Current Socioeconomic Position Research Articles

Subjective social mobility and health in Germany

ABSTRACT One’s current socioeconomic position is intimately tied to one’s health status. Further, childhood living conditions also exert lasting effects on the health of adults. However, studies on changes in one’s socioeconomic position over the life course rarely find consistent and systematic effects of social mobility for individual health and wellbeing. Such studies almost exclusively draw on objective measures of social mobility and do not consider subjective appraisals of social mobility by individuals themselves. We conduct an analysis of cross-sectional, representative German survey data to explore the question as to how subjective perceptions as opposed to objective accounts of occupational status mobility affect five self-reported health and wellbeing outcomes differentially. We show that objective and subjective accounts of social mobility overlap, yet this association is far from perfect. Further, there are relatively small associations between objective and subjective mobility accounts and health outcomes. Associations between subjective mobility perceptions and health outcomes are intriguingly independent of objective social mobility trajectories. Mismatches between objective and subjective mobility are also correlated with some health outcomes. We discuss implications of our findings that social mobility is associated with those aspects of health which are more closely related to psychological wellbeing rather than physical health.

The importance of socioeconomic position in smoking, cessation and environmental tobacco smoke exposure during pregnancy

Tobacco is still a leading cause of premature death and morbidity. Particular attention has been given to pregnant women due to the scientific evidence on the importance of early life exposures for disease onset later in life. The purpose of this study was to assess smoking prevalence, smoking cessation rate and environmental tobacco smoke (ETS) exposure, and the role of socioeconomic position (SEP) on these behaviors among pregnant women. Cross-sectional data of 619 pregnant women, aged between 18 and 46 years, from Porto Metropolitan Area, Portugal, on current smoking, ETS exposure and SEP indicators was collected, face-to-face, using a questionnaire filled in during a personal interview at the postpartum hospital stay. The smoking prevalence, and ETS exposure among non-smokers before pregnancy was 27.6% and 57.4%, respectively. 4.1% of the participants reported to have stopped smoking before pregnancy, whereas about 41% quitted along pregnancy, resulting in a smoking prevalence at birth of 14.6%. Exposure to ETS also decreased throughout pregnancy to 49.8% at birth. Lower educational level was significantly associated with both higher smoking prevalence and exposure to ETS and lower smoking cessation. This study demonstrates that smoking and ETS exposure during pregnancy remains high, and that there are still significant socioeconomic inequalities in smoking; thus tobacco-focused preventive interventions need to be reinforced.

Socioeconomic position in childhood and depressive symptoms in later adulthood in the Czech Republic

BackgroundDepression risk may partly originate from socioeconomic hardship in childhood. We investigated the association of childhood socioeconomic position with depressive symptoms in later adulthood in a Central and Eastern European country. MethodsWe analyzed data from the Czech arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. We estimated the associations of three indicators of childhood socioeconomic position (access to household amenities at age of 10 years, father´s education and mother´s education) with high depressive symptoms, operationalized as ≥16 points on the Center for Epidemiological Studies – Depression 20 scale, controlling for age and sex, current socioeconomic position and other social and health-related factors. ResultsThe analytical sample included 4,213 individuals (mean age 58 years, 54% women). All three indicators of childhood socioeconomic position were inversely associated with depressive symptoms in age-sex adjusted models (p for trends: access to household amenities p<0.001; mother´s education p<0.001; father´s education p=0.03). Adjustment for current socioeconomic position attenuated the associations of depressive symptoms with access to household amenities (p for trend 0.04) and mother´s education (p for trend 0.05) and virtually eliminated the association with father´s education (p for trend 0.82). LimitationsIndividuals with higher depressive symptoms and more adverse socioeconomic position are likely to be underrepresented in the study sample. Data on childhood socioeconomic position may be reported inaccurately. ConclusionsSocioeconomic hardship in childhood may have long-lasting consequences on mental health in later adulthood.

