Adult Socioeconomic Position Research Articles

Socio‐economic position across the life course and hysterectomy in three British cohorts: a cross‐cohort comparative study

To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts. Cross-cohort comparative study. Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland. Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status. Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy. Self-reported hysterectomy with or without oophorectomy. Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance. Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.

Adult socioeconomic position and the association between height and coronary heart disease mortality: findings from 33 years of follow-up in the Whitehall Study.

In the Whitehall Study, which followed 17,139 male civil servants over 33 years, the association between tall stature and coronary heart disease (CHD) mortality differed between employment grades. In men without CHD at study entry, the hazard ratio per 15-cm increase in height was 0.77 (95% confidence interval [CI]=0.69, 0.85; P<0.001) for the highest grades, but 0.84 (95% CI=0.69, 1.03; P=.10) for middle and 0.95 (95% CI=0.75, 1.20; P=.65) for low grades, suggesting that childhood and adult social conditions may interact in their influence on coronary risk.

The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison

Our objective was to investigate the contribution of childhood and adult socioeconomic position (SEP) to adult obesity and smoking behaviour, in particular to establish the role of childhood circumstances across different studies in Europe and the US. Seven population-based surveys in six Western countries (Britain, Denmark, Finland, Netherlands, Sweden, US) were examined, with participants aged 30-50 yr and born between 1910 and 1960. Adult smoking was analysed using three outcomes (ever, current, or ex-) and adult obesity was defined as body mass index (kg/m(2)) > or =30. A strong effect of adult social position was observed for smoking outcomes and obesity. For example, manual SEP in adulthood increased the risk of ever smoking (adjusted odds ratio (OR) 1.47-2.00 for men; 0.94-1.81 for women), and obesity (adjusted OR 1.06-2.24 for men, 1.21-3.26 for women). In most studies, childhood position was not associated with ever-smoking. For current smoking, manual childhood position was associated among women (adjusted OR 1.09-1.54), but no consistent pattern was seen for men. For ex-smoking, manual childhood origins lowered the chance of quitting among women (adjusted OR 0.64-0.81) except in the US (OR = 1.17); among men this association was seen in fewer studies (adjusted OR 0.74-1.09). For obesity, manual origins increased the risk for women (adjusted OR 0.96-2.50); effects were weaker among men but mostly in the same direction (adjusted OR 0.79-1.42). As expected, adult SEP was an important influence on smoking behaviour and obesity. In addition, factors related to disadvantaged social origins appeared to increase the risk of obesity and reduce the probability of quitting smoking in adulthood, particularly in women.

Socioeconomic Position across the Lifecourse: How Does it Relate to Cognitive Function in Mid-life?

To examine the association between socioeconomic position (SEP) over the lifecourse and cognitive function in middle age. Two alternative models were assessed: the "direct effects model" where temporally distinct measures of SEP have only direct effects on adult cognition, and the "indirect effects" model where the effect of early life SEP are mediated through later life measures of SEP. Data are from the Whitehall II study (N=10,308 at baseline), a longitudinal cohort study of British civil servants, aged between 46 and 68 years at the time of cognitive testing. Structural equation models were used to compare the fit of direct and indirect effects models, and quantify the effects of different measures of SEP on cognition. Childhood SEP, education, and adult SEP were used to model SEP across the lifecourse. Cognitive function was assessed as a latent construct composed of the following: verbal memory, AH 4-I, Mill Hill, phonemic and semantic fluency. The indirect effects model provided a better fit to the data. Childhood SEP had no direct effect on cognitive function but had a substantial "indirect effect," mediated through education and adult SEP. 78.4% of the effect of education in men and 100% in women was indirect. Socioeconomic differences in adult cognition are a result of the socioeconomic trajectory of individuals throughout their lifecourse. Early measures of SEP influence cognition indirectly, through their influence on later measures of SEP.

How far are socioeconomic differences in coronary heart disease hospitalization, all-cause mortality and cardiovascular mortality among adult Swedish males attributable to negative childhood circumstances and behaviour in adolescence?

