Socioeconomic Status Trajectories Research Articles

The impact of area-level socioeconomic status in childhood on mental health in adolescence and adulthood: A prospective birth cohort study in Aotearoa New Zealand

Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18–40 years. Findings revealed some associations between distinct SES trajectories and mental health. The study underscores the importance of using a spatial lifecourse epidemiology framework to understand long-term environmental impacts on later-life health.

Life-course socioeconomic status and its impact on functional health of Portuguese older adults

Abstract Background Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive, and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socioeconomic status (SES) and different dimensions of functional health in older adults. Methods Data on 821 Portuguese adults aged 50 and over in 2013-2015 were analyzed. Life-course SES was computed using participants’ paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm+nm), upward (m+nm), downward (nm+m), stable low (m+m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health. Results Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β=−9.75; 95%CI: -14.34;-5.15; SF-36 mental health: β=−7.33; 95%CI: -11.55;-3.11; handgrip strength: β=−1.60; 95%CI: -2.86;-0.35; walking time, highest tertile: OR = 5.28; 95%CI: 3.07;9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95%CI: 0.96;3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95%CI: 1.78;11.95). Conclusions A disadvantaged life-course SES impacts older adults’ physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health. Key messages • Overall, stable high SES leads to better functional health, but for mental health functioning, handgrip strength and walking speed, it is possible to overcome the initial social disadvantage. • These results reinforce that even though health disparities may start early in life, they are mutable and capable of changing through the improvement of socioeconomic conditions.

Life-course socio-economic status and its impact on functional health of Portuguese older adults.

Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women.

Exposure to socioeconomic disadvantage is associated with early-onset cognitive aging. Biological aging, the progressive loss of system integrity that occurs as we age, is proposed as a modifiable process mediating this health inequality. We examined whether socioeconomic disparities in cognitive aging in mid-to late-life adults is explained by accelerated biological aging similarly across race, ethnicity, and sex/gender. Data were from a prospective cohort study of the US Health and Retirement Study DNA methylation substudy. Socioeconomic status (SES) was measured from years of education and household wealth at baseline. The extent and pace of biological aging were quantified using 3 DNA methylation measures: PhenoAge, GrimAge, and DunedinPoAm. Cognitive aging was measured from repeated longitudinal assessments of immediate and delayed word recall. Latent growth curve modeling estimated participants' level of memory performance and rate of decline over 2-11 follow-up assessments spanning 2-20 years. Multiple-group models were estimated to assess whether the relationship between SES and memory trajectories was mediated by biological aging across racial-ethnic by sex/gender subgroups. Data from a total of 3,997 adults aged 50-100 years were analyzed. Participants with lower SES had a lower memory performance, had a faster decline, and exhibited accelerated biological aging (SES effect size associations [β] ranged from 0.08 to 0.41). Accelerated biological aging was associated with decreased memory performance and faster memory decline (effect size range 0.03-0.23). SES-biological aging associations were the strongest for White men and women and weakest for Latinx women. The relationship between biological aging measures and memory was weaker for Black participants compared with that for White and Latinx people. In mediation analysis, biological aging accounted for 4%-27% of the SES-memory gradient in White participants. There was little evidence of mediation in Black or Latinx participants. Among a national sample of mid-to late-life adults, DNA methylation measures of biological aging were variably associated with memory trajectories and SES across White, Black, and Latinx mid-to late-life adults. These results challenge the assumption that DNA methylation biomarkers of aging that were developed in primarily White people can equivalently quantify aging processes affecting cognition in Black and Latinx mid-to late-life adults.

The intersectionality of life course socioeconomic status, race, and cognitive decline: An 18-year follow-up.

Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories. Using 8376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents. Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet the effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages. Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life.

Association of neighbourhood socioeconomic trajectories with preterm birth and small-for-gestational-age in the Netherlands: a nationwide population-based study.

