Deprivation in infancy or in adult life: which is more important for mortality risk?

A fetus in the world: Physiology, epidemiology, and the making of fetal origins of adult disease

Since the late 1980s, the fetal origins of adult disease, from 2003 developmental origins of health and disease (DOHaD), has stimulated significant interest in and an efflorescence of research on the long-term effects of the intrauterine environment. From the start, this field has been interdisciplinary, using experimental animal, clinical and epidemiological tools. As the influence of DOHaD on public health and policy expanded, it has drawn criticism for reducing the complex social and physical world of early life to women's reproductive bodies as drivers of intergenerational ills. This paper explains this narrowing of focus in terms of a formative and consequential exchange between David Barker, the British epidemiologist whose work is credited with establishing the field, and the discipline of fetal physiology. We suggest that fetal physiologists were a crucial constituency of support for Barker's hypothesis about early life origins of disease. Their collaborations with Barker helped secure and sustain the theory amid considerable controversy. The trajectory of DOHaD and its focus on the maternal body can be understood, we argue, as a consequence of this alliance, which brought together two distinct conceptualizations of the intrauterine environment, one from epidemiology and the other from fetal physiology. Along the way, we trace the histories of these conceptualizations, both of which were products of mid-to-late twentieth century British science, and show how Barker's early emphasis on social and economic conditions was superseded by a narrower focus on physiological mechanisms acting upon the autonomous fetus.

Birth weight and cardiometabolic risk factors: a discordant twin study in the UK Biobank

One of the longstanding debates in life-course epidemiology is whether an adverse intrauterine environment, often proxied by birth weight, causally increases the future risk of cardiometabolic disease. The use of a discordant twin study design, which controls for the influence of shared genetic and environmental confounding factors, may be useful to investigate whether this relationship is causal. We conducted a discordant twin study of 120 monozygotic (MZ) and 148 dizygotic (DZ) twin pairs from the UK Biobank to explore the potential causal relationships between birth weight and a broad spectrum of later-life cardiometabolic risk factors. We used a linear mixed model to investigate the association between birth weight and later-life cardiometabolic risk factors for twins, allowing for both within-pair differences and between-pair differences in birth weight. Of primary interest is the within-pair association between differences in birth weight and cardiometabolic risk factors, which could reflect an intrauterine effect on later-life risk factors. We found no strong evidence of association in MZ twins between the within-pair differences in birth weight and most cardiometabolic risk factors in later life, except for nominal associations with C-reactive protein and insulin-like growth factor 1. However, these associations were not replicated in DZ twin pairs. Our study provided no strong evidence for intrauterine effects on later-life cardiometabolic risk factors, which is consistent with previous large-scale studies of singletons testing the potential causal relationship. It does not support the hypothesis that adverse intrauterine environments increase the risk of cardiometabolic disease in later life.

Relationship between birth weight and chronic kidney disease: evidence from systematics review and two-sample Mendelian randomization analysis

Observational studies showed an inverse association between birth weight and chronic kidney disease (CKD) in adulthood existed. However, whether such an association is causal remains fully elusive. Moreover, none of prior studies distinguished the direct fetal effect from the indirect maternal effect. Herein, we aimed to investigate the causal relationship between birth weight and CKD and to understand the relative fetal and maternal contributions. Meta-analysis (n = ~22 million) showed that low birth weight led to ~83% (95% confidence interval [CI] 37-146%) higher risk of CKD in late life. With summary statistics from large scale GWASs (n = ~300 000 for birth weight and ~481 000 for CKD), linkage disequilibrium score regression demonstrated birth weight had a negative maternal, but not fetal, genetic correlation with CKD and several other kidney-function related phenotypes. Furthermore, with multiple instruments of birth weight, Mendelian randomization showed there existed a negative fetal casual association (OR = 1.10, 95% CI 1.01-1.16) between birth weight and CKD; a negative but non-significant maternal casual association (OR = 1.09, 95% CI 0.98-1.21) was also identified. Those associations were robust against various sensitivity analyses. However, no maternal/fetal casual effects of birth weight were significant for other kidney-function related phenotypes. Overall, our study confirmed the inverse association between birth weight and CKD observed in prior studies, and further revealed the shared maternal genetic foundation between low birth weight and CKD, and the direct fetal and indirect maternal causal effects of birth weight may commonly drive this negative relationship.

Developmental programming of cardiovascular function: a translational perspective

The developmental origins of health and disease (DOHaD) is a concept linking pre- and early postnatal exposures to environmental influences with long-term health outcomes and susceptibility to disease. It has provided a new perspective on the etiology and evolution of chronic disease risk, and as such is a classic example of a paradigm shift. What first emerged as the 'fetal origins of disease', the evolution of the DOHaD conceptual framework is a storied one in which preclinical studies played an important role. With its potential clinical applications of DOHaD, there is increasing desire to leverage this growing body of preclinical work to improve health outcomes in populations all over the world. In this review, we provide a perspective on the values and limitations of preclinical research, and the challenges that impede its translation. The review focuses largely on the developmental programming of cardiovascular function and begins with a brief discussion on the emergence of the 'Barker hypothesis', and its subsequent evolution into the more-encompassing DOHaD framework. We then discuss some fundamental pathophysiological processes by which developmental programming may occur, and attempt to define these as 'instigator' and 'effector' mechanisms, according to their role in early adversity. We conclude with a brief discussion of some notable challenges that hinder the translation of this preclinical work.

Maternal and fetal genetic effects on birth weight and their relevance to cardio-metabolic risk factors

Birth weight variation is influenced by fetal and maternal genetic and non-genetic factors, and has been reproducibly associated with future cardio-metabolic health outcomes. In expanded genome-wide association analyses of own birth weight (n = 321,223) and offspring birth weight (n = 230,069 mothers), we identified 190 independent association signals (129 of which are novel). We used structural equation modeling to decompose the contributions of direct fetal and indirect maternal genetic effects, then applied Mendelian randomization to illuminate causal pathways. For example, both indirect maternal and direct fetal genetic effects drive the observational relationship between lower birth weight and higher later blood pressure: maternal blood pressure-raising alleles reduce offspring birth weight, but only direct fetal effects of these alleles, once inherited, increase later offspring blood pressure. Using maternal birth weight-lowering genotypes to proxy for an adverse intrauterine environment provided no evidence that it causally raises offspring blood pressure, indicating that the inverse birth weight-blood pressure association is attributable to genetic effects, and not to intrauterine programming.