Coronary heart disease (CHD) and mortality are unevenly distributed between social classes, the lower being disadvantaged compared with the higher. Adverse social circumstances in childhood have been related to an increased risk of CHD and mortality in adulthood. The present purpose was to investigate the effect of differences in social disadvantage in early life on later differences in risk of CHD, all-cause mortality, and cardiovascular mortality between socioeconomic groups among Swedish men aged 40-50. Data on circumstances in childhood and adolescence, e.g. crowded housing and low social position of the father, measured at age 9-11, was collected among 49,323 men, born in 1949-51, and conscripted for compulsory military training in 1969/70. Data on adult socioeconomic position was obtained from the 1990 census, data on CHD from the Swedish In-patient Care register 1991-2000, and data on mortality from the Causes of Death register 1991-2000. A social gradient was found for all health outcomes. The relative risk of CHD, all-cause mortality, and cardiovascular mortality among unskilled workers compared with that among high-level non-manual employees was 1.82 (95% CI: 1.36, 2.44), 2.24 (95% CI: 1.72, 2.93), and 2.38 (95% CI: 1.47, 3.86) respectively. The early life risk indicators, such as crowded housing and low childhood social position (measured at age 9-11), short stature (measured at age 18-20), and low education (reported at age 18-20), were more common among those who in 1990 (i.e. at age 39-41) were manual workers than among those who were in non-manual occupations. In multivariate analyses, considering the indicators of childhood social disadvantage and adjusting for lifestyle factors established at age 18-20, (smoking, alcohol consumption, overweight) the increased relative risk of CHD hospitalization and cardiovascular mortality in the four categories of employed workers was reduced by 72-100%. Predictors of CHD measured in childhood and adolescence may explain a substantial part of the social gradient in CHD, cardiovascular mortality, and all-cause mortality among the 40-50 year old males studied.

Childhood body mass index and later cancer risk: a 50-year follow-up of the Boyd Orr study.

Associations between childhood BMI and adult cancer risk were investigated in a historical cohort study based on the Carnegie ("Boyd Orr") Survey of Diet and Health in Pre-War Britain (1937-9). In 14 centres in England and Scotland, children had their height and weight measured. We included 2,347 individuals aged between 2 and 14 years 9 months at the time of measurement, who were traced through the National Health Service Central Register. Relative cancer risk (registration or death) was estimated in relation to age- and sex-specific BMI SD scores. We studied associations with (i) all cancers, (ii) cancer groups stratified according to their relationship to smoking and (iii) certain site-specific cancers. In the 50 years of follow-up, 188 men and 192 women developed cancer. There was a 9% increase (95% CI -3 to 22%) in risk of cancer in adulthood per SD increase in BMI measured in childhood. There was no evidence of confounding by childhood or adulthood socioeconomic position, other anthropometric variables, childhood energy intake or birth order. There was a 30% increase (95% CI 10-54%) in risk of smoking-related cancers per SD increase in childhood BMI. There was no relationship between BMI and cancers not related to smoking. Associations for all cancers and non-smoking-related cancers tended to be stronger in children who were measured at an older (>8 years) rather than a younger (< or =8 years) age. We conclude that childhood BMI is related to increased risk of cancer in later life, particularly smoking-related cancers.

Do circumstances in early life contribute to tooth retention in middle age?

The relative contributions of factors operating in fetal life, childhood, and adulthood to risk of disease in middle age have become an important research issue, though oral health has rarely been considered. This study investigated the relative impacts of risk factors operating at different stages throughout life on the number of teeth retained at ages 49-51 yrs based on data from the Newcastle Thousand Families cohort. Very little variation in tooth retention in middle age was explained by factors operating at earlier stages in life. The previously noted relationship between childhood socio-economic status and oral health in adulthood appears, with respect to tooth retention, to diminish with increasing age as adult socio-economic position and lifestyle factors have an increasing effect. Promotion of a healthier adult lifestyle and continued improvements in oral hygiene would appear to be the public health interventions most likely to increase tooth retention in middle age.

Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position.