SUMMARYBackgroundAdverse birth outcomes have serious health consequences, not only during infancy but throughout the entire life course. Most evidence linking neighbourhood socioeconomic status (SES) to birth outcomes is based on cross-sectional SES measures, which do not reflect neighbourhoods’ dynamic nature. We investigated the association between neighbourhood SES trajectories and adverse birth outcomes, i.e. preterm birth and being small-for-gestational-age (SGA), for births occurring in the Netherlands between 2003 and 2017.MethodsWe linked individual-level data from the Dutch perinatal registry to the Netherlands Institute for Social Research neighbourhood SES scores. Based on changes in their SES across four-year periods, neighbourhoods were categorised into seven trajectories. To investigate the association between neighbourhood SES trajectories and birth outcomes we used adjusted multilevel logistic regression models.FindingsData on 2 334 036 singleton births were available for analysis. Women living in stable low-SES neighbourhoods had higher odds of preterm birth (OR[95%CI]= 1·12[1·07-1·17]) and SGA (OR[95%CI]= 1·19[1·15-1·23]), compared to those in high SES areas. Higher odds of preterm birth (OR[95%CI]= 1·12[1·05-1·20]) and SGA (OR[95%CI]=1·12[1·06-1·18]) were also observed for those living in areas declining to low SES. Women living in a neighbourhood where SES improved from low to medium showed higher odds of preterm birth (OR[95%CI]= 1·09[1·02-1·18]), but not of SGA (OR[95%CI]= 1·04[0.98-1·10]). The odds of preterm or SGA birth in other areas were comparable to those seen in high SES areas.InterpretationIn the Netherlands, disadvantaged neighbourhood SES trajectories were associated with higher odds of adverse birth outcomes. Longitudinal neighbourhood SES measures should also be taken into account when selecting a target population for public health interventions.FundingErasmus Initiative Smarter Choices for Better Health.

Race, Lifetime SES, and Allostatic Load Among Older Adults.

Prior research demonstrates that Black Americans receive fewer health benefits at high levels of socioeconomic status (SES) relative to Whites. Yet, few studies have considered the role of lifetime SES (ie, changes in SES from childhood to adulthood) in shaping these patterns among older adults. This study investigates the extent to which racial disparities in allostatic load (AL), an indicator of accelerated physiological aging, vary across levels of lifetime SES among Black and White adults aged 50 and older. With data from the Nashville Stress and Health Study, modified Poisson regression models were used to assess racial differences in the odds of high AL (4+ high-risk biomarkers) among Black and White older adults (N = 518) within each level of lifetime SES (ie, stable low SES, upward mobility, downward mobility, and stable high SES). Stable high SES was associated with greater odds of high AL; there was not a significant association between other lifetime SES trajectories and AL. However, the magnitude of racial disparities varied across levels of lifetime SES, with a significant Black-White difference in AL observed only among upwardly mobile (odds ratio [OR] = 1.76, 95% confidence interval [CI] = 1.24-2.51) and high SES groups (OR = 2.22, 95% CI = 1.37-3.58). Our study demonstrates that racial disparities in AL among older adults depend on individuals' lifetime SES trajectories and that older Black Americans receive fewer health benefits for achieving higher SES. These findings underscore the need to evaluate socioeconomic resources across the life course to clarify the extent of racial disparities among aging populations.

Lifecourse socioeconomic changes and late-life cognition in a cohort of U.S.-born and U.S. immigrants: findings from the KHANDLE study