Lessons from Child Welfare

It is an historical fact that tamariki Mäori are over-represented in Aotearoa New Zealand’s child welfare system, with a recent disproportionate increase in that over-representation. The recent spotlight on the removal of babies and, in particular, several highly visible examples in the media of attempted removals of babies, however, has once again raised the issue of the legitimacy of state involvement in ensuring the care and protection of children among Mäori. Increased accountability and transparency is one vital step towards restoring the public legitimacy of the child welfare system. This article examines the factors that led to and exacerbated the most recent crisis in Mäori views of the legitimacy of the child welfare system, and details contextual factors both common among state actors and unique to New Zealand’s child welfare system that influence systems of accountability. I conclude by providing a set of key factors that are imperative when moving towards increased systemic accountability of the child welfare system – factors that acknowledge and incorporate the historical legacy, current socio-economic position, and the significance of whänau and family.

Social selection in historical time: The case of tuberculosis in South Korea after the East Asian financial crisis.

The perspectives of social selection and causation have long been debated. Social selection theory is as “social” as social causation theory, since all diseases are social and no biological process occurs outside society. To identify the social selection pathway and historical juncture affected by socioeconomic and political changes, we investigated the reciprocal impact of suffering from tuberculosis (TB) on the current socioeconomic position (SEP), stratified by childhood SEP. We also examined the extent to which the social consequences of ill health changed since the East Asian economic downturn. Data were collected for 2007–2012 from the Korea National Health and Nutritional Examination Survey. To identify associations between TB history and current household income (HHI), we constructed an ordinal logistic regression model adjusted for covariates, including age, gender, educational attainment, and job status. We adopted a recursive regression model to examine trend changes in this association from 1980–2012 to 2003–2012. Of 28,136 participants, 936 had experienced TB. In the first ordinal logistic regression, the TB group was more likely to have lower HHI than the non-TB group. The odds ratios (ORs) increased from 1.30 (1980–2012) to 1.86 (2003–2012) for the TB group, increasing their probability of having low HHI. Among the low childhood SEP group, the TB group’s probability of having low HHI was 1.35 (95% confidence interval [CI]: 1.16–1.57) during 1980–2012, which increased to 2.01 (95% CI: 1.37–2.95) during 2003–2012. For the high childhood SEP group, the TB group’s OR range fluctuated, similar to that for the non-TB group. The results support the social selection pathway from TB history to adverse impact on current SEP. Our study identified downward social mobility due to TB history among the low childhood SEP group. Moreover, negative social consequences deteriorated since the East Asian economic crisis.

Life course socioeconomic inequalities and oral health status in later life: ELSI-Brazil.

ABSTRACTOBJECTIVE To investigate the association between life course socioeconomic conditions and two oral health outcomes (edentulism and use of dental prostheses among individuals with severe tooth loss) among older Brazilian adults.METHODS This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) which includes information on persons aged 50 years or older residing in 70 municipalities across the five great Brazilian regions. Regression models using life history information were used to investigate the relation between childhood (parental education) and adulthood (own education and wealth) socioeconomic circumstances and edentulism and use of dental prostheses. Slope index of inequality and relative index of inequality for edentulism and use of dental prostheses assessed socioeconomic inequalities in both outcomes.RESULTS Approximately 28.8% of the individuals were edentulous and among those with severe tooth loss 80% used dental prostheses. Significant absolute and relative inequalities were found for edentulism and use of dental prostheses. The magnitude of edentulism was higher among individuals with lower levels of socioeconomic position during childhood, irrespective of their current socioeconomic position. Absolute and relative inequalities related to the use of dental prostheses were not related to childhood socioeconomic position.CONCLUSIONS These findings substantiate the association between life course socioeconomic circumstances and oral health in older adulthood, although use of dental prostheses was not related to childhood socioeconomic position. The study also highlights the long-lasting relation between childhood socioeconomic inequalities and oral health through the life course.

Early-life socioeconomic status and malocclusion in adolescents and young adults in Uruguay.

