The socioeconomic position of employed women, risk factors and mortality

Socioeconomic position over the life course from childhood and smoking status in mid-adulthood: results from a 25-year follow-up study

Background

It remains unclear how life course socioeconomic position (SEP) variations impact later smoking status. We aimed to investigate the associations using a novel methodology – a structured regression framework and to explore the potential underlying mechanisms.

Methods

Data were from an Australian national cohort (n = 1489). SEP was measured in childhood (aged 7–15 years), young- (aged 26–36 years) and mid-adulthood (aged 31–41 years), including highest parental occupation in childhood and self-occupation in young- and mid-adulthood. Smoking status was self-reported in mid-adulthood. Four smoking-related variables in childhood including exposure to parental smoking, smoking experimentation, self-rated importance to be a non-smoker and intention to smoke were tested as potential mediators. A structured life course modelling approach was used to select the best-fit life course model(s). The log multinomial model was used to estimate the smoking risk in mid-adulthood with never smokers as the excluded category.

Results

63.6% of participants were classified as stable non-manual occupation across the life course from childhood. The sensitive period and the accumulation model described the data equally as well as the saturated model. In the sensitive period model, compared to the non-manual group, those who had highest parental occupation of manual had a 21% lower risk of being former smokers and a 32% greater risk of being current smokers in mid-adulthood, and those who were occupied manually in mid-adulthood reported a 55% greater risk of being current smokers in mid-adulthood. In the accumulation model, compared to those who consistently reported non-manual occupations across the life course, those with manual occupations for longer had higher risk of being current smokers in mid-adulthood, with a 43% risk increase per time point in a manual occupation. Exposure to parental smoking and intention to smoke during childhood explained up to 40.2% of the excess risk of being current smokers in mid-adulthood associated with manual occupations in the sensitive period and the accumulation model.

Conclusions

Childhood, young- and mid-adulthood are all important, but SEP in childhood and mid-adulthood may be of more importance in determining mid-adulthood smoking status. Exposure to parental smoking and intention to smoke in childhood seems to moderately mediate the associations.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6483-0) contains supplementary material, which is available to authorized users.

From cradle to grave: tracking socioeconomic inequalities in mortality in a cohort of 11 868 men and women born in Uppsala, Sweden, 1915-1929

BACKGROUND

Ample evidence has shown that early-life social conditions are associated with mortality later in life. However, little attention has been given to the strength of these effects across specific age intervals from birth to old age. In this paper, we study the effect of the family's socioeconomic position and mother's marital status at birth on all-cause mortality at different age intervals in a Swedish cohort of 11 868 individuals followed across their lifespan.

METHODS

Using the Uppsala Birth Cohort Multigenerational Study, we fitted Cox regression models to estimate age-varying HRs of all-cause mortality according to mother's marital status and family's socioeconomic position.

RESULTS

Mother's marital status and family's socioeconomic position at birth were associated with higher mortality rates throughout life (HR 1.18 (95% CI 1.12 to 1.26) for unmarried mothers; 1.19 (95% CI 1.12 to 1.25) for low socioeconomic position). While the effect of family's socioeconomic position showed little variation across different age groups, the effect of marital status was stronger for infant mortality (HR 1.47 (95% CI 1.23 to 1.76); p=0.04 for heterogeneity). The results remained robust when early life and adult mediator variables were included.

CONCLUSIONS

Family's socioeconomic position and mother's marital status involve different dimensions of social stratification with independent effects on mortality throughout life. Our findings support the importance of improving early-life conditions in order to enhance healthy ageing.

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.

Socioeconomic position during childhood and physical activity during adulthood: a systematic review

OBJECTIVES

A growing body of evidence links socioeconomic position early in life and physical activity during adulthood. This systematic review aimed to summarize this evidence.

METHODS

Medline and EMBASE were searched for studies that assessed socioeconomic position before age 18 years and physical activity at age ≥18 years. Studies were rated according to three key methodological quality criteria: (1) was childhood socioeconomic position assessed prospectively? (2) Was socioeconomic position during adulthood included in the statistical analysis? (3) Was a validated instrument used to measure of physical activity?