BackgroundLow socioeconomic status (SES) in early and late life has been associated with lower late-life cognition. Less is known about how changes in SES from childhood to late life are associated with late-life cognition, especially among diverse populations of older adults.MethodsIn a multi-ethnic sample (n = 1353) of older adults, we used linear regression to test associations of change in comprehensive measures of SES (financial, cultural, and social domains) from childhood to late life with semantic memory, episodic memory, and executive function. We tested whether the association between SES trajectory and late-life cognition differed by populations who resided in the U.S. during childhood or immigrated to the U.S. as adults.ResultsParticipants with low childhood/high late-life financial capital had better semantic memory (β = 0.18; 95% CI: 0.04, 0.32) versus those with low financial capital in both childhood and late life, regardless of childhood residence. We observed a significant interaction in the association of verbal episodic memory and cultural capital by childhood residence (p = 0.08). Participants with a foreign childhood residence had higher verbal episodic memory if they had low childhood/high late-life cultural capital (β = 0.32; 95% CI: 0.01, 0.63), but lower verbal episodic memory if they had high childhood/low late-life cultural capital (β = − 0.40; 95% CI: − 0.94, 0.13). Having high lifecourse social capital was associated with better verbal episodic memory scores among those with a U.S. childhood (β = 0.34; 95% CI: 0.14, 0.55), but lower verbal episodic memory among those with a foreign childhood (β = − 0.10; 95% CI: − 0.51, 0.31).ConclusionsHigh financial and cultural capital in late life is associated with better cognition, regardless of early childhood SES or childhood residence.

The Reciprocal Relationship between Socioeconomic Status and Health and the Influence of Sex: A European SHARE-Analysis Based on Structural Equation Modeling.

It is well recognized that socioeconomic status (SES) is an important determinant of health, but many studies fail to address the possibility of reverse causation. We aim to investigate the reciprocal relationship between trajectories of SES and health, and how these associations differ by sex. We performed a longitudinal study including 29,824 men and 37,263 women aged 50+ participating in at least two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using structural equation modeling, we found that baseline household income and wealth led to improvements in cognitive function, grip strength, quality of life and depressive symptoms, and a better initial health led to higher income and wealth for both sexes. However, the results indicated that the relative effect of cognitive function and grip strength on SES trajectories was overall greater than the corresponding effect of SES on health changes, particularly regarding income among women, but for quality of life and depressive symptoms, the reverse was indicated, though most pronounced for the associations with wealth. The reciprocal associations between SES and physical function were stronger for men than for women, whereas most associations with cognitive function and mental health were similar between sexes. This study demonstrates that both social causation and health selection contribute to social inequalities in health, but the influence of each direction and the importance of sex differences may vary according to the health outcomes investigated.

Socioeconomic status trajectories across the life course, daily discrimination, and inflammation among Black and white adults

ObjectiveThis study replicates and expands Surachman et al.’s (2020) findings documenting socioeconomic status (SES) trajectories across the life course in an independent sample of Black (majority recruited from Milwaukee, WI) and white adults in the United States. We extend this work by examining whether SES trajectories and daily discrimination are independently associated with markers of inflammation. MethodData were from 215 Black adults (188 recruited from Milwaukee, WI; 27 recruited from across the continental US) and 985 white adults (7 recruited from Milwaukee, WI; 978 recruited from across the continental US) who completed the baseline interview and biomarker assessment during the second wave of the Midlife in the United States (MIDUS) Study (ages = 34–84). SES life course trajectories were examined using latent class analysis based on objective (e.g., income and education) and subjective (e.g., social status and financial strain) indicators of SES. The association between life course SES trajectories and daily discrimination with markers of inflammation (IL-6, CRP, fibrinogen) were examined using multiple linear regression analyses, controlling for demographic, psychological, behavioral, and health-related covariates. ResultsBlack and white participants showed different patterns of life course SES trajectories. Among Black participants, the trajectories were Objectively Stable Low (45.16%), Downwardly Mobile (18.05%), and Upwardly Mobile (36.79%). Compared to the Upwardly Mobile, the Objectively Stable Low class showed elevated IL-6 after controlling for all covariates. Further, daily discrimination, but not SES trajectories, was significantly associated with CRP and fibrinogen after controlling for demographic, psychological, and behavioral covariates. White participants’ experiences of life course SES trajectories were characterized as Objectively Stable Low (7.02%), Subjectively Downward (12.48%), Upwardly Mobile (39.99%), and Stable High (40.51%). Among white participants, SES trajectories, but not daily discrimination, were associated with all markers of inflammation (controlling for age and sex). DiscussionConsistent with the fundamental cause theory, multiple independent pathways link SES trajectories across the life course and daily discrimination to racial disparities in IL-6, CRP, and fibrinogen.

