and tooth retention in adulthood was to a large extent mediated by adulthood SEP and to a much lesser extent by SOC. There was only a weak association between childhood SEP and adult SOC, but favourable oral health-related behaviours appeared to link a strong SOC with greater tooth retention. The model was invariant across sexes and age groups. SOC is associated with tooth retention through oral health-related behaviours, but contributes little to the relationship between childhood SEP and tooth retention.

P1-206 Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?

IntroductionWe examine the potential mediating role of multiple individual indicators of adult socioeconomic position (SEP) in the associations of childhood SEP with self-reported health measures and health behaviours.MethodsData came from...

O3-1.5 Using data linkage to explore use of GP services by smokers

Introduction It is understood how confounding of mediator-outcome associations resulting in collider biases may cause error when estimating direct and indirect effects. Here we assess the impact of non-differential and independent measurement error of the exposure and mediator. Methods We used as a motivating example the association of childhood socioeconomic position (exposure) with adult psychological distress (outcome), and possible mediation by adult socioeconomic position (mediator). We use quantitative bias analysis methods to quantify the impact of misclassification of exposure and mediator on three target parameters: the total effect of exposure on outcome; the direct effect (by conditioning on the mediator); and the indirect effect (identified by the percentage reduction in the excess OR upon adjusting for the mediator). Results ORs before and after adjustment for mediators are both biased to the null by non-differential misclassification of the exposure, but the percentage reduction in the excess OR is not affected by measurement error of the exposure. Conversely, measurement error of the mediator rapidly biases the percentage reduction the excess OR downwards. Conclusions If the research objective is to quantify the proportion of the total association that is due to mediation (ie, indirect effect), then minimising (or adjusting for) non-differential misclassification bias of the mediator is much more important than that for the exposure (or outcome). Considering the relative importance of collider bias and measurement error when estimating direct and indirect effects, measurement error (of mediators in particular) will often be a (much) greater source of systematic error.