This study aims to estimate orthodontic treatment need among 15-24 year-old individuals in Montevideo, Uruguay, and the association of occlusal traits with demographic, clinical and socioeconomic factors, considering a life course approach. A cross-sectional study using data from the First National Oral Health Survey in Uruguay was conducted. A two-stage cluster procedure was used to select a sample of 278 individuals in Montevideo. Household interviews and oral examinations were performed by six dentists. Dental Aesthetic (DAI) and Decayed Missing and Filled Teeth Indices (DMFT) were used to assess orthodontic treatment need and dental caries, respectively. Early life and current socioeconomic factors were obtained from the interview. Ordinal logistic regression was used to model the DAI index. Prevalence of definite malocclusion was 20.6%, followed by severe (8.2%) and very severe (7.6%). In the adjusted analysis, individuals with untreated dental caries (OR = 1.11; 95%CI: 1.03-1.20) and those who reported a lower socioeconomic level at 6 years of age (OR = 5.52; 95%CI: 1.06-28.62) had a higher chance of being a worse case of malocclusion. Current socioeconomic position was not associated with orthodontic treatment need. Individuals aged 22-24 years (OR = 1.59; 95%CI: 1.05-2.41) had a lower chance than those aged 14-17. This study shows that orthodontic treatment need is relatively high in Uruguayan adolescents and young adults. There is a potential relationship between early life socioeconomic status and the occurrence of malocclusion in adolescents and young adults under a life course approach.

Associations Between Preschool Education Experiences and Adulthood Self-rated Health.

ObjectivesThis study aimed to examine the association between preschool education experiences and adulthood self-rated health using representative data from a national population-based survey.MethodsData from the Korean Labor and Income Panel Study in 2006 and 2012 were used. A total of 2391 men and women 21-41 years of age were analyzed. Log-binomial regression analyses were conducted to examine the associations between preschool education experience and self-rated health in adulthood. Parental socioeconomic position (SEP) indicators were considered as confounders of the association between preschool education experience and adulthood subjective health, while current SEP indicators were analyzed as mediators. Age-adjusted prevalence ratios (PRs) and the associated 95% confidence intervals (CIs) were estimated.ResultsCompared with men without any experience of preschool education, those with both kindergarten and other preschool education experiences showed a lower prevalence of self-rated poor health (PR, 0.65; 95% CI, 0.47 to 0.89). In women, however, such an association was not evident. The relationship of preschool education experiences with self-rated poor health in adulthood among men was confounded by parental SEP indicators and was also mediated by current SEP indicators. After adjustment for parental and current SEP indicators, the magnitude of the associations between preschool education experiences and adulthood subjective health was attenuated in men.ConclusionsPreschool education experience was associated with adulthood self-rated health in men. However, this association was explained by parental and current SEP indicators. Further investigations employing a larger sample size and objective health outcomes are warranted in the future.

Abstract # 1698 Childhood experience of parental separation and associations with perinatal inflammation

Adversities in childhood are suggested to affect neuroendocrine pathways that in turn increases the risk of elevated inflammation and inflammatory disease in adulthood. During pregnancy, maternal immune activation has been linked with poor pregnancy outcome and risk for neurodevelopmental disease in the offspring. This study investigates childhood experience of parental separation and current socio economic position in relation to adult immune reaction at the event of giving birth, term or preterm. Sixty-four women were sampled during delivery and post-partum. Serum levels of Interleukin (IL)-6 were analyzed from maternal (preterm n = 27, term n = 37) and cord blood (preterm n = 23, term n = 32). Information on annual income and childhood family situation was collected through questionnaires. Multiple linear regression analyses using log transformed IL-6 data, showed associations between childhood experience of parental separations and elevated levels of maternal IL-6 from labor and post-partum, p p

Crime among young Moroccan men in the Netherlands: Does their regional origin matter?

