Adult Socioeconomic Position Research Articles

Life course socioeconomic position and DNA methylation age acceleration in mid-life

BackgroundAgeing biomarkers can help us better understand how well-established socioeconomic position (SEP) disparities in ageing occur. A promising new set of DNAm methylation (DNAm)-based ageing biomarkers indicate through their age...

Impact of lockdown on key workers: findings from the COVID-19 survey in four UK national longitudinal studies

BackgroundKey workers played a pivotal role during the national lockdown in the UK’s response to the COVID-19 pandemic. Although protective measures have been taken, the impact of the pandemic on...

Early-Life Socioeconomic Position and the Accumulation of Health-Related Deficits by Midlife in the 1958 British Birth Cohort Study.

Reducing population levels of frailty is an important goal, and preventing its development in midadulthood could be pivotal. There is limited evidence on associations between childhood socioeconomic position (SEP) and frailty. Using data on the 1958 British birth cohort (followed from 1958 to 2016; n = 8,711), we aimed to 1) establish the utility of measuring frailty in midlife, by examining associations between a 34-item frailty index at age 50 years (FI50y) and mortality at ages 50–58 years, and 2) examine associations between early-life SEP and FI50y and investigate whether these associations were explained by adult SEP. Hazard ratios for mortality increased with increasing frailty; for example, the sex-adjusted hazard ratio for the highest quintile of FI50y versus the lowest was 4.07 (95% confidence interval (CI): 2.64, 6.25). Lower early-life SEP was associated with higher FI50y. Compared with participants born in the highest social class, the estimated total effect on FI50y was 42.0% (95% CI: 35.5, 48.4) for participants born in the lowest class, with the proportion mediated by adult SEP being 0.45% (95% CI: 0.35, 0.55). Mediation by adult SEP was negligible for other early-life SEP classes. Findings suggest that early-life SEP is associated with frailty and that adult SEP only partially explains this association. Results highlight the importance of improving socioeconomic circumstances across the life course to reduce inequalities in midlife frailty.

Life Course Socioeconomic Position, Intergenerational Social Mobility, and Hypertension Incidence in ELSA-Brasil.

Life course epidemiology is a powerful framework to unravel the role of socioeconomic position (SEP) disparities in hypertension (HTN). This study investigated whether life course SEP is associated with HTN incidence. Specifically, to test whether cumulative low SEP throughout life and unfavorable intergenerational social mobility increased HTN incidence. Longitudinal analysis of 8,754 ELSA-Brasil participants without HTN or cardiovascular in visit 1 (2008-2010). The response variable was the incidence of HTN between visits 1 and 2 (2012-2014). The explanatory variables were childhood, youth, and adulthood SEP, cumulative low SEP, and intergenerational social mobility. Associations were estimated by incidence rate ratios (IRRs) obtained by generalized linear models, with Poisson distribution and logarithmic link function, after adjustment for sociodemographic, behavioral, and health factors. The incidence of HTN was 43.2/1,000 person-years, being higher in males, elderly (70-74 years), self-declared black, and low SEP individuals. After considering sociodemographic factors, low SEP in childhood, youth, and adulthood remained statistically associated with increased HTN incidence. Individuals in the third (IRR: 1.26; 95% confidence interval (CI): 1.11-1.44) and fourth top quartiles (IRR: 1.29; 95% CI: 1.11-1.49) of cumulative low SEP, vs. first, as well as those with low stable intergenerational trajectory (IRR: 1.29; 95% CI: 1.16-1.43), vs. high stable, also had increased HTN incidence rates. Socioeconomic disparities at all phases of the life cycle appear to raise HTN incidence rates, being the individuals with greater accumulation of exposure to low SEP and with more unfavorable intergenerational mobility at greatest risk, even in a short follow-up time.

Abstract PO-174: Racial and socioeconomic disparities in height and body size in adolescence and risk for breast cancer subtypes in the Young Women’s Health History Study