Association of Long-Term Trajectories of Neighborhood Socioeconomic Status With Weight Change in Older Adults

Studying long-term changes in neighborhood socioeconomic status (SES) may help to better understand the associations between neighborhood exposure and weight outcomes and provide evidence supporting neighborhood interventions. Little previous research has been done to examine associations between neighborhood SES and weight loss, a risk factor associated with poor health outcomes in the older population. To determine whether improvements in neighborhood SES are associated with reduced likelihoods of excessive weight gain and excessive weight loss and whether declines are associated with increased likelihoods of these weight outcomes. This cohort study was conducted using data from the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health study (1995-2006). The analysis included a cohort of 126 179 adults (aged 50-71 years) whose neighborhoods at baseline (1995-1996) were the same as at follow-up (2004-2006). All analyses were performed from December 2018 through December 2020. Living in a neighborhood that experienced 1 of 8 neighborhood SES trajectories defined based on a national neighborhood SES index created using data from the US Census and American Community Survey. The 8 trajectory groups, in which high, or H, indicated rankings at or above the sample median of a specific year and low, or L, indicated rankings below the median, were HHH (ie, high in 1990 to high in 2000 to high in 2010), or stable high; HLL, or early decline; HHL, or late decline; HLH, or transient decline; LLL, or stable low; LHH, or early improvement; LLH, or late improvement; and LHL, or transient improvement. Excessive weight gain and loss were defined as gaining or losing 10% or more of baseline weight. Among 126 179 adults, 76 225 (60.4%) were men and the mean (SD) age was 62.1 (5.3) years. Improvements in neighborhood SES were associated with lower likelihoods of excessive weight gain and weight loss over follow-up, while declines in neighborhood SES were associated with higher likelihoods of excessive weight gain and weight loss. Compared with the stable low group, the risk was significantly reduced for excessive weight gain in the early improvement group (odds ratio [OR], 0.87; 95% CI, 0.79-0.95) and for excessive weight loss in the late improvement group (OR, 0.89; 95% CI, 0.80-1.00). Compared with the stable high group, the risk of excessive weight gain was significantly increased for the early decline group (OR, 1.19; 95% CI, 1.08-1.31) and late decline group (OR, 1.13; 95% CI, 1.04-1.24) and for excessive weight loss in the early decline group (OR, 1.15; 95% CI, 1.02-1.28). The increases in likelihood were greater when the improvement or decline in neighborhood SES occurred early in the study period (ie, 1990-2000) and was substantiated throughout the follow-up (ie, the early decline and early improvement groups). Overall, we found a linear association between changes in neighborhood SES and weight outcomes, in which every 5 percentile decline in neighborhood SES was associated with a 1.2% to 2.4% increase in the risk of excessive weight gain or loss (excessive weight gain: OR, 1.01; 95% CI, 1.00-1.02 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; excessive weight loss: OR, 1.02; 95% CI, 1.01-1.03 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; P for- trend < .0001). These findings suggest that changing neighborhood environment was associated with changes in weight status in older adults.

Beyond the social gradient: the role of lifelong socioeconomic status in older adults' health trajectories.

Inequalities in older adults’ health rarely consider life-course aspects of socioeconomic status (SES). We examined the association between lifelong SES and old-age health trajectories, and explored the role of lifestyle factors and depressive symptoms in this association. We followed 2760 adults aged 60+ from the Swedish National Study on Care and Aging, Kungsholmen. SES groups were derived using latent class analysis incorporating seven socioeconomic measures spanning childhood, midlife, and late life. We measured health using the Health Assessment Tool, which combines gait speed, cognition, multimorbidity, and disability. Linear mixed models were used to estimate health trajectories. Four SES groups were identified: High (34.9%), Middle (40.2%), Low (21.2%), and Mixed (3.8%). The Mixed group reported greater financial difficulties in childhood and older age, but varying SES attainment in midlife. Baseline health scores indicated that Mixed SES experienced substantial cognitive and physical deficits 12 years earlier than the High SES group. Compared to the High SES group, the Mixed SES group had the fastest health deterioration (β×time=−0.07, 95% CI:−0.11,−0.02); other groups followed a gradient (High>Middle>Low). Lifestyle factors and depressive symptoms attenuated the gradient but did not explain Mixed group’s health disadvantage. Life-long SES measures are crucial for understanding older adults’ health inequalities.