High crime rates among second-generation immigrants are usually attributed to the ethnic group’s weak socioeconomic position in the host society. The causes of crime can, however, also be sought in their native countries or regions. Owing to a lack of empirical data, this has rarely been tested. The Netherlands is an exception: small-scale ethnographic case studies among young Moroccan men in Dutch cities suggest that their regional background and culture, particularly if they are from the less developed Rif Mountains area, may explain their high crime rates. In this article we examine whether this applies to the results of a quantitative study on all the Moroccan male juveniles in the Netherlands. At the individual level, our unique dataset is a combination of their native regions, criminal records (ever suspected of a crime) and demographic and socioeconomic characteristics. Logistic regression analysis shows that current socioeconomic position is a strong predictor of ever having been suspected of a criminal offence, and the impact of geographical descent, directly or indirectly via socioeconomic position in the Netherlands, is negligible. Accordingly, our findings on Moroccans in the Netherlands do not warrant our questioning the common explanation of the immigrant–crime connection in criminology and suggest further research to determine the specific host society’s features that explain the overrepresentation of ethnic groups in crime statistics.

The emergence of health inequalities in early adulthood: evidence on timing and mechanisms from a West of Scotland cohort

BackgroundEvidence is inconsistent as to whether or not there are health inequalities in adolescence according to socio-economic position (SEP) and whether or when they emerge in early adulthood. Despite the large health inequalities literature, few studies have simultaneously compared the relative importance of ‘health selection’ versus ‘social causation’ at this life-stage. This study followed a cohort through the youth-adult transition to: (1) determine whether, and if so, when, health inequalities became evident according to both class of origin and current SEP; (2) compare the importance of health selection and social causation mechanisms; and (3) investigate whether these phenomena vary by gender.MethodsData are from a West-of-Scotland cohort, surveyed five times between age 15 (in 1987, N=1,515, response=85%) and 36. Self-reported physical and mental health were obtained at each survey. SEP was based on parental occupational class at 15, a combination of own education or occupational status at 18 and own occupational class (with an additional non-employment category) at older ages. In respect of when inequalities emerged, we used the relative index of inequality to examine associations between both parental and own current SEP and health at each age. In respect of mechanisms, path models, including SEP and health at each age, investigated both inter and intra-generational paths from SEP to health (‘causation’) and from health to SEP (‘selection’). Analyses were conducted separately for physical and mental health, and stratified by gender.ResultsAssociations between both physical and mental health and parental SEP were non-significant at every age. Inequalities according to own SEP emerged for physical health at 24 and for mental health at 30. There was no evidence of selection based on physical health, but some evidence of associations between mental health in early adulthood and later SEP (intra-generational selection). Paths indicated intra-generational (males) and inter-generational (females) social causation of physical health inequalities, and intra-generational (males and females) and inter-generational (females) social causation of mental health inequalities.ConclusionsThe results suggest complex and reciprocal relationships between SEP and health and highlight adolescence and early adulthood as a sensitive period for this process, impacting on future life-chances and health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2674-5) contains supplementary material, which is available to authorized users.

Family history of premature myocardial infarction, life course socioeconomic position and coronary heart disease mortality — A Cohort of Norway (CONOR) study

Background/objectivesTo investigate self-reported family history (FH) of premature myocardial infarction (MI) in first-degree relatives as a risk factor for coronary heart disease (CHD) mortality, and assess whether any observed effect could be explained by current or life course socioeconomic position. Methods130,066 participants from Cohort of Norway were examined during 1994–2003. A subgroup (n=84,631) had additional life course socioeconomic data. Using Cox proportional hazard analyses, we calculated hazard ratios (HR) for CHD mortality, assessed by linkages to the Norwegian Cause of Death Registry through 2009. For subgroup analyses, we created an index of life course socioeconomic position, and assessed its role as a potential confounder in the association of FH with CHD. ResultsFor men, MI in parents and siblings were both a significant risk factor for CHD mortality after adjusting for established risk factors and current socioeconomic conditions; the highest risk was with MI in siblings (HR: 1.44 [1.19–1.75]). For women, FH constituted significant risk after similar adjustment only for those with MI in parents plus siblings (HR: 1.78 [1.16–2.73]). Adjusting for current and life course socioeconomic conditions only marginally lowered the estimates, and those with FH did not have worse life course socioeconomic position than those without. ConclusionsFH of premature MI is an independent risk factor for CHD mortality that differs in magnitude of effect by the sex of the index person and type of familial relationship. Life course socioeconomic position has little impact on the association between FH and CHD, suggesting the effect is not confounded by this.