RESULTS

Forty-two publications were included. Twenty-six (61.9 %) found a significant association between socioeconomic position early in life and physical activity during adulthood. Twenty-one studies met at least two methodological quality criteria. Among those, the proportion was higher: 15/21 (71.4 %). Associations were of weak to moderate strength, positive for physical activity during leisure time, and negative for transports and work.

CONCLUSIONS

The bulk of the evidence supports the notion that there is a life course association between socioeconomic position early in life and physical activity during adulthood. Studies using more rigorous methodology supported this conclusion more consistently.

After 50 years and 200 papers, what can the Midspan cohort studies tell us about our mortality?

OBJECTIVE

To distil the main findings from published papers on mortality in three cohorts involving over 27,000 adults, recruited in Scotland between 1965 and 1976 and followed up ever since.

METHOD

We read and summarized 48 peer-reviewed papers about all-cause and cause-specific mortality in these cohorts, published between 1978 and 2013.

RESULTS

Mortality rates were substantially higher among cigarette smokers in all social classes and both genders. Exposure to second-hand smoke was also damaging. Exposure to higher levels of black smoke pollution was associated with higher mortality. After smoking, diminished lung function was the risk factor most strongly related to higher mortality, even among never-smokers. On average, female mortality rates were much lower than male but the same risk factors were predictors of mortality. Mortality rates were highest among men whose paternal, own first and most recent jobs were manual. Specific causes of death were associated with different life stages. Upward and downward social mobility conferred intermediate mortality rates. Low childhood cognitive ability was strongly associated with low social class in adulthood and higher mortality before age 65 years. There was no evidence that daily stress contributed to higher mortality among people in lower social positions. Men in manual occupations with fathers in manual occupations, who smoked and drank >14 units of alcohol a week had cardiovascular disease mortality rates 4.5 times higher than non-manual men with non-manual fathers, who neither smoked nor drank >14 units. Men who were obese and drank >14 units of alcohol per day had a mortality rate due to liver disease 19 times that of normal or underweight non-drinkers. Among women who never smoked, mortality rates were highest in severely obese women in the lowest occupational classes.

CONCLUSION

These studies highlight the cumulative effect of adverse exposures throughout life, the complex interplay between social circumstances, culture and individual capabilities, and the damaging effects of smoking, air pollution, alcohol and obesity.

Socioprofessional trajectories and mortality in France, 1976-2002: a longitudinal follow-up of administrative data

BACKGROUND

Occupying a low socioeconomic position is associated with increased mortality risk. To disentangle this association, previous studies considered various dimensions of socioeconomic trajectories across the life course. However, they used a limited number of stages. We simultaneously examined various dimensions of the whole professional trajectory and its association with mortality.

METHODS

We used a large sample (337,706 men and 275,378 women) of the data obtained by linking individuals' annual occupation (collected in 1976-2002 from a representative panel of the French salaried population in the semipublic and private sectors) with causes of death obtained from registries. All-cause and cause-specific HRs were estimated using Cox's regression models adjusted for the occupational class at the beginning of the follow-up, the current occupational class, the transition rates between occupational categories and the duration of time spent in occupational categories.

RESULTS

An increase in the time spent in the clerk class increased men and women's cardiovascular mortality risk compared with that in the upper class (HRs=1.59 (1.14 to 2.20) and 2.65 (1.14 to 6.13) for 10 years increase, respectively, for men and women). Men with a high rate of transitions had about a 1.2-fold increased risk of all-cause and external-cause mortality compared with those without transitions during their professional life. This association was also observed for women's all-cause mortality.

CONCLUSIONS

Strong associations between professional trajectories and mortality from different causes of death were found. Long exposure to lower socioeconomic conditions was associated with increased mortality risk from various causes of death. The results also suggest gradual associations between transition rates and mortality.

Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review

Background

This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region.

Methods

Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18–65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated.

Results

A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced.

Conclusions

The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.