Determinants of dental prosthetic treatment need: A birth cohort study.

To estimate the incidence of the need for a dental prosthesis during early adulthood and its association with socioeconomic and oral disorder trajectories. In 1982, in the city of Pelotas, all live births (n=5914) and their mothers were assessed. A representative sample of this cohort study was examined for oral health conditions at 15, 24 and 31years (Oral Health Study-OHS). The need for a dental prosthesis was assessed at 24 and 31years of age, and variables of interest (gender, skin colour, socioeconomic status (SES), use of dental services, caries and periodontal disease) were collected from different waves of this cohort. Longitudinal association between outcome and variables of interest was assessed using multilevel mixed models. A total of 539 individuals were assessed in 2013 (60.7% response rate). The need for a dental prosthesis was 28.9% at 24years. (95% CI 24.9-33.2) and 49.0% at 31years (95% CI 44.7-53.3). Risk of presenting with a need for a dental prosthesis was higher in users of public services. Downwardly mobile and lower SES trajectory groups presented a higher risk of the need for a dental prosthesis. High-risk caries trajectory group showed a higher risk of presenting with the need for a dental prosthesis from 24 to 31years. Our findings demonstrate that the need for dental prosthesis from 24 to 31years old was determined by trajectories of exposure during the life cycle, reinforcing that tackling socioeconomic inequalities at any stage of life can have an effect on an individual's oral health.

High to low, low to high: neighbourhood socioeconomic trajectories and birth outcomes

Abstract Background A growing body of literature has consistently linked neighbourhood socioeconomic status (SES) with adverse birth outcomes. However, the available evidence is based on cross-sectional indicators of neighbourhood SES, which fail to reflect neighbourhoods' dynamic nature. The objective of this study was to explore the relationship between temporal trajectories of neighbourhood socioeconomic change and adverse birth outcomes. Methods The study population consisted of registered singleton births occurred in the Netherlands 2003-2017 between 24 and 41 weeks of gestation (N = 2,335,449). Based on neighbourhood socioeconomic data from The Netherlands Institute for Social Research, we categorized neighbourhoods into longitudinal SES trajectories (e.g. stable, declining, ascending). Multilevel logistic regression models were used to estimate the relationship between neighbourhood SES trajectories and birth outcomes, i.e., preterm birth and small-for-gestational-age (SGA). Results Living in a Stable Low SES neighbourhood was associated with higher odds of preterm birth (OR[CI]=1.10[1.06; 1.14]), and SGA (OR[CI]=1.15[1.12; 1.18]), compared to living in Stable High SES areas. Also, women living in a Declining (Middle to Low SES) neighbourhood had higher odds for preterm birth (OR = 1.08[1.03; 1.14]) and SGA (OR = 1.10 [1.06; 1.15]), compared to Stable High SES areas. Conclusions Women from neighbourhoods with long-term low or declining SES were more likely to experience adverse birth outcomes. Policies aimed at mitigating the effect of long-term neighbourhood disadvantage or preventing neighbourhoods' decline have potential to benefit early life health outcomes. Key messages Women living in long-term low or declining socioeconomic status neighbourhoods were more likely to experience adverse birth outcomes. Our results can provide guidance to policies aimed at improving early life health outcomes.