Life Course Socioeconomic Position and Mid-Late Life Cognitive Function in Eastern Europe

Objectives.To investigate whether the positive relation between socioeconomic position (SEP) across the life course and later life cognitive function observed in Western populations exists in former communist countries with apparently smaller income inequalities.Method.Structural equation modeling analysis of cross-sectional data on 30,846 participants aged 45–78 years in four Central and Eastern European centers: Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania), and six Czech towns from the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study. SEP was measured using self-reported childhood (maternal education, household amenities), adult (education), and older adult (current material circumstances) indicators. Latent variable for cognition was constructed from word recall, animal naming, and letter search.Results.Associations between SEP measures over the life course and cognition were similar across study centers. Education had the strongest direct association with cognition, followed by current material circumstances. Indirect path from education to cognition, mediated by current SEP, was small. Direct path from mother’s education to cognition was significant but modest, and partially mediated by later SEP measures, particularly education.Discussion.In these Eastern European populations, late life cognition reflected life course socioeconomic trajectories similarly to findings in Western countries.

The Association of Early Life Supplemental Nutrition With Lean Body Mass and Grip Strength in Adulthood: Evidence From APCAPS

In the present study, we examined the associations of early nutrition with adult lean body mass (LBM) and muscle strength in a birth cohort that was established to assess the long-term impact of a nutrition program. Participants (n = 1,446, 32% female) were born near Hyderabad, India, in 29 villages from 1987 to 1990, during which time only intervention villages (n = 15) had a government program that offered balanced protein-calorie supplementation to pregnant women and children. Participants’ LBM and appendicular skeletal muscle mass were measured using dual energy x-ray absorptiometry; grip strength and information on lifestyle indicators, including diet and physical activity level, were also obtained. Ages (mean = 20.3 years) and body mass indexes (weight (kg)/height (m)2; mean = 19.5) of participants in 2 groups were similar. Current dietary energy intake was higher in the intervention group. Unadjusted LBM and grip strength were similar in 2 groups. After adjustment for potential confounders, the intervention group had lower LBM (β = −0.75; P = 0.03), appendicular skeletal muscle mass, and grip strength than did controls, but these differences were small in magnitude (<0.1 standard deviation). Multivariable regression analyses showed that current socioeconomic position, energy intake, and physical activity level had a positive association with adult LBM and muscle strength. This study could not detect a “programming” effect of early nutrition supplementation on adult LBM and muscle strength.

Lifelong Socio Economic Position and biomarkers of later life health: Testing the contribution of competing hypotheses

The relative contribution of early or later life Socio Economic Position (SEP) to later life health is not fully understood and there are alternative hypotheses about the pathways through which they may influence health. We used data from the English Longitudinal Study of Ageing with a formal approach for the identification of mediating factors in order to investigate alternative hypotheses about life course influences on biomarkers of later life health. We found that early life SEP predicts physical health at least 65 years later. However, a more complicated pattern of associations than that implied by previous findings was also observed. Age group specific effects emerged, with current SEP dominating the effect on later life physical health and fibrinogen levels in participants under 65, while early life SEP had a more prominent role in explaining inequalities in physical health for men and women over 75. We extend previous findings on mid adulthood and early old age, to old age and the beginnings of late old age. The complexity of our findings highlights the need for further research on the mechanisms that underlie the association between SEP and later life health.