Life course models of socioeconomic position and cardiovascular risk factors: 1946 birth cohort

PURPOSE

To identify the life course model that best describes the association between life course socioeconomic position (SEP) and cardiovascular (CVD) risk factors (ie, body mass index [BMI], systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and glycated hemoglobin) and explore BMI across the life course as mediators of the relationship.

METHODS

The Medical Research Council National Survey of Health and Development was used to compare partial F-tests of simpler nested life course SEP models corresponding to critical period, accumulation, and social mobility models with a saturated model. Then, the chosen life course model for each CVD risk factor was adjusted for BMI at age 53 and lifetime BMI (ages 4, 26, 43, and 53 years).

RESULTS

Among women, SEP was generally associated with CVD risk factors in a cumulative manner, whereas childhood critical period was the prominent model for men. When the best-fitting SEP models were used, we found that adjustment for BMI at age 53 reduced associations for all outcomes in both genders. Further adjustment for lifetime BMI (4, 26, 43, and 53 years) did not substantially alter most associations (except for triglycerides).

CONCLUSIONS

SEP at different points across life influences CVD risk factors differently in men and women.

Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes

Socio-economic gradients in cardiovascular disease (CVD) and diabetes have been found throughout the developed world and there is some evidence to suggest that these gradients may be steeper for women. Research on social gradients in biological risk factors for CVD and diabetes has received less attention and we do not know the extent to which gradients in biomarkers vary for men and women. We examined the associations between two indicators of socio-economic position (education and household income) and biomarkers of diabetes and cardiovascular disease (CVD) for men and women in a national, population-based study of 11,247 Australian adults. Multi-level linear regression was used to assess associations between education and income and glucose tolerance, dyslipidaemia, blood pressure (BP) and waist circumference before and after adjustment for behaviours (diet, smoking, physical activity, TV viewing time, and alcohol use). Measures of glucose tolerance included fasting plasma glucose and insulin and the results of a glucose tolerance test (2 h glucose) with higher levels of each indicating poorer glucose tolerance. Triglycerides and High Density Lipoprotein (HDL) Cholesterol were used as measures of dyslipidaemia with higher levels of the former and lower levels of the later being associated with CVD risk. Lower education and low income were associated with higher levels of fasting insulin, triglycerides and waist circumference in women. Women with low education had higher systolic and diastolic BP and low income women had higher 2 h glucose and lower HDL cholesterol. With only one exception (low income and systolic BP), all of these estimates were reduced by more than 20% when behavioural risk factors were included. Men with lower education had higher fasting plasma glucose, 2 h glucose, waist circumference and systolic BP and, with the exception of waist circumference, all of these estimates were reduced when health behaviours were included in the models. While low income was associated with higher levels of 2-h glucose and triglycerides it was also associated with better biomarker profiles including lower insulin, waist circumference and diastolic BP. We conclude that low socio-economic position is more consistently associated with a worse profile of biomarkers for CVD and diabetes for women.

Associations between childhood socioeconomic position and adulthood obesity

Childhood socioeconomic position (SEP) is inversely associated with cardiovascular disease and all-cause mortality. Obesity in adulthood may be a biologic mechanism. Objectives were to systematically review literature published between 1998 and 2008 that examined associations of childhood SEP with adulthood obesity. Five databases (Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science) were searched for studies from any country, in any language. Forty-eight publications based on 30 studies were identified. In age-adjusted analyses, inverse associations were found between childhood SEP and adulthood obesity in 70% (14 of 20) of studies in females and 27% (4 of 15) in males. In studies of females showing inverse associations between childhood SEP and adulthood obesity, typical effect sizes in age-adjusted analyses for the difference in body mass index between the highest and lowest SEP were 1.0-2.0 kg/m(2); for males, effect sizes were typically 0.2-0.5 kg/m(2). Analyses adjusted for age and adult SEP showed inverse associations in 47% (8 of 17) of studies in females and 14% (2 of 14) of studies in males. When other covariates were additionally adjusted for, inverse associations were found in 4 of 12 studies in females and 2 of 8 studies in males; effect sizes were typically reduced compared with analyses adjusted for age only. In summary, the findings suggest that childhood SEP is inversely related to adulthood obesity in females and not associated in males after adjustment for age. Adulthood SEP and other obesity risk factors may be the mechanisms responsible for the observed associations between childhood SEP and adulthood obesity.