Socioeconomic status trajectories and health in China

After 40 years of reform and opening up, China’s social and economic conditions have undergone tremendous changes. For individuals who have experienced this historical period, the socioeconomic transition has brought different effects on their health status. This research examines the issue and provides evidence that government policies need to be improved. This study adopted data from the 2015 China Health and Retirement Longitudinal Study (CHARLS). We set the education level, occupation, and family income during old age as the socioeconomic status for the early, middle, and late stages of life. Based on specific criteria, we classified the population as disadvantaged and advantaged, considering eight changing trajectories of socioeconomic status. We used multiple regression analysis to examine how the eight trajectories affect individuals’ physical and mental health. After controlling for social demography and health behavior variables, we found that, compared with those in the advantaged group long term, people who were in the disadvantaged group suffered from a significantly negative impact of their socioeconomic status on physical and mental health. The health status of those who moved upward in socioeconomic status was substantially better than those who remained in the same status. This study confirms that early disadvantaged socioeconomic status has a long-term adverse effect on health. However, the negative impact can be mitigated by improving one’s occupation during middle age or family income during old age throughout China’s socioeconomic transitions. Therefore, increasing upward social mobility at any stage helps eliminate health inequalities.

Socioeconomic trajectories across the life course and risk of total and cause-specific mortality: prospective findings from the Moli-sani Study

BackgroundA life course approach has been suggested as the most appropriate to establish the total impact of socioeconomic status (SES) on adult health outcomes; however, such an approach has been...

Early-life socioeconomic disadvantage, not current, predicts accelerated epigenetic aging of monocytes

Low socioeconomic status (SES) in early-life and adulthood independently contribute to increased risk for aging-related chronic diseases. One mechanistic hypothesis for these associations involves faster cellular aging of immune cells, which could plausibly contribute to chronic disease pathogenesis by compromising host resistance and/or up-regulating inflammation. However, little is known about the association between life-course SES and cellular aging. The present study examines the association of early-life and current SES with a novel biomarker of cellular aging termed the “epigenetic clock,” in monocytes. Additionally, we examine health behaviors and depressive symptoms as potential explanatory pathways. The study involved 335 participants between the ages of 15 and 55 from Vancouver, Canada and surrounding areas. Enrolled participants had to fit into four life-course SES trajectories, corresponding to low-low, low-high, high-low and high-high combinations of early-life (ages 0 to 5) and current SES respectively. Cellular aging of monocytes was measured using Horvath's DNA methylation derived measure of epigenetic age acceleration. Results indicated that socioeconomic disadvantage during early-life, but not later in life, was associated with accelerated epigenetic aging of monocytes. No early-life SES by current SES interaction was detected, suggesting that socioeconomic mobility is unrelated to epigenetic age acceleration. In path analyses, neither current health behaviors nor current depressive symptoms emerged as mediators of the early-life SES effect. These findings suggest socioeconomic disadvantage in early-life is independently predictive of cellular aging of immune cells, with potential implications for aging-related diseases later in life.

Abstract 031: Socioeconomic Trajectories Across the Life Course and Risk of All-cause and Cardiovascular Mortality: Prospective Findings From the Moli-sani Study

Introduction: A life course approach has been suggested as the most appropriated to establish the actual impact of socioeconomic status (SES) on health outcomes. Hypothesis: We assessed the hypothesis that SES trajectories from childhood to adulthood are useful to better evaluate the role of SES towards mortality risk in a large general population-based cohort. Methods: Longitudinal analysis on 22,194 subjects recruited in the general population of the Moli-sani study, Italy (2005-2010). Educational attainment (low/high) and SES in adulthood (measured by a score including occupational social class, housing and overcrowding, and dichotomized as low/high) were used to define four possible trajectories both in low and high SES in childhood (age of 8). Hazard ratios (HR) with 95% confidence intervals (95%CI) were calculated by multivariable Cox regression and competing risk models. Results: Over a median follow-up of 8.3 years (182,924 person-years), 1155 all-cause, of which 414 cardiovascular (CVD), deaths were ascertained. In the group with low SES in childhood, as opposed to those stably low (low education and low SES in adulthood), an upward in both educational attainment and material factors in adulthood was associated with lower risk of both all-cause (HR=0.64; 95%CI 0.52-0.79; Table) and CVD mortality (HR=0.62; 0.43-0.88), respectively. Subjects with high childhood SES experienced an increased risk of total and CVD death in absence of higher educational attainment despite a higher SES in adulthood (HR=1.47; 1.04-2.07 and HR=1.75;1.00-3.05, respectively) as compared to the group with both high education and high SES in adulthood. Conclusions: In conclusion, for individuals with low SES in childhood, an upward of both educational attainment and material factors over the life course is associated with lower risk of total and CVD death. In advantaged groups in childhood, lack of a higher educational attainment, rather than material factors, over the life course appears to be unfavourably associated with survival.