DO BIOMARKERS VARY BY SOCIAL CLASS, EDUCATION AND REGION AND IS MIGRATION IMPORTANT? EVIDENCE FROM A COHORT OF BRITISH ADULTS

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire & Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

The association of early life socioeconomic position on breast cancer incidence and mortality: a systematic review

OBJECTIVES

We conducted a systematic review of the literature relating early life socioeconomic position (SEP) to breast cancer incidence and mortality from a critical period and life-course trajectory perspective.

METHODS

PubMed, EMBASE and Web of Science were searched to identify cohort studies that evaluated the impact of early life SEP indicators on the incidence and/or mortality from breast cancer in adulthood.

RESULTS

Nine distinct studies evaluated the relationship between early life SEP and breast cancer between 1990 and 2016. Five reports assessed breast cancer incidence and five assessed breast cancer mortality as outcomes; one study assessed both incidence and mortality. While lower early life SEP was associated with reduced breast cancer incidence and increased breast cancer mortality in the US, studies conducted in Europe were unable to establish a consistent association.

CONCLUSIONS

We found moderate support for the association between early life SEP and incidence and mortality from breast cancer. The impact of early life SEP on breast cancer incidence and mortality appeared to vary between countries. We urge further investigation of the role of lifelong SEP trajectories in breast cancer outcomes.

Sex-Based Differences in the Determinants of Old Age Life Expectancy: The Influence of Perimenopause

Studies using the sensitive periods framework typically examine the effects of early life exposures on later life health, due to the significant growth and development occurring during the first few years of life. The menopausal transition (i.e., perimenopause) is similarly characterized by rapid physiological change, yet rarely has been tested as a sensitive window in adulthood. Cohort mortality data drawn from three historic populations, Sweden (1751-1919), France (1816-1919), and England and Wales (1841-1919), were analyzed using time series methods to assess whether conditions at midlife significantly influenced or "programmed" later life longevity. Results indicated a significant inverse association between mortality at ages 45-49, the average age range in which perimenopause occurred, and life expectancy at age 60 among females in all three countries. Study findings suggest a degree of plasticity associated with women's aging and, in particular, the age group correlated with perimenopause.

Early-life conditions and adult mortality decline in Dutch cohorts born 1812-1921

Mounting evidence suggests that early-life conditions have an enduring effect on an individual's mortality risks as an adult. The contribution of improvements in early-life conditions to the overall decline in adult mortality, however, remains a debated issue. We provide an estimate of the contribution of improvements in early-life conditions to mortality decline after age 30 in Dutch cohorts born between 1812 and 1921. We used two proxies for early-life conditions: median height and early-childhood mortality. We estimate that improvements in early-life conditions contributed more than five years or about a third to the rise in women's life expectancy at age 30. Improvements in early-life conditions contributed almost three years or more than a quarter to the rise in men's life expectancy at age 30. Height appears to be the more important of the two proxies for early-life conditions.

Birth in the South and chronic disease mortality rates in the late twentiethcentury United States

Southern-born black and white Americans suffered severe economic deprivations during the first half of the twentieth century. We hypothesized that these conditions increased their risks of dying from cancer, diabetes, heart and cerebrovascular diseases. Mortality files for the years 1979 to 1991 for the United States and a specially constructed US Census population file were used to calculate age-specific and age-adjusted death rates for black and white males and females by region of birth and region of residence at time of death. Death rates of Southern-born populations were compared to the death rates of populations born in the Northeast, Midwest and West. The Southern-born effect was manifested in higher death rates from cancer, diabetes, heart and cerebrovascular diseases for both black and white populations. The Southern-born effect is larger than black/white differences for cancer and of similar magnitude for heart and cerebrovascular diseases. Follow-up investigations are needed to isolate key elements of the Southernborn effect that can be addressed through interventions.

Socio-economic Differentials in Health

The first Whitehall Study of British civil servants demonstrated an inverse gradient in mortality. The lower the grade the higher was the mortality risk. This higher mortality risk applies to most but not all causes of death. The Whitehall II Study, set up to investigate causes of this social gradient shows similarly marked gradients in morbidity. A review of potential causes of the gradient suggests that it is due neither to health selection nor simply to differences in lifestyle, but that relative deprivation—a psychosocial concept—and the accumulation of socially-patterned exposures over the life course, must be important. Whitehall II suggests that the operation of these factors is to be found in the specific circumstances under which people grow, live and work.

Some Observations on Health and Socio economic Status

Health and socio-economic status are powerfully linked. This association cannot be attributed to social-selection effects, and the unequal distribution of behavioural risk factors, such as smoking, explains only a part of the variance. Differential exposure to physical hazards plays a role, but the persistence of health differentials into the better-off social strata and the significance of relative as well as absolute living standards suggest psychosocial factors also. We outline a conceptual model that regards the clustering of adverse physical and psychosocial factors over the life course as critical. Identifying the salient physical and psychosocial factors is a formidable research mission. In pursuing this mission we should not lose sight of the key fact that socio economic health differentials are intimately bound up with material differentials, and that remediation demands strategies that counter socio-economic disparity.

Socioeconomic position in childhood and cancer in adulthood: a rapid-review

Background

The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes.

Methods and results

We performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest.

Conclusions

Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented.

Retinal vascular imaging in early life: insights into processes and risk of cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent years, studies have shown that the origins of CVD may be traced to vascular and metabolic processes in early life. Retinal vascular imaging is a new technology that allows detailed non-invasive in vivo assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low-fibre and high-sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight/obesity, childhood depression/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. Thus, the retina is a useful site for pre-clinical assessment of microvascular processes that may underlie the future development of CVD in adulthood.