Childhood Socioeconomic Position and Blood Pressure Dipping in Early Adulthood: a Longitudinal Study

The experience of low socioeconomic position in childhood may increase risk for adult cardiovascular disease above and beyond the effects of current socioeconomic position. One limitation of most previous research is that childhood socioeconomic position was assessed retrospectively. Measures of ambulatory blood pressure, heart rate, and heart rate variability were obtained from 110 young men (22 years) who were enrolled in a long-term study of child development at age 6. Men who had lower childhood socioeconomic position had smaller decreases in systolic blood pressure (SBP) during sleep independent of current education, daytime SBP, and body mass index (BMI). They also displayed smaller decreases in low-frequency heart rate variability during sleep. Twenty-four-hour SBP was negatively associated with childhood socioeconomic position independent of current education and BMI. While the mechanisms are unclear, childhood socioeconomic position may influence blood pressure in early adulthood independent of current life circumstances.

PS22 Life Course Socio-Economic Position and Quality of Life in Adulthood: A Systematic Review of Life Course Models

BackgroundMeasurement and determinants of quality of life are of increasing interest to researchers and policymakers. A relationship between current socio-economic position and subjective quality of life has been demonstrated, using...

Life Course Pathways to Prenatal Maternal Stress

To evaluate the impact of childhood stressors, recalled childhood stress, and stressors in adulthood on perceived stress in pregnancy. Prospective cohort study. Pregnant women were recruited from pre-birth clinics in two communities. Four-hundred and twenty-one pregnant women. Perceived prenatal maternal stress was the main outcome measure. Recalled childhood stress was positively associated with prenatal stress (β=.54) after adjusting for other child and adult factors. Low family cohesion during childhood was indirectly associated with prenatal stress through its effects on recalled childhood stress, current family cohesion, and current subjective socioeconomic position (SEP). Low levels of adult subjective SEP (β=-.44) and family cohesion (β=-.25) were directly associated with prenatal stress. Perceived social support during childhood was indirectly associated with prenatal stress through its effect on recalled childhood stress and perceived social support in adulthood. Childhood subjective SEP indirectly influenced prenatal stress through its effect on adult subjective SEP and recalled childhood stress. Prenatal stress is a result of the interplay between factors from childhood and adulthood. The study findings can be used to inform psychosocial risk assessment and interventions across the lifespan to decrease prenatal stress and its adverse outcomes.

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...

Life course socio-economic position and quality of life in adulthood: a systematic review of life course models.

BackgroundA relationship between current socio-economic position and subjective quality of life has been demonstrated, using wellbeing, life and needs satisfaction approaches. Less is known regarding the influence of different life course socio-economic trajectories on later quality of life. Several conceptual models have been proposed to help explain potential life course effects on health, including accumulation, latent, pathway and social mobility models. This systematic review aimed to assess whether evidence supported an overall relationship between life course socio-economic position and quality of life during adulthood and if so, whether there was support for one or more life course models.MethodsA review protocol was developed detailing explicit inclusion and exclusion criteria, search terms, data extraction items and quality appraisal procedures. Literature searches were performed in 12 electronic databases during January 2012 and the references and citations of included articles were checked for additional relevant articles. Narrative synthesis was used to analyze extracted data and studies were categorized based on the life course model analyzed.ResultsTwelve studies met the eligibility criteria and used data from 10 datasets and five countries. Study quality varied and heterogeneity between studies was high. Seven studies assessed social mobility models, five assessed the latent model, two assessed the pathway model and three tested the accumulation model. Evidence indicated an overall relationship, but mixed results were found for each life course model. Some evidence was found to support the latent model among women, but not men. Social mobility models were supported in some studies, but overall evidence suggested little to no effect. Few studies addressed accumulation and pathway effects and study heterogeneity limited synthesis.ConclusionsTo improve potential for synthesis in this area, future research should aim to increase study comparability. Recommendations include testing all life course models within individual studies and the use of multiple measures of socio-economic position and quality of life. Comparable cross-national data would be beneficial to enable investigation of between-country differences.