Changes in self-perceived economic satisfaction and mortality at old ages: Evidence from a survey of middle-aged and elderly adults in Taiwan

Experiencing a low socioeconomic status (SES) throughout the life course has been reported to be correlated with poor health outcomes. Several studies have suggested that income, wealth, and perceptions of economic status are associated with increased risk of death among elderly people. Few studies have investigated the association between lifetime SES and mortality among elderly adults. The analysis in this study was based on 2310 elderly adults for whom SES data from the four phases of the longitudinal survey of Health and Living Status of the Elderly in Taiwan (1989, 1993, 1996, and 1999) were available, and who were alive in 1999. The SES measures included in the analysis were annual income, the household wealth, and the self-perceived economic satisfaction. A group-based trajectory modelling approach was employed to create SES trajectories. Cox proportional hazard models were employed to examine the association between SES trajectories and 8-year all-cause mortality (1999–2007). Irrespective of whether income, wealth, or self-perceived economic satisfaction was used, the elderly adults with consistently low SES trajectory throughout early old age were independently and significantly associated with higher hazards of mortality than were those in a consistently high SES trajectory. Downward or upward mobility of income and wealth were associated with increased hazard of mortality. However, decreased self-perceived economic satisfaction was not significantly associated with increased hazard of mortality. According to the results, the strong distinction between trajectory patterns of income, wealth, and self-perceived economic satisfaction among elderly adults indicate that neither should be overlooked when investigating the role of SES mobility in mortality. Retirement policies or strategies for maintaining and promoting favorable SES in early old age may benefit the health of elderly adults later in life.

Socioeconomic inequalities and body mass index in Västerbotten County, Sweden: a longitudinal study of life course influences over two decades.

IntroductionLife course socioeconomic inequalities in heart disease, stroke and all-cause mortality are well studied in Sweden. However, few studies have sought to explain the mechanism for such associations mainly due to lack of longitudinal data with multiple measures of socioeconomic status (SES) across the life course. Given the population health concern about how socioeconomic inequality is related to poorer health, we aim to tackle obesity as one of the prime suspects that could explain the association between SES inequality and cardiovascular disease and consequently premature death. The aim of this study is to test which life course model best describes the association between socioeconomic disadvantage and obesity among 60 year old inhabitants of Västerbotten County in Northern Sweden.MethodsA birth cohort consisting of 3340 individuals born between 1930 and 1932 was studied. Body mass index (BMI) at the age of 60 and information on socioeconomic status at three stages of life (ages 40, 50, and 60 years) was collected. Independent samples t-test was used to compare BMI between advantaged and disadvantaged groups and one-way ANOVA was used to compare BMI among eight SES trajectories. We applied a structured modeling approach to examine three different hypothesized life course SES models (accumulation, critical period, and social mobility) in relation to BMI.ResultsWe found sex differences in the way that late adulthood socioeconomic disadvantage is associated with BMI among inhabitants of Northern Sweden. Our study suggests that social adversity in all stages of late adulthood is a particularly important indicator for addressing the social gradients in BMI among women in Northern Sweden and that unhealthy behaviors in terms of smoking and physical inactivity are insufficient to explain the relationships between social and lifestyle inequalities and BMI.ConclusionIn order for local authorities to develop informed preventive efforts, we suggest further research to identify modifiable risk factors across the life course which could explain this health inequality.