Auxological perspectives on 'growth' in DOHaD

David Barker established growth as a seminal link between early development and later health attainment and disease risk. This was nothing less than a paradigm shift in health and medicine, turning the focus of disease causality away from contemporary environmental influences to earliest growth as a time when functional anatomy and physiology sets in place critical structures and function for a lifetime. Barker's prodigious work investigated time- and place-specific interactions between maternal condition and exogenous environmental influences, focusing on how growth unfolds across development to function as a mechanistic link to ensuing health. Subsequent applications do not always attend to the specificity and sensitivity issues included in his original work, and commonly overlook the long-standing methods and knowledge base of auxology. Methodological areas in need of refinement include enhanced precision in how growth is represented and assessed. For example, multiple variables have been used as a referent for 'growth,' which is problematic because different body dimensions grow by different biological clocks with unique functional physiologies. In addition, categorical clinical variables obscure the spectrum of variability in growth experienced at the individual level. Finally, size alone is a limited measure as it does not capture how individuals change across age, or actually grow. The ground-breaking notion that prenatal influences are important for future health gave rise to robust interest in studying the fetus. Identifying the many pathways by which size is realized permits targeted interventions addressing meaningful mechanistic links between growth and disease risk to promote health across the lifespan.

Can 'early programming' be partly explained by smoking? Results from a prospective, population-based cohort study

BACKGROUND

Numerous studies have focused the association between low birthweight and later disease. Our objective was to study the association between birthweight and later adult smoking and thereby explore a possible mechanism for the association between low birthweight and later adult disease.

METHODS

We studied associations between birthweight of women (n=247704) born in 1967-1995 and smoking habits at the end of their pregnancy 13-42 years later in a prospective, population-based cohort study from The Medical Birth Registry of Norway. Similarly, the association between birthweight of men (n=194393) and smoking habits of their partners were assessed. Finally, we studied the relation between smoking habits of the participating women and the cause specific death of their mothers (n=222808).

RESULTS

Twenty per cent of women with birthweight less than 2000 g were adult daily smokers compared with 11% with birthweight 4000-4499 g [relative risk=1.8, 95% confidence interval 1.4, 2.2]. Similarly, we found an association between men's birthweight and their partners smoking habits. Mothers of smoking women had doubled risk of dying from lung cancer and from cardiovascular disease compared with mothers of non-smoking women.

CONCLUSIONS

Being born with low birthweight is associated with smoking in adulthood. Associations of adult smoking with partners' birthweight and mothers' smoking-related causes of death suggest a shared smoking environment, and may account for some of the established association between birthweight and later cardiovascular disease.

Visualizing Europe's demographic scars with coplots and contour plots

We present two enhancements to existing methods for visualizing vital statistics data. Data from the Human Mortality Database were used and vital statistics from England and Wales are used for illustration. The simpler of these methods involves coplotting mean age of death with its variance, and the more complex of these methods is to present data as a contour plot. The coplot method shows the effect of the 20th century's epidemiological transitions. The contour plot method allows more complex and subtle age, period and cohort effects to be seen. The contour plot shows the effects of broad improvements in public health over the 20th century, including vast reductions in rates of childhood mortality, reduced baseline mortality risks during adulthood and the postponement of higher mortality risks to older ages. They also show the effects of the two world wars and the 1918 influenza pandemic on men of fighting age, women and children. The contour plots also show a cohort effect for people born around 1918, suggesting a possible epigenetic effect of parental exposure to the pandemic which shortened the cohort's lifespan and which has so far received little attention. Although this article focuses on data from England and Wales, the associated online appendices contain equivalent visualizations for almost 50 series of data available on the Human Mortality Database. We expect that further analyses of these visualizations will reveal further insights into global public health.

THE FRAGILITY OF THE FUTURE AND THE TUG OF THE PAST: LONGEVITY IN LATIN AMERICA AND THE CARIBBEAN

BACKGROUND

Cohorts that will attain age 60 after 2010 in the Latin American and Caribbean region (LAC) are beneficiaries of a massive mortality decline that began as early as 1930. The bulk of this decline is due to diffusion of low-cost medical technology that improved recovery rates from infectious diseases. This changes the composition of elderly cohorts in a distinct way: more among those who could experience the deleterious impact of adverse early conditions as adults survive to attain old ages.

OBJECTIVE

To compute bounds for the size of effects on old age mortality of changes in cohorts' composition by exposure to early conditions. We calculate estimates for countries in the LAC region that span the entire range of post-1950 mortality decline.

METHODS

We use counterfactual population projections to estimate bounds of changes in the composition of cohorts by exposure to early conditions. These are combined with empirical effects of adverse early conditions on adult mortality to generate estimates of foregone gains in life expectancy at age 60.

RESULTS

under somewhat conservative assumptions life expectancy at age 60 will at best increase much more slowly than in the past and at worst reach a steady state or decline. Foregone gains may be as high as 20% of projected values over a period of 30 to 50 years, the time it takes for cohorts that reaped the benefits of the secular mortality decline to become extinct.

CONCLUSIONS

Changing composition of cohorts by early exposures constitutes a powerful force that could drag down or halt short-run progress of life expectancy at older ages.

Migration selection, protection, and acculturation in health: a binational perspective on older adults

In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the "salmon bias," emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.

Nutrition deficiency increases the risk of stomach cancer mortality

BACKGROUND

The purpose of the study is to determine whether exposure to malnutrition during early life is associated with increased risk of stomach cancer in later life.

METHODS

The design protocol included analyzing the trend of gastric cancer mortality and nutrition and evaluating the association between nutrient deficiency in early life and the risk of gastric cancer by hierarchical age-period-birth cohort (APC) analysis using general log-linear Poisson models and to compare the difference between birth cohorts who were exposed to the 1959-1961 Chinese famine and those who were not exposed to the famine. Data on stomach cancer mortality from 1970 to 2009 and the dietary patterns from 1955 to 1985 which included the 1959-1961 Chinese famine period in the Zhaoyuan County population were obtained. The nutrition information was collected 15 years prior to the mortality data as based on the latest reference of disease incubation.

RESULTS

APC analysis revealed that severe nutrition deficiency during early life may increase the risk of stomach cancer. Compared with the 1960-1964 birth cohort, the risk for stomach cancer in all birth cohorts from 1900 to 1959 significantly increased; compared with the 1970-1974 cohort, the risk for stomach cancer in the 1975-1979 cohort significantly increased, whereas the others had a steadily decreased risk; compared with 85-89 age group in the 2005-2009 death survey, the ORs decreased with younger age and reached significant levels for the 50-54 age group after adjusting the confounding factors. The 1930 to 1964 group (exposed to famine) had a higher mortality rate than the 1965 to 1999 group (not exposed to famine). For males, the relative risk (RR) was 2.39 and the 95% confidence interval (CI) was 1.51 to 3.77. For females, RR was 1.64 and 95% CI was 1.02 to 2.62.