To determine whether there are socioeconomic differences in the intakes of total fat, fatty acids and fruit among adults in the Netherlands using childhood (parental) and participant's own socioeconomic position (SEP). Furthermore, to quantify the independent effects of childhood and adulthood SEP on dietary behavior in adulthood. Cross-sectional study among participants in the GLOBE study. A total of 2512 men and women, aged 25-78 y, living in a region in the southeast Netherlands. Dietary intakes were collected by an interviewer-administered quantitative food frequency questionnaire. Average daily intakes of total energy, total, saturated, monounsaturated, polyunsaturated fat and fruit were calculated. The highest educational level was used to classify the participant's adulthood SEP. Parental indicators (mother's education and father's occupation when participants were 12 y of age) were used to classify childhood SEP. Males with lower levels of education had moderately higher energy intakes than their more educated counterparts, but did not differ in their intakes of total fat, fatty acids and fruit. Among females, the least educated groups had marginally higher intakes of total and monounsaturated fat than the most educated group, and were less likely to consume fruit. For most of these significant differences, the participant's own education demonstrated independent effects that were consistent with chronic disease inequalities. A small residual effect of mother's education was also demonstrated for intakes of some nutrients for males and females, and for fruit consumption among females. However, the effect size of mother's education was rather small and not always consistent with disease inequalities. The results imply that socioeconomic disparities in intakes of some dietary factors may contribute to inequalities in chronic disease. Adulthood SEP potentially has a more direct influence on dietary intake inequalities than childhood SEP.

Socioeconomic trajectories across the life course and health outcomes in midlife: evidence for the accumulation hypothesis?

Recent research in social epidemiology has established the importance of considering the accumulation of advantage and disadvantage across the life course when examining adult health outcomes. This paper examines (1) accumulation across trichotomous categories of socioeconomic position (SEP), and (2) accumulation in analysis stratified by adult SEP. Data are from the Whitehall II study. Each participant was categorized as having high (0), intermediate (1), or low (2) SEP at three time points in the life course, leading to 27 socioeconomic trajectories. These trajectories were summarized to yield a scale ranging from 0 (high SEP at all three time points) to 6 (low SEP at all three time points). Logistic regression was used to examine odds of incident coronary heart disease (CHD), poor mental and physical functioning, and minor psychiatric disorder. There was a graded linear relationship between accumulation of socioeconomic exposure and health. Men with a score of 6 had increased odds of CHD (2.53, 95% CI: 1.3, 5.1), poor physical functioning (2.19, 95% CI: 1.4, 4.1), and poor mental functioning (2.60, 95% CI: 1.4, 4.9) compared with men with a score of 0. In women there was an accumulation effect for CHD and physical functioning. No cumulative effect of SEP on minor psychiatric disorder was observed. The effects of accumulation were weaker in analyses stratified by adult SEP, with early deprivation followed by high adult SEP particularly detrimental for CHD. The health effects of socioeconomic disadvantage accumulate over the life course. In addition to accumulation effects, analysis stratified by adult SEP also provided support for the critical period and the pathway model.

The association of socio‐economic position across the life course and age at menopause: the British Women's Heart and Health Study

To assess the association of indicators of adverse socio-economic position from across the life course with age at menopause. Cross sectional study as part of the British Women's Heart and Health Study. 23 British towns. Three thousand and five hundred and thirteen women aged 60-79 years from a total cohort of 4286. Women who underwent a hysterectomy or oophorectomy prior to their 'natural' menopause or who were taking hormone replacement therapy around the perimenopausal period and for whom a biological age at menopause could not be calculated were excluded from this study. Age at menopause. Most of the 10 indicators of adverse socio-economic position from childhood through to adulthood were linearly associated with a younger age at menopause. In age adjusted analyses, women from manual social classes in childhood began their menopause on average 0.68 years (95% confidence interval [CI] 0.11, 1.3) earlier than those from non-manual social classes. Those who lived in a house as a child without a bathroom began their menopause 0.47 years (95% CI 0.12, 0.82) earlier than those with a bathroom. Those who shared a bedroom began 0.36 years (95% CI 0.03, 0.70) earlier than those who had their own bedroom and finally those who lived in a household with no access to a car as a child began their menopause 0.47 years (95% CI 0.02, 0.95) earlier than those with access to a car. Adult indicators of adverse socio-economic position were similarly associated with earlier age at menopause. Age at completing full time education was not substantively associated with age at menopause. The inverse associations between each of the indicators of both childhood and adult socio-economic position and age at menopause were not importantly affected by adjustment for other reproductive factors but they attenuated by between 6% and 21% with adjustment for adult smoking and body mass index. The inverse associations between each of the childhood indicators of socio-economic position only and age at menopause attenuated markedly (between 12% and 70%) with adjustment for adult leg length. There was a cumulative effect of disadvantage across the life course demonstrated by a strong linear trend between a composite score of the 10 socio-economic indicators and young age at menopause. The age at onset of menopause for women who had 9 or 10 adverse socio-economic indicators was on average 1.70 years (95% CI 0.36, 3.0) younger than that of women with none or only one indicator. Adverse socio-economic circumstances in childhood, as well as in adulthood, are associated with an earlier age at menopause. The association between childhood deprivation and early menopause may at least in part be mediated via exposures, such as childhood diet, which affect both linear growth and age at menopause.