Abstract The etiology of breast cancer (BC) appears to vary by tumor subtypes and currently, in the United States, non-Hispanic White (NHW) women are at an increased risk for luminal A BC and non-Hispanic-Black (NHB) women are at an increased risk for triple negative (TN) BC. Adolescence is a sensitive time for breast development, and childhood overweight/obesity and short height are associated with lower risk of premenopausal BC. The role of adolescent body size on BC risk by subtype, however, has not been well-studied. Relative to NHW girls and girls with higher socioeconomic position (SEP), NHB girls and those with lower SEP are at increased risk of overweight/obesity throughout life. We examined the association between height and body size in adolescence and odds of BC subtypes and the distribution of these factors by self-reported race and SEP. Data are from the Young Women’s Health History Study, a population-based case-control (case n=1812; control n=1381) study of invasive BC among NHB and NHW women aged 20-49 years. BC was diagnosed in Metro Detroit and Los Angeles County SEER registries, 2010-2015. Tumors were classified as luminal A, luminal B, HER2-type, or TN based on estrogen, progesterone, and HER2 receptor status and tumor grade. Area-based controls were frequency matched to cases on site, race and age. During in-home interviews, participants recalled body size at age 12 years with somatotypes (6 levels), weight at age 18 years (used to calculate body mass index (BMI)), and both measured and recalled adult height (<64, 65-66, >67 inches). Data were also collected on self-reported race, adult SEP (household percent poverty (HHP)), and established BC risk factors to evaluate confounding. Adjusted weighted logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) of BC subtype (vs controls). We also examined potential interactions with race and SEP. Among controls, NHB women and women with lower SEP (<150% HHP) were more likely to report a higher age 12 somatotype (SEP X2 p=0.02; race X2 p=0.08) and age 18 BMI (SEP X2 p<0.01; race X2 p<0.01); height did not vary by race or SEP. For age 12 somatotype a trend for reduced odds with increased somatotype was observed for Luminal B BC (p=0.05) and potentially TN (p=0.08). Women with age 18 BMI >30 vs 18.5-<25 kg/m2 had lower odds of luminal A (OR=0.43, 95% CI 0.22, 0.87); women with age 18 BMI <18.5 vs 18.5-<25 kg/m2 had increased odds of HER2-type BC (OR=1.85, 95% CI 1.03, 3.32). Taller height (>67 vs 65-66 inches), was associated with increased odds of all BC subtypes, most strongly for HER2-type (OR=1.80, 95% CI: 1.07, 3.03) and TN (OR=1.42, 95% CI: 0.98, 2.07) BC. The effect of these three body size measures on BC subtype risk did not vary by race or SEP. Body size in adolescence appears to be associated with risk for some BC subtypes, perhaps through hormonal mechanisms, and may partially contribute to explanations for racial and SEP disparities. Citation Format: Lydia R. Marcus, Dorothy P. Pathak, Ann S. Hamilton, Kendra L. Schwartz, Richard Houang, Dan A. Sanfelippo, Ellen M. Velie. Racial and socioeconomic disparities in height and body size in adolescence and risk for breast cancer subtypes in the Young Women’s Health History Study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-174.

Does Prolonged Education Causally Affect Dementia Risk When Adult Socioeconomic Status Is Not Altered? A Swedish Natural Experiment in 1.3 Million Individuals.

Intervening on modifiable risk factors to prevent dementia is of key importance, since progress-modifying treatments are not currently available. Education is inversely associated with dementia risk, but causality and mechanistic pathways remain unclear. We aimed to examine the causality of this relationship in Sweden using, as a natural experiment, data on a compulsory schooling reform that extended primary education by 1 year for 70% of the population between 1936 and 1949. The reform introduced substantial exogenous variation in education that was unrelated to pupils' characteristics. We followed 18 birth cohorts (n=1,341,842) from 1985 to 2016 (up to ages 79-96 years) for a dementia diagnosis in the National Inpatient and Cause of Death registers and fitted Cox survival models with stratified baseline hazards at the school-district level, chronological age as the time scale, and cohort indicators. Analyses indicated very small or negligible causal effects of education on dementia risk (main hazard ratio=1.01, 95% confidence interval: 0.98, 1.04). Multiple sensitivity checks considering only compliers, the pre-/post- design, differences in health-care-seeking behavior, and the impact of exposure misclassification left the results essentially unaltered. The reform had limited effects on further adult socioeconomic outcomes, such as income. Our findings suggest that without mediation through adult socioeconomic position, education cannot be uncritically considered a modifiable risk factor for dementia.