CONCLUSION

The results of the present study suggested that prolonged malnutrition during early life may increase the risk of stomach cancer mortality in later life.

Comparing Blood Pressure of Twins and Their Singleton Siblings: Being a Twin Does Not Affect Adult Blood Pressure

The hypothesis was tested that monozygotic (MZ) and dizygotic (DZ) twins, with their lower average birth weight, have higher adult blood pressure than their singleton brothers or sisters. From the Netherlands Twin Registry, 261 twin families were recruited from a young adult and an older adult cohort with mean ages of 26.2 and 50.4 respectively. These families yielded 204 MZ twins with 71 singleton siblings and 271 DZ twins with 103 of their singleton siblings. Anti-hypertensive medication use of these 649 participants was assessed twice with a two-year interval. Resting blood pressure was measured thrice during a standardized laboratory protocol. In spite of a significant difference in birth weight (1036 gram), no differences were found in anti-hypertensive medication use at both time points between twins and singletons nor between their resting laboratory diastolic or systolic blood pressure. These results applied to each gender and to both age cohorts. Limiting the analyses to matched twin-sibling pairs of the same families and taking current weight and height into account did not change the results; no evidence was found for a twin-singleton difference. It was concluded that estimates of genetic and environmental contributions to blood pressure deriving from twin studies do not appear to be biased and may be generalized to singletons. Our results suggest that the lower birth weight in twins does not reflect the intrauterine disadvantage described by the Barker hypothesis.

Health Inequalities, General Trends in Mortality and Morbidity, and Associated Factors

All measures of health status are ultimately derived from observations of individuals. At the field level we have such measures as self-assessed health status, report of a specific disease, record of a particular death, or an individual’s test on a biomarker, such as blood pressure or serum cholesterol. The observations for individuals are combined and summarized to represent subnational geographic areas, demographic or socioeconomic groups within countries, or national populations. The summary measures, whether they are percentages, averages, or rates, apply to groups. A problem arises when the measures that are based on groups are assumed to represent individuals. The analysis becomes especially problematic when the units analyzed are geographic areas and inferences are being made about individuals from the analysis for these geographic areas.

Childhood economic conditions and length of life: evidence from the UK Boyd Orr cohort, 1937-2005

We study the importance of childhood socioeconomic conditions in predicting differences in life expectancy using data from a large sample of children collected in 16 locations in England and Scotland in 1937-39, who have been traced through official death records up to 2005. We estimate a number of duration of life models that control for unobserved family heterogeneity. Our results confirm that childhood conditions such as household income and the quality of the home environment are significant predictors of longevity. Importantly, however, the role of socioeconomic status appears to differ across cause of death, with household income being a significant predictor of death from smoking-related cancer. Moreover, we find that (1) poor housing conditions in childhood is associated with reduced longevity, that (2) early doctor-assessed childhood health conditions significantly predict a reduced length of life, that (3) children born in a location with relatively high infant mortality rates live significantly fewer years, and that (4) there is a high correlation in longevity across children from the same family across all causes of death. We estimate that the difference in life expectancy between those with the 'best' and 'worst' observable characteristics is about 9 years, which increases to 20 years when we take into account the 'best' and 'worst' observable and unobservable household characteristics.

Occupational career and risk of mortality among US Civil War veterans

Previous studies have extended the traditional framework on occupational disparities in health by examining mortality differentials from a career perspective. Few studies, however, have examined the relation between career and mortality in a historical U.S. population. This study explores the relation between occupational career and risk of mortality in old age among 7096 Union Army veterans who fought the American Civil War in the 1860s. Occupational mobility was commonplace among the veterans in the postbellum period, with 54% of them changing occupations from the time of enlistment to 1900. Among veterans who were farmers at enlistment, 46% of them changed to a non-farming occupation by the time of 1900. Results from the Cox Proportional Hazard analysis suggest that relative to the average mortality risk of the sample, being a farmer at enlistment or circa 1900 are both associated with a lower risk of mortality in old age, although the effect is more salient for veterans who were farmers at enlistment. Occupational immobility for manual labors poses a serious threat to chance of survival in old age. These findings still hold after adjusting for the effects of selected variables characterizing risk exposures during early life, wartime, and old age. The robustness of the survival advantage associated with being a farmer at enlistment highlights the importance of socioeconomic conditions early in life in chance of survival at older ages.

Risk Exposures in Early Life and Mortality at Older Ages: Evidence from Union Army Veterans

This study examines the relation between risk exposures in early life and hazard of mortality among 11,978 Union Army veterans aged 50 and over in 1900. Veterans' risk exposures prior to enlistment-as approximated by birth season, country of origin, residential region, city size, and height at enlistment-significantly influence their chance of survival after 1900. These effects are robust irrespective of whether or not socioeconomic well-being circa 1900 has been taken into account; however, they are sensitive to the particular age periods that have been selected for survival analysis. Whereas some of the effects such as being born in Ireland and coming from big cities became fully unfolded in the first decade after 1900 and then dissipated over time, the effects of birth season, being born in Germany, residential region in the U.S., and height at enlistment were more salient in the post-1910 periods. Height at enlistment shows a positive association with risk of mortality in the post-1910 periods. Compared to corresponding findings from more recent cohorts, the exceptional rigidity of the effects of risk exposures prior to enlistment on old-age mortality among the veterans highlights the harshness of living conditions early in their life.

Childhood leukaemia and socioeconomic status: what is the evidence?

The objectives of this systematic review are to summarise the current literature on socioeconomic status (SES) and the risk of childhood leukaemia, to highlight methodological problems and formulate recommendations for future research. Starting from the systematic review of Poole et al. (Socioeconomic status and childhood leukaemia: a review. Int. J. Epidemiol. 2006;35(2):370-384.), an electronic literature search was performed covering August 2002-April 2008. It showed that (1) the results are heterogeneous, with no clear evidence to support a relation between SES and childhood leukaemia; (2) a number of factors, most importantly selection bias, might explain inconsistencies between studies; (3) there is some support for an association between SES at birth (rather than later in childhood) and childhood leukaemia and (4) if there are any associations, these are weak, limited to the most extreme SES groups (the 10-20% most or least deprived). This makes it unlikely that they would act as strong confounders in research addressing associations between other exposures and childhood leukaemia. Future research should minimise case and control selection bias, distinguish between different SES measures and leukaemia subtypes and consider timing of exposures and cancer outcomes.