Multiple measures of socio-economic position and psychosocial health: proximal and distal measures

The aim of this paper is to compare three models for exploring the links between different measures of adult socioeconomic position (SEP)-education, occupation, income-and psychosocial health. Model I is a basic univariate regression model with psychosocial health as the outcome and a measure of SEP as the predictor. Model II is a multiple regression model with psychosocial health as the outcome with all three measures of SEP allocated the same temporal position as predictors. Model III treats education, a distal measure of SEP, as antecedent to the proximal measures of SEP in the prediction equations linking SEP to health. Participants were drawn from the Whitehall II study, a prospective cohort study of British civil servants. Data analysed here are from Phase 5 (1997-1999) of data collection, 7830 individuals in all. The measures of SEP and psychosocial health were assessed via a self-administered questionnaire. The three models can lead to completely different conclusions. Model III, our preferred model, shows education to have a stronger indirect effect on psychosocial health when compared to its direct effect. The indirect effect is due to the effect of education on proximal measures of social position, occupation, and income in this case. Results reported here support the hypothesis that a comparison of the relative importance of the different measures of social position in predicting health is meaningless if the causal relationships among these measures are not accounted for.

Life course socioeconomic conditions and adult psychosocial functioning

Various psychosocial factors have been linked to adult physical health and are also associated with socioeconomic position in adulthood. We evaluated the effect of socioeconomic conditions over the life course on measures of psychosocial functioning in adulthood.Life course socioeconomic position was assessed by retrospective recall of parents' education and occupation when the respondent was age 10, and the respondents' education, occupation, and income in 2585 men from eastern Finland aged 42, 48, 54, and 60 years. Measures of psychosocial functioning were derived from scales measuring cynical hostility, hopelessness, and depressive symptoms.Men with both parents who had less than a primary school education or who both had unskilled manual jobs had higher age-adjusted levels of cynical hostility, hopelessness, and depressive symptoms in adulthood. Mutually adjusted analyses showed that parents' education and the respondents' education, occupation, and income all had statistically independent effects on adult levels of cynical hostility and hopelessness. For instance, men for whom neither parent had completed primary education had a 0.15 standard deviation (P = 0.006) higher cynical hostility score, and a 0.20 standard deviation (P = 0.00018) higher hopelessness score, after adjustment for education, occupation and income. In contrast, depressive symptoms in adulthood were only associated with the respondent's occupation and income.Childhood socioeconomic position was associated with adult psychosocial functioning, but these effects were specific to some aspects of adult psychosocial functioning--cynical hostility and hopelessness, but not depressive symptoms. Adult occupation and income were associated with all measures of psychosocial functioning. In addition to the impact of adult socioeconomic position, some aspects of poor psychosocial functioning in adulthood may also have socioeconomic roots early in life.

Life course socioeconomic conditions and adult psychosocial functioning

Various psychosocial factors have been linked to adult physical health and are also associated with socioeconomic position in adulthood. We evaluated the effect of socioeconomic conditions over the life course on measures of psychosocial functioning in adulthood. Life course socioeconomic position was assessed by retrospective recall of parents' education and occupation when the respondent was age 10, and the respondents' education, occupation, and income in 2585 men from eastern Finland aged 42, 48, 54, and 60 years. Measures of psychosocial functioning were derived from scales measuring cynical hostility, hopelessness, and depressive symptoms. Men with both parents who had less than a primary school education or who both had unskilled manual jobs had higher age-adjusted levels of cynical hostility, hopelessness, and depressive symptoms in adulthood. Mutually adjusted analyses showed that parents' education and the respondents' education, occupation, and income all had statistically independent effects on adult levels of cynical hostility and hopelessness. For instance, men for whom neither parent had completed primary education had a 0.15 standard deviation (P = 0.006) higher cynical hostility score, and a 0.20 standard deviation (P = 0.00018) higher hopelessness score, after adjustment for education, occupation and income. In contrast, depressive symptoms in adulthood were only associated with the respondent's occupation and income. Childhood socioeconomic position was associated with adult psychosocial functioning, but these effects were specific to some aspects of adult psychosocial functioning--cynical hostility and hopelessness, but not depressive symptoms. Adult occupation and income were associated with all measures of psychosocial functioning. In addition to the impact of adult socioeconomic position, some aspects of poor psychosocial functioning in adulthood may also have socioeconomic roots early in life.