Adverse childhood experiences and depressive symptoms in later life: Longitudinal mediation effects of inflammation

BackgroundAdverse childhood experiences (ACEs) have been associated with both inflammation and depression. However, few studies have examined the role of inflammation as a possible biological mechanism underlying the association of ACEs with depression in later life using longitudinal data. This study investigated the longitudinal mediation effects of inflammation in the relationship between ACEs and depressive symptoms in older adults. MethodsWe utilised data from the English Longitudinal Study of Ageing (N = 4382). ACEs (i.e. threat, family dysfunction, low parental bonding, loss experiences) were assessed retrospectively at wave 3 (2006/07). C-reactive protein (CRP), an inflammatory marker, was measured at waves 2 (2004/05), 4 (2008/09), and 6 (2012/13). Depressive symptoms were ascertained from wave 6 to 8 (2016/17). The mediation analysis was conducted using parallel process latent growth curve modelling. ResultsGreater ACEs cumulative exposure was associated with higher CRP and depressive symptoms at baseline (βCRPi = 0.066[0.030–0.102]; βDEPi = 0.149[0.115–0.183]) and with their increase over time (βCRPs = 0.205[0.095–0.315]; βDEPs = 0.355[0.184–0.526]). Baseline CRP levels were positively associated with baseline depressive symptoms (βDEPi = 0.145[0.104–0.186]) and their trajectory (βDEPs = 0.215[0.124–0.306]). The mediation analysis indicated that higher baseline CRP levels mediated respectively 7% and 5% of the total effect of ACEs cumulative exposure on the baseline value and change in depressive symptoms. These mediation effects were larger for Loss experiences (i.e. 20% and 12% respectively) than for other types of ACEs. In addition, they were independent of possible confounders and additional mediators including adult socioeconomic position and lifestyle factors. ConclusionACEs were related to higher depressive symptoms partly via elevated CRP levels. Inflammation might be one of the psychobiological mechanisms underlying the link between ACEs and depression. Psychosocial and behavioural interventions to prevent and reduce the negative impact of ACEs might help to lower the risk of inflammation and depression in the population.

Education across the life-course and hypertension in adults from Southern Brazil.

The present study examines the association between life-course socioeconomic position (SEP) and hypertension (SAH), focusing on the health impacts of childhood SEP (SEPc), adult SEP (SEPa), as well as SEP mobility. Data from the Brazilian EpiFloripa Cohort Study (n = 1,720; 56% women; 55% <= 30 years) were analyzed. SAH was determined by the average of two measures of systolic and diastolic blood pressure, previous medical diagnosis or use of anti-hypertensive medication (43% of the sample was hypertensive). The main independent variables were: SEPa - participants' level of education; SEPc - parental educational attainment; and SEP mobility - the socio-economic trajectories from SEPc to SEPa. Five logistic regressions models were adjusted for sex, age or income, and were compared among each other. High SEPa was associated with a 37% reduction in the odds of SAH compared to low SEPa. High SEP over the life course was associated with 34-37% lower odds of SAH compared to persistent low SEP. Mobility models explained more of the outcome variance than the sensitive period model. The results reinforce the importance of education in the risk of SAH and the relevance of a socioeconomic mobility approach for the analysis of social inequalities in health.

A Dream Deferred: African American Women's Diminished Socioeconomic Returns of Postponing Childbearing from Teenage to Adulthood.

Brookings Institution has identified postponing childbirth from teenage to adulthood as a major strategy that is needed for upward social mobility of women. However, according to the Minorities' Diminished Returns (MDRs), the associations between aspirations, investments, behaviors, and socioeconomic position (SEP) may be diminished for marginalized groups such as African Americans. To extend the existing knowledge on the MDRs, the current study had two aims: First to compare White and African American women for the association between postponing childbearing to adulthood and SEP in a national sample of American women. Second, to test correlates of postponing childbearing to adulthood and SEP at birth with long term outcomes 15 years later when the child was 15 years old. For this longitudinal study, data came from the Fragile Families and Child Well-being Study (FFCWS), a national longitudinal prospective study in the United States (US) that followed an ethnically diverse sample of women from childbirth for 15 years from 1998 to 2016. For the first aim, this study included 2679 women composed of 723 Whites and 1956 African Americans. For the second aim, among 1842 individuals who had available data 15 years later, we measured various economic, behavioral, and mental health outcomes when the child was 15 years old. For aim 1 we ran linear regression. Postponing childbearing to adulthood was the independent variable. The dependent variable, SEP (poverty) was treated as a continuous measure with higher score indicating more poverty. Confounders included marital status and delivery characteristics. For the aim 2, we ran Pearson correlation test (exploratory analysis) to test if baseline SEP correlates with future outcomes. Postponing childbearing from adolescence to adulthood was associated with higher SEP in adulthood, net of all confounders including marital status and education. We found a significant interaction between postponing childbearing from adolescence to adulthood and race on SEP, suggesting that the economic reward of postponing childbearing may be weaker for African American women than for White women. Although postponing the age at childbirth is a recommended strategy for women who wish to maximize their chance of upward social mobility, this strategy may be associated with smaller economic returns for African American women than White women. The results can also be interpreted as MDRs in investments in terms of a postponing childbearing. In a fair society, the same investment should be similarly rewarded across diverse racial groups. In the reality, however, the US society differently rewards White and African American women who postpone childbearing. Research should explore the roles of social stratification, blocked opportunities, and concentrated poverty in explaining the unequal return of such an investment for African American and White women.