Do intrauterine growth restriction and overweight at primary school age increase the risk of elevated body mass index in young adults?

Obesity is one of the rising public health problems characterized as a risk factor for many chronic diseases in adulthood. Early life events such as intrauterine growth restriction, as well as life style, are associated with an increased prevalence of this disease. The present study was performed to determine if intrauterine growth restriction interacts with overweight at primary school age to affect body mass index (BMI) in young adults. From June 1, 1978 to May 31, 1979, 6827 singleton liveborns from Ribeirão Preto, São Paulo State, Brazil, corresponding to 98% of all births at the 8 maternity hospitals, were examined and their mothers were interviewed. Samples from the initial cohort were examined again at primary school age (8 to 11 years of age) and at the time of military service (18 years of age). There were 519 male individuals with complete measurements taken in the three surveys. Intrauterine growth-restricted individuals had a BMI 0.68 kg/m(2) lower than that of individuals who were not restricted (95%CI = -1.34 to -0.03) and overweight at primary school age showed a positive and strong effect on BMI at 18 years of age (coefficient 5.03, 95%CI = 4.27 to 5.79). However, the increase in BMI was much higher--6.90 kg/m(2)--when the conscript had been born with intrauterine growth restriction and presented overweight at primary school age (95%CI = 4.55 to 9.26). These findings indicate that the effect of intrauterine growth restriction on BMI at 18 years of age is modified by later weight gain during school age.

The influence of early conditions on health status among elderly Puerto Ricans

The demographic origins of aging in Puerto Rican and other Latin American and Caribbean (LAC) countries may have important implications for the profile of health status and mortality of elderly people. For this article we tested a general conjecture about the relation between early childhood conditions and adult health status among Puerto Rican elderly using a rich data set recently collected through an island-wide survey (N = 4,293). We examined the association between markers of early nutritional status, self-reports of health and on socioeconomic conditions during early childhood, and the prevalence of 3 conditions during adult ages: obesity, diabetes, and cardiovascular diseases. Although we found that obesity and diabetes are associated with markers of early malnutrition, that heart disease is associated with early deprivations and selected early childhood conditions, the evidence we were able to tease out from the data provides only fragile support for the conjecture.

Is birth weight a risk factor for ischemic heart disease in later life?

BACKGROUND

An inverse association between birth weight and ischemic heart disease (IHD) has been seen in observational studies.

OBJECTIVE

We wanted to determine the strength and consistency of the association between birth weight and subsequent IHD.

DESIGN

We conducted a systematic review of observational studies.

RESULTS

Seventeen published studies of birth weight and subsequent IHD were identified that included a total of 144,794 singletons. Relative risk estimates for the association between birth weight and IHD were available from 16 of these studies. Additional data from 2 unpublished studies of 3801 persons were also included. In total, the analyses included data from 18 studies on 4210 nonfatal and 3308 fatal IHD events in 147,009 persons. The mean weighted estimate for the association between birth weight and the combined outcome of nonfatal and fatal IHD was 0.84 (95% CI: 0.81, 0.88) per kilogram of birth weight (P<0.0001). No significant heterogeneity was observed between estimates in different studies (P=0.09), nor was there evidence of publication bias (P=0.3, Begg test). Neither restricting the analysis to fatal IHD events nor adjusting for socioeconomic status had any appreciable effect on the findings.

CONCLUSIONS

These findings are consistent with a 1 kg higher birth weight being associated with a 10-20% lower risk of subsequent IHD. However, even if causal, interventions to increase birth weight are unlikely to reduce the incidence of IHD materially. Further studies are needed to determine whether the observed association reflects a stronger underlying association with a related exposure or is due (at least in part) to residual confounding.

Life-course approaches to inequalities in adult chronic disease risk

A life-course approach to chronic-disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular manner in which timing in relation to physical growth, reproduction, infection, social mobility, behavioural transitions etc. can influence various adult chronic diseases in different ways, and more ambitiously by how these temporal processes are interconnected and manifested in health inequalities within a population and in population-level disease trends. The paper will discuss some historical background to life-course epidemiology and theoretical models of life-course processes, and will review some of the empirical evidence linking life-course processes to CHD, haemorrhagic stroke, stomach cancer and other chronic diseases in adulthood. It will also underscore that a life-course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life-course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society

OBJECTIVE

Low birth weight remains a major cause of morbidity and mortality in early infancy and childhood. It is associated with an increased risk of health problems later in life, particularly coronary heart disease and stroke. A meeting was convened to identify the key health issues facing a child born small for gestational age (SGA) and to propose management strategies.

PARTICIPANTS

There were 42 participants chosen for their expertise in obstetrics, peri- and neonatal medicine, pediatrics, pediatric and adult endocrinology, epidemiology, and pharmacology.

EVIDENCE

Written materials were exchanged, reviewed, revised, and then made available to all. This formed the basis for discussions at the meeting. Where published data were not available or adequate, discussion was based on expert clinical opinions.

CONSENSUS PROCESS

Each set of questions was considered by all and then discussed in plenary sessions with consensus and unresolved issues identified. The consensus statement was prepared in plenary sessions and then edited by the group chairs and shared with all participants.

CONCLUSIONS

The diagnosis of SGA should be based on accurate anthropometry at birth including weight, length, and head circumference. We recommend early surveillance in a growth clinic for those without catch-up. Early neurodevelopment evaluation and interventions are warranted in at-risk children. Endocrine and metabolic disturbances in the SGA child are recognized but infrequent. For the 10% who lack catch-up, GH treatment can increase linear growth. Early intervention with GH for those with severe growth retardation (height sd score, <-2.5; age, 2-4 yr) should be considered at a dose of 35-70 microg/kg x d. Long-term surveillance of treated patients is essential. The associations at a population level between low birth weight, including SGA, and coronary heart disease and stroke in later life are recognized, but there is inadequate evidence to recommend routine health surveillance of all adults born SGA outside of normal clinical practice.