Socioeconomic position across the lifecourse and cognitive function in late middle age.

To examine the influence of childhood and adult socioeconomic position, socioeconomic mobility, and cumulative disadvantage across the lifecourse on cognitive function in late middle age. Cross-sectional population-based study of 486 men age 58 and 64 from eastern Finland. Respondent's socioeconomic position in childhood was measured using parent's education and occupation, and respondent's position in adulthood was indicated by attained education and personal income. Cognitive function was assessed using five neuropsychological tests: Trail Making, Selective Reminding, Verbal Fluency, Visual Reproduction, and the Mini-Mental State Exam. Each indicator of socioeconomic position made statistically independent contributions to levels of cognitive function: Respondents from poor childhood backgrounds, and those who attained a limited education and earned a low income, performed worst on each test. Men who occupied a disadvantaged socioeconomic position in childhood and then experienced upward mobility over the lifecourse exhibited better cognitive performance than those with similar socioeconomic origins but limited or no upward mobility. Conversely, men from advantaged childhood backgrounds who later in life experienced downward mobility scored poorer on each cognitive test than their counterparts who remained in the most advantaged groups throughout the lifecourse. There was a strong, graded association between cumulative socioeconomic disadvantage and cognitive function: Men who occupied a low socioeconomic position during both childhood and adulthood scored worse on every test than those who occupied a high position at all points in their lives. Socioeconomic conditions across all stages of the lifecourse appear to make unique contributions to cognitive function in late middle age. These results also suggest that in terms of cognitive function, origin is not necessarily destiny, as disadvantaged socioeconomic circumstances in childhood may be overcome to some extent by upward mobility later in life.

The contribution of risk factors to stroke differentials, by socioeconomic position in adulthood: the Renfrew/Paisley Study

This study investigated stroke differentials by socioeconomic position in adulthood. The relation of risk of stroke to deprivation category and social class was assessed among 6955 men and 7992 women who were aged 45 to 64 years and had been screened in 1972 to 1976. A total of 594 men and 677 women had a hospital admission for stroke or died from stroke. There were large differences in stroke by deprivation category or social class. Adjustment for risk factors (smoking, blood pressure, height, respiratory function, body mass index, cholesterol, diabetes, and preexisting heart disease) attenuated these differences. Risk factors for stroke can explain some of the socioeconomic differences in stroke risk. Women living in the most deprived areas seem particularly at risk of stroke.

Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

Objective: To quantify the direct and indirect effects of fetal life, childhood, and adult life on risk of cardiovascular disease at age 49–51 years.Design: Follow up study of the “Newcastle...

When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood.

STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood...

Adult female twins' recall of childhood social class and father's education: a validation study for public health research.

To assess recall of childhood socioeconomic position for public health research, the authors conducted a cross-sectional study of 352 adult women twin pairs enrolled in Examination II of the Kaiser Permanente Women Twins Study carried out in 1989-1990 in Oakland, California. Among twin pairs, 91% (95% confidence interval (CI) 89-94%) agreed on their father's educational level and 81% (95% CI 77-85%) on their childhood social class. Recall did not differ by adult socioeconomic position, zygosity, race/ethnicity, or age. Thus, epidemiologic studies can validly use retrospective data on childhood socioeconomic position to study its relation to adult health status.

Measuring social class in US public health research: concepts, methodologies, and guidelines.

Increasing social inequalities in health in the United States and elsewhere, coupled with growing inequalities in income and wealth, have refocused attention on social class as a key determinant of population health. Routine analysis using conceptually coherent and consistent measures of socioeconomic position in US public health research and surveillance, however, remains rare. This review discusses concepts and methodologies concerning, and guidelines for measuring, social class and other aspects of socioeconomic position (e.g. income, poverty, deprivation, wealth, education). These data should be collected at the individual, household, and neighborhood level, to characterize both childhood and adult socioeconomic position; fluctuations in economic resources during these time periods also merit consideration. Guidelines for linking census-based socioeconomic measures and health data are presented, as are recommendations for analyses involving social class, race/ethnicity, and gender. Suggestions for research on socioeconomic measures are provided, to aid monitoring steps toward social equity in health.