Early-life social and health determinants of adult socioeconomic position: associations and trends across generations

BackgroundSocial and biological circumstances at birth are established predictors of adult socioeconomic position (SEP). This study aims to assess the trends in these associations across two generations and examine the...

Childhood Psychosocial Environment and Adult Cardiac Health: A Causal Mediation Approach

This study used causal mediation analysis to assess the life-course associations of a favorable childhood psychosocial environment with left ventricular mass and diastolic function in adulthood and the extent to which adult health behaviors mediate these associations. The sample included 880 participants (56% women) from the Young Finns Study with data on the childhood environment from 1980, adult health behaviors (smoking, physical activity, diet, and BMI) from 2001 and an echocardiographic assessment of the left ventricular mass (g/m2.7) and diastolic function (E/e' ratio; higher values indicating a lower diastolic function) from 2011. The associations of the childhood environment with the left ventricular mass and E/e' ratio and mediation pathways through health behaviors were assessed using marginal structural models that were controlled for age, sex, and time-dependent confounding by adult socioeconomic position (measured as educational attainment) via inverse probability weighting. The data were analyzed in 2018-2019. The mean age in 2011 was 41 (range 34-49) years. Those above versus below the median childhood score had a 1.28 g/m2.7 lower left ventricular mass (95% CI= -2.63, 0.07) and a 0.18 lower E/e' ratio (95% CI= -0.39, 0.03). There was no evidence for indirect effects from childhood environments to left ventricular outcomes through adult health behaviors after controlling for time-dependent confounding by the adult socioeconomic position (indirect effect β= -0.30, 95% CI= -1.22, 0.63 for left ventricular mass; β= -0.04, 95% CI= -0.18, 0.11 for E/e' ratio). The results after multiple imputation were similar. A favorable childhood environment is associated with more optimal cardiac structure and function in adulthood. After accounting for socioeconomic positions, adult health behaviors explain little of the associations.

Life course socioeconomic position and incidence of mid–late life depression in China and England: a comparative analysis of CHARLS and ELSA

BackgroundDespite the growing prevalence of depression in the Chinese elderly, there is conflicting evidence of life course socioeconomic position (SEP) and depression onset in China, and whether this association is...

Day-to-day physical activity producing low gravitational impacts is associated with faster visual processing speed at age 69: cross-sectional study

BackgroundLittle is known about how different physical activity (PA) parameters relate to cognitive function in older adults. Using accelerometers calibrated to detect vertical impacts from ground reaction forces we examined the associations of low, medium and higher impact PA with processing speed, verbal memory and cognitive state in older adults.MethodsParticipants were 69-year old British men and women from the Medical Research Council National Survey of Health and Development included in a vertical impacts and bone sub-study (n = 558; 48.2% female). Counts of low (0.5 < g < 1.0 g), medium (1 < g < 1.5 g), or higher (≥1.5 g) magnitude impacts were derived from vertical acceleration peaks recorded over 7 days by hip-worn accelerometers. Processing speed was assessed by a timed visual letter search task, verbal memory by a 15-word list learning test and cognitive state by the Addenbrooke’s Cognitive Examination (ACE-III). Potential confounders were childhood cognitive ability, adult socioeconomic position, body mass index and depression.ResultsIn initial sex-adjusted models, low magnitude impacts were associated with better performance in all three cognitive function tests; standard deviation differences in test scores per doubling in number of low impacts: letter search speed = 0.10 (95% confidence intervals (CI): 0.03 to 0.16), word learning test = 0.05 (95% CI: 0.00 to 0.11), ACE-III scale = 0.09 (95% CI: 0.03 to 0.14). After adjustment for confounders, differences persisted for letter search speed (0.09; 95% CI: 0.02 to 0.16) but were closer to the null for the word learning test (0.02; 95% CI: − 0.04 to 0.07) and ACE-III scores (0.04; 95% CI: − 0.01 to 0.09). Low impacts remained associated with letter search speed after sensitivity analyses excluding those with functional and musculoskeletal problems, and after adjustment for impacts in higher bands. Modest positive associations between higher magnitude impacts and cognitive test scores were most likely due to chance.ConclusionAccelerometer-derived low impact physical activity was associated with better visual processing speed in 69-year old men and women independently of childhood cognitive ability and other measured confounders. Day-to-day low impact physical activity may therefore have the potential to benefit cognitive health in older adults.