Lifecourse influences on health among British adults: effects of region of residence in childhood and adulthood

BACKGROUND

It has been suggested that early life exposures are important determinants of geographical variations in adult diseases. We examined inter-regional migrants in Britain to evaluate the relative importance of early and recent exposures for adult cardiorespiratory risk factors, mental ill-health and sensory function.

METHODS

A total of 9023 persons born throughout England, Scotland and Wales during 1 week in 1958 were followed periodically through childhood into adulthood. At 44-45 years, height, body mass index (BMI), blood pressure (BP), glycosylated haemoglobin, total and high-density lipoprotein (HDL) cholesterol, triglycerides, fibrinogen, total immunoglobulin E (IgE), one-second forced expiratory volume (FEV1), hearing threshold at 4 kHz, visual impairment, symptoms of depression and anxiety, and chronic widespread pain were measured. Analysis of migration between 12 regions included 3125 cohort members who were examined in a region different to their birthplace.

RESULTS

Height, BMI, diastolic BP (DBP), FEV1, log-transformed IgE and hearing threshold varied by region among non-migrants (each P < 0.05). Among inter-regional migrants, the spatial associations with current region, independent of birthplace, followed closely the geographical pattern shown among non-migrants for BMI, DBP and FEV1 (each P < 0.001). In contrast, of the 15 outcomes, only adult height was related to region of birth, after adjustment for region of examination (P = 0.002)

CONCLUSIONS

Although individual disease risk is predicted by early life factors, early exposures do not explain regional variations in cardiovascular and respiratory risk factors among middle-aged adults in Britain. Geographical inequalities in cardiorespiratory health are more strongly related to factors associated with region of examination that influence obesity, BP and ventilatory function.

Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

OBJECTIVES

To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries.

STUDY DESIGN AND SETTING

Data on ischemic heart disease (IHD) and stroke mortality in 1950-1999 in the Netherlands, England & Wales, France, and four Nordic countries were analyzed. We used Poisson regression to describe trends in mortality according to birth cohort, for the cohorts born between 1860 and 1939. Pearson correlation coefficients were calculated to determine associations between IMR and IHD, or stroke mortality.

RESULTS

IHD mortality increased for successive cohorts up to 1900, and then started to decline. Stroke mortality levels were virtually stable among birth cohorts up to 1880, but declined rapidly among later cohorts. A strong positive association was found between cohort-specific IMR levels and stroke mortality rates. There were no strong cohort-wise associations between IMR and IHD mortality.

CONCLUSION

These results support other studies in suggesting that living conditions in early childhood may influence population levels of stroke mortality. Future studies should determine the contribution of specific early life factors to the mortality decline in IHD and especially stroke.

Trends in stomach cancer mortality in relation to living conditions in childhood. A study among cohorts born between 1860 and 1939 in seven European countries

AIM

To assess whether secular trends in stomach cancer mortality were correlated with trends in infant mortality rate (IMR) or gross domestic product (GDP).

METHODS

Data from seven European countries were analyzed. We used Poisson regression to describe mortality trends among birth cohorts of 1865-1939 and correlation coefficients to determine associations with IMR/GDP.

RESULTS

Large differences were observed between birth cohorts in mortality from stomach cancer. In each country, these cohort differences were closely related to IMR/GDP levels at birth time. However, stronger associations were observed with measures of living conditions during later life. In comparisons between countries, stomach cancer mortality rates were not consistently related to national levels of IMR/GDP.

CONCLUSION

General living conditions in childhood do not seem to have had a predominant effect on secular trends in stomach cancer mortality. The mortality decline is likely to be related to more 1specific factors, such as declining Helicobacter pylori prevalence.

Association between gross domestic product throughout the life course and old-age mortality across birth cohorts: Parallel analyses of seven European countries, 1950–1999

Mortality levels of national populations have often been studied in relation to levels of gross domestic product (GDP) at time of death. Following the life course perspective, we assessed whether old-age mortality levels for subsequent cohorts are differentially associated with GDP levels prevailing at different ages of the cohorts. We used all-cause and cause-specific mortality data by sex, age at death (65-99), year at death (1950-1999), and year of birth (1865-1924) for Denmark, England and Wales, Finland, France, the Netherlands, Norway, and Sweden. Trends in national GDP per capita between 1865 and 1999 were reconstructed from historical national accounts data. Through Poisson regression analyses, we determined for each country both univariate and multivariate associations across five-year birth cohorts between mortality and GDP levels prevailing at time of death, and at earlier ages of the cohorts (i.e. 0-5, 6-19, 20-49, and 50-64). For the subsequent cohorts, levels of GDP at time of death were strongly inversely associated with all-cause mortality, especially among women, and among men in England and Wales, Finland, and France. In most countries, stronger associations were observed with GDP levels prevailing at earlier ages of the cohorts. After control for GDP at time of death, these associations remained. An independent association of GDP at earlier ages of the cohort was also observed for cause-specific mortality. The associations were negative for ischaemic heart diseases, cerebrovascular diseases, and stomach cancer. They were positive for prostate cancer, breast cancer, COPD (women), and lung cancer (women). GDP prevailing at ages 20-49 (men) and ages 50-64 (women) had the largest associations with old-age mortality. These findings suggest an independent, mostly negative effect of GDP prevailing at earlier ages of subsequent cohorts on old-age mortality. Socio-economic circumstances during adulthood and middle age seem more important in determining old-age mortality trends than those during infancy or childhood.

Experimental Intrauterine Growth Retardation in the Rat Causes a Reduction of Pancreatic B-Cell Mass, Which Persists into Adulthood

BACKGROUND AND OBJECTIVES

The aim of this study was to investigate the possibility that intrauterine growth retardation (IUGR) causes alterations of glucose tolerance, insulin secretory response to glucose, and pancreatic B-cell growth, and if such changes may persist into adulthood.

METHODS

Pregnant rats were operated on day 16 of pregnancy ad modum Wigglesworth to induce IUGR. Operated rats gave birth to viable offspring but litter size was reduced. The mothers nursed their pups, which were subsequently weaned and reared to an age of 3 months in apparent good health.