The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort.

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

Influence of individual life course and neighbourhood socioeconomic position on dietary intake in African Americans: the Jackson Heart Study

ObjectiveAfrican Americans, especially those in the Southeastern USA, have different dietary behaviours from the general US population, and have the highest prevalence, incidence and mortality of diet-related disease outcomes, such...

Socioeconomic Disadvantage across the Life Course Is Associated with Diet Quality in Young Adulthood.

Socioeconomic position (SEP) is a key determinant of diet quality across the life course. Young adulthood is a unique period of transition where dietary inequities between groups with lower and higher SEP may widen. This study investigated associations between SEP in both childhood and young adulthood and diet quality in young adulthood. Data from 1949 Canadian young adults aged 18–30 who participated in the Canada Food Study were analyzed. Healthy Eating Index–2015 (HEI-2015) scores were calculated based on one 24-hour dietary recall. Childhood and young adult SEP were represented by self-report of participants’ parent(s)’ and their own highest educational level, respectively. Linear regression was used to examine associations between childhood and adult SEP and adult HEI-2015 score. Mediation analyses examined whether adult SEP mediated the relationship between childhood SEP and adult HEI-2015 score. Lower SEPs in childhood and adulthood were each associated with lower HEI-2015 scores in young adulthood. Adult SEP mediated up to 13.0% of the association between childhood SEP and adult HEI-2015 scores. Study findings provide support for key life course hypotheses and suggest latent, pathway, and cumulative effects of SEP across the early life course in shaping the socioeconomic patterning of diet quality in young adulthood.

Life Course Socioeconomic Position, Allostatic Load, and Incidence of Type 2 Diabetes among African American Adults: The Jackson Heart Study, 2000-04 to 2012.

We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans. Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP. Sample of 4,012 nondiabetic adults aged 25-84 years at baseline. Incident t2DM identified by self-report, hemoglobin A1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, or use of diabetes medication. During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjustment for adult SEP or t2DM risk factors. Upward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex. Childhood SEP and upward social mobility may influence t2DM incidence in African American women but not in men.

Actionable Analysis: Toward a Jurisdictional Evaluation of Primary Care Access in the Community Context.

Primary care is the foundation of health care systems and has potential to alleviate inequities in population health. We examined multiple measures of adult primary care access, health status, and socioeconomic position at the New York City Council District level—a unit of analysis both relevant to and actionable by local policymakers. The results showed significant associations between measures of primary care access and health status after adjustment for socioeconomic factors. We found that an increase of 1 provider per 10 000 people was associated with a 1% decrease in diabetes rates and a 5% decrease in rates of adults without an influenza immunization. Furthermore, higher rates of primary care providers in high-poverty districts accepted Medicaid and had Patient-Centered Medical Home recognition, increasing constituent accessibility. Our findings highlight the significant contribution of primary care access to community health; policies and resource allocation must prioritize primary care facility siting and provider recruitment in low-access areas.

The effect of early-life and adult socioeconomic position on development of lifestyle-related diseases.

Early-life socioeconomic position (SEP) is associated with lifestyle-related diseases in adulthood. However, evidence is lacking on the extent to which adult SEP mediates this association. Time to either chronic obstructive pulmonary disease (COPD), cardiovascular disease or diabetes were assessed in the Danish population born between 1961 and 1971 (n = 793 674) from age 30 until 2015. Early-life position was assessed in 1981 (by parental) and again at age 30 (own) by four markers; income, occupation, education-divided into high, middle, low-and a combined score for all markers. Using a counterfactual approach, we estimated the total effect of early-life position on disease onset and the degree to which adult position mediated this effect. Results of the time-to-event analysis showed a gradient of all early-life markers on the risk of developing all lifestyle-related diseases. Notably, comparing those in the lowest to the highest educational position, the hazard of COPD was 130% higher for women [hazard ratio = 2.30(95% confidence interval = 2.20-2.41)] and 114% higher for men [2.14 (2.05-2.25)]. About 67%(63-70%) of the effect of educational position was mediated through adult position for COPD, 55% for cardiovascular disease and 50% for diabetes. For the combined score 44, 29 and 33%, respectively, was mediated. About one-tenth to two-thirds of the effect of early-life position is mediated by the position attained in adulthood. The degree mediated depend on the outcome investigated, gender and the social position marker used indicating that alternative pathways may play a key role in developing effective policies targeting early-life behaviours.

Early life social and health determinants of adult socioeconomic position across two generations

Early life social and health determinants of adult socioeconomic position across two generations