RESULTS

At 1 day of age, IUGR pups were 10% lighter than control newborns whose mothers had been subjected to a sham operation. Pancreatic B-cell mass and insulin content were reduced by 35-40% in newborn IUGR offspring. Postnatal growth did not differ between IUGR and control animals of either sex and the difference in body weight at birth was not apparent from 1 week of age and onwards. Tests performed at 3 months of age could not demonstrate differences in glucose tolerance between IUGR and control animals. In females, but not in males, the peak insulin secretory response to glucose was lower in IUGR animals compared to controls. In the 3-month-old rats, B-cell mass was reduced by 40% in male and by 45% in female IUGR rats compared to controls, a reduction corresponding to a similar decrease in pancreatic insulin content (male reduction 48%, female reduction 45%).

CONCLUSIONS

In the rat, IUGR causes a diminution of pancreatic B-cell mass which persists into adulthood. Normal glucose tolerance could be maintained but it is conceivable that increasing demands on insulin secretion may not be met by the reduced B-cell mass and that impaired glucose tolerance and even diabetes would hence develop.

Cohort patterns in mortality trends among the elderly in seven European countries, 1950–99

BACKGROUND

Secular trends in old-age mortality are of crucial importance to population ageing. For the understanding and prediction of these trends, it is important to determine whether birth cohort effects, i.e. long-lasting effects of exposures earlier in life, are important in determining mortality trends up to old age. This study aimed to identify and describe cohort patterns in trends in mortality among the elderly (>60 years of age) in seven European countries.

METHODS

A standard age-period-cohort analysis was applied to all-cause and cause-specific mortality data by 5-year age groups and sex, for Denmark, England and Wales, Finland, France, The Netherlands, Norway, and Sweden, in the period 1950-99.

RESULTS

Cohort patterns were identified in all countries, for both the sexes and virtually all causes of death. They strongly influenced the trends in all-cause mortality among Danish, Dutch, and Norwegian men, and the trends in mortality from infectious diseases, lung cancer (men only), prostate cancer, breast cancer, and chronic obstructive pulmonary disease (COPD). All-cause mortality decline stagnated among Danish, Dutch, and Norwegian male birth cohorts born between 1890 and 1915, among French men born after 1920, and among women from all countries born after 1920. Where all-cause mortality decline stagnated, cohort patterns in mortality from lung cancer, COPD, and to a lesser extent ischaemic heart diseases, were unfavourable as well. For infectious diseases, stomach cancer, and cerebrovascular diseases, mortality increased among cohorts born before 1890, and decreased strongly thereafter.

CONCLUSIONS

Cohort effects related to factors such as living conditions in childhood and smoking in adulthood were important in determining the recent trends in mortality among the elderly in seven European countries.

A life course approach to chronic disease epidemiology

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways, and more ambitiously, by how these temporal processes are interconnected and manifested in population-level disease trends. In this review, we discuss some historical background to life course epidemiology and theoretical models of life course processes, and we review some of the empirical evidence linking life course processes to coronary heart disease, hemorrhagic stroke, type II diabetes, breast cancer, and chronic obstructive pulmonary disease. We also underscore that a life course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study

BACKGROUND

Numerous studies have demonstrated social inequalities in coronary heart disease using a variety of measures of social position. In this study we examine associations between persistent economic difficulties and serious coronary events. Our aim is to assess whether these associations are (i) explained by other measures of socioeconomic status, and (ii) mediated by psychosocial, behavioural and biological factors.

METHODS

The data come from 5021 middle-aged, white-collar men in the Whitehall II study. Self-reported household financial problems, measured at baseline (1985-88) and Phase 3 (1991-93), were used to construct a five-category score of persistent economic difficulties. Associations between economic difficulties and incident coronary events were determined over an average follow-up of 7 years. Other socioeconomic, psychosocial, behavioural and biological explanatory variables were obtained from the Phase 3 questionnaire and clinical examination.

RESULTS

Age-adjusted Cox regression analyses demonstrated steep gradients in the incidence of coronary events with economic difficulties. The relative hazard between the bottom and the top of the difficulties hierarchy was 2.5 (95% confidence intervals (CI) 1.2-5.2) for fatal and non-fatal myocardial infarction (MI), 2.1 (1.3-3.6) for MI plus definite angina and 2.8 (1.9-4.2) for total coronary events. Adjustment for other markers of socioeconomic position, early life factors, psychosocial work environment characteristics and health-related behaviours had little effect, while adjustment for the biological factors reduced the association between difficulties and coronary events by 16-24%.

CONCLUSION

We have demonstrated an economic difficulties gradient in coronary events in men that is independent of other markers of socioeconomic position and appears to be only partially mediated by well-known risk factors in mid-life.

Area effects on health variation over the life-course: analysis of the longitudinal study sample in England using new data on area of residence in childhood

There is a growing literature which demonstrates that (a) conditions throughout the life-course are important for health outcomes in older people and (b) "contextual" conditions in the place of residence, as well as individual characteristics influence health variations. This paper contributes to this debate by presenting results of an analysis of data from the Office for National Statistics Longitudinal Study (LS) for England and Wales. The analysis makes use of a new set of variables, which have been added to the LS, describing the social and economic conditions in the 1930s in residential areas where members of the LS sample were registered as living in 1939. The analysis focuses on people who were aged 0-16 in 1939. The health outcomes considered are death between 1981 and 1991, and for those still living, whether long-term illness was reported in the 1991 census. Regression analysis is used to examine the effects of residence in 1981, and data on the registered place of residence in 1939. The analysis shows that individual characteristics and type of area of residence in 1981 were associated with health outcomes. In addition, some variables describing socio-economic conditions in the 1930s contribute independently to the regression models (notably measures of economic deprivation and unemployment). The results suggest that conditions in residential area in early life may help to explain relatively poor health experience of populations in some parts of Britain today.

Determinantes socioeconómicos en un colectivo de familias inmigrantes

INTRODUCTION

In the last few years, the number of immigrant families in Spain has greatly increased, which has challenged healthcare services and posed new health problems.

OBJECTIVES

To determine the main social risk factors present in an immigrant population group in order to take active measures to ensure the appropriate development of children in this population.

METHODS

A descriptive cross-sectional study consisting of interviews with 179 foreign women with children under 1 year of age attending a public healthcare program.

RESULTS

Most of the women were from Latin America (80 %), 11 % were from Morocco, and the remaining women were from other countries. A total of 14.5 % had university studies. In general, the women worked in domestic service and only 36 % had the documents required to live in Spain. Fifty-five percent of the women had lost their jobs because of their pregnancy. Most of the families lived in apartments with an average of 2.3 people per room, and 88 % shared their residence with other people. Twenty-five percent of the women had their first child before the age of 18 years. Pregnancy was unwanted in 50 % of the women. Seventy-one percent of deliveries were normal, and 83 % of the women breast-fed their children. Ninety-eight percent of the children were correctly vaccinated and 95 % visited a pediatrician regularly.

CONCLUSIONS

The immigrant population is concentrated in the most disadvantaged social strata. Measures that provide adequate social support and healthcare to this population should be established to encourage the appropriate development of their children

The association between birthweight and current blood pressure: a cross‐sectional study in an Australian Aboriginal community

OBJECTIVES

To study the relationship of blood pressure to birthweight and current body mass index in a population with high rates of low birthweight (< 2.5 kg).

DESIGN

A cross-sectional population screening program conducted between 1992 and 1998, with retrospective retrieval of birthweights.

SETTING

A remote coastal Australian Aboriginal community with a high prevalence of diabetes, cardiovascular and renal disease.

PARTICIPANTS

Eighty-two per cent of the community members (1473/1805) were screened. Birthweights were available for 767 (71%) of the screened participants aged 7-43 years.

MAIN OUTCOME MEASURES

The association between birthweight and current blood pressure, accounting for current body mass index.

RESULTS

Mean birthweights were low, and 18% of children and 35% of adults had been low-birthweight babies. In children (7-17 years), blood pressure was not correlated with birthweight, but in adults there was an inverse correlation - a 1 kg increase in birthweight was associated with a 2.9 mmHg (95% CI, 0.3-5.5 mmHg) decrease in systolic blood pressure, after adjusting for age, sex and current weight. Overweight adults with low birthweight had the highest blood pressures.

CONCLUSIONS

Low birthweight is significantly associated with higher blood pressure in adult life, and the effect is amplified by higher current weight. Given the high rates of low birthweight in Aboriginal people in remote areas, and the detrimental effect of higher blood pressures on chronic diseases (currently present in epidemic proportions), interventions should focus on improving birthweights and on weight control in adolescents and adults. Special attention should be paid to children with low birthweight to avoid their becoming overweight in adult life.

Cumulative social class and mortality from various causes of adult men

STUDY OBJECTIVE

It is possible that circumstances over the lifecourse contribute to social inequalities in mortality in adulthood. The aim of this study is to assess the cumulative effect of social class at childhood and adulthood on mortality from various causes of death in young adult men.

DESIGN

The data consist of census records for all Finnish men born in 1956-60 (112,735 persons and 895,001 person years), and death records (1834 deaths) by cause of death for 1991-98.

MAIN RESULTS

Mortality from each cause of death increased from the stable non-manual group to mobile groups, and further to the stable manual group. However, mortality in the downwardly mobile group was 150% higher than in the upwardly mobile group. Furthermore, analyses show that mortality was mainly related to current adult social class, though, within each adult social class men with a manual parental background showed slightly increased mortality from cardiovascular disease and from alcohol related causes.

CONCLUSIONS

In these data the effects of adult social class were stronger than childhood class for all causes of death. It is more useful to differentiate between childhood and adulthood effects than to use a combined measure of social class to assess the contribution of social class at different stages of life on mortality.

[Socioeconomic circumstances and premature mortality from chronic diseases]

BACKGROUND AND OBJECTIVE

Our aim was to investigate the association between socioeconomic factors in childhood or adolescence and adulthood and premature mortality from various causes of death.

SUBJECTS AND METHOD

Men and women aged 25-74 years residing on May 1, 1996, in the Autonomous Community of Madrid. For the next 19 months, information on individuals who died and the cause of death were obtained from the Mortality Register. We estimated the mortality from 5 types of cancer and from 4 chronic diseases by the educational level--as an indicator of the socioeconomic circumstances in childhood or adolescence--and by income--as an indicator of the socioeconomic circumstances in adulthood.

RESULTS

When both variables were included in the analysis simultaneously, the relative mortality ratio for men with second grade first phase and lower educational level versus those with second grade, second phase and higher educational level and the relative mortality ratio for men belonging to income quartiles 3 and 4 (lowest) versus those belonging to quartiles 1 and 2 were, respectively: 1.15 (95% confidence interval 1.01-1.31) and 1.22 (1.09-1.36) for lung cancer; 1.46 (1.19-1,93) and 1.13 (0.90-1.41) for gastric cancer; 1.80 (1.32-2.44) and 1.46 (1.18-1.80) for chronic obstructive pulmonary disease; and 1.18 (0.77-1.81) and 0.68 (0.47-0.98) for diabetes mellitus. For women the relative mortality ratios were, respectively: 0.63 (0.43-0.92) and 0.72 (0.52-0.99) for lung cancer; 1.68 (0.99-2.83) and 1.17 (0.86-1.60) for gastric cancer; 0.76 (0.61-0.94) and 0.98 (0.82-1.16) for breast cancer; 1.36 (0.95-1.95) and 1.20 (0.97-1.48) for ischemic heart disease; 1.72 (1.19-2.50) and 0.93 (0.75-1.16) for stroke; and 2.23 (0.94-5.27) and 1.51 (1.02-2.25) for diabetes mellitus.

CONCLUSIONS

Premature mortality in adulthood is associated with several socioeconomic factors acting across the whole course of life. The contribution of these socioeconomic circumstances to mortality varies regarding the cause of death and gender.

Understanding the association between socioeconomic status and physical health: do negative emotions play a role?

In this article, the authors evaluate the possible roles of negative emotions and cognitions in the association between socioeconomic status (SES) and physical health, focusing on the outcomes of cardiovascular diseases and all-cause mortality. After reviewing the limited direct evidence, the authors examine indirect evidence showing that (a) SES relates to the targeted health outcomes, (b) SES relates to negative emotions and cognitions, and (c) negative emotions and cognitions relate to the targeted health outcomes. The authors present a general framework for understanding the roles of cognitive-emotional factors, suggesting that low-SES environments are stressful and reduce individuals' reserve capacity to manage stress, thereby increasing vulnerability to negative emotions and cognitions. The article concludes with suggestions for future research to better evaluate the proposed model.