Is the "Glasgow effect" of cigarette smoking explained by socio-economic status?: a multilevel analysis

BACKGROUND

The Glasgow area has elevated levels of deprivation and is known for its poor health and associated negative health-related behaviours, which are socially patterned. Of interest is whether high smoking rates are explained by the area's socio-economic profile.

METHODS

Data on age, sex, current/previous smoking status, area deprivation, social class, education, economic activity, postcode sector, and health board region were available from Scottish Health Surveys conducted in 1995, 1998 and 2003. Multilevel logistic regression models were applied by sex, unadjusted and adjusted for age, survey year, and socio-economic factors, accounting for geographical hierarchy and missing data.

RESULTS

Compared with the rest of Scotland, men living in Greater Glasgow were 30% and women 43% more likely to smoke [odds ratio (OR) = 1.30, (95% CI = 1.08-1.56) and (OR = 1.43, CI = 1.22-1.68), respectively] before adjustment. In adjusted results, the association between living in Greater Glasgow and current smoking was attenuated [OR = 0.92, CI = 0.78-1.09 for men, and OR = 1.08, CI = 0.94-1.23 for women; results based on multiply imputed data to account for missing values remained borderline significant for women]. Accounting for individuals who had been told to give up smoking by a medical person/excluding ex-smokers did not alter results.

CONCLUSION

High levels of smoking in Greater Glasgow were attributable to its poorer socio-economic position and the strong social patterning of smoking. Tackling Glasgow's, and indeed Scotland's, poor health must involve policies to alleviate problems associated with poverty.

Do conditions in early life affect old-age mortality directly and indirectly? Evidence from 19th-century rural Sweden

Previous research has shown that the disease load experienced during the birth year, measured as the infant mortality rate, had a significant influence on old-age mortality in nineteenth-century rural Sweden. We know that children born in years with very high rates of infant mortality, due to outbreaks of smallpox or whooping cough, and who still survived to adulthood and married, faced a life length several years shorter than others. We do not know, however, whether this is a direct effect, caused by permanent physical damage leading to fatal outcomes later in life, or an indirect effect, via its influence on accumulation of wealth and obtained socio-economic status. The Scanian Demographic Database, with information on five rural parishes in southern Sweden between 1813 and 1894, contains the data needed to distinguish between the two mechanisms. First, the effects of conditions in childhood on obtained socio-economic status as an adult are analyzed, then the effects of both early-life conditions and socio-economic status at various stages of life on old-age mortality. By including random effects, we take into account possible dependencies in the data due to kinship and marriage. We find that a high disease load during the first year of life had a strong negative impact on a person's ability to acquire wealth, never before shown for a historical setting. This means that it is indeed possible that the effects of disease load in the first year of life indirectly affect mortality in old age through obtained socio-economic status. We find, however, no effects of obtained socio-economic status on old-age mortality. While the result is interesting per se, constituting a debatable issue, it means that the argument that early-life conditions indirectly affect old-age mortality is not supported. Instead, we find support for the conclusion that the effect of the disease load in early-life is direct or, in other words, that physiological damage from severe infections at the start of life leads to higher mortality at older ages. Taking random effects at family level into account did not alter this conclusion.

Social inequalities in mortality in older women cannot be explained by biological and health behavioural factors -- results from a Norwegian health survey (the HUNT Study)

AIMS

To assess mortality inequalities related to education, employment and marital status in older women, and whether educational and employment inequalities can be explained by biological, health behavioural or marital factors.

METHODS

Data, collected by questionnaires and medical examinations, on 5607 Norwegian women aged > or =70 participating in the population-based Nord-Trøndelag health study in 1995-97, were linked with information from the Death Registry at Statistics Norway at 31.12.2004. Cox regression model was used to estimate hazard ratios (HR) of all-cause and cardiovascular mortality related to educational level and previous employment, and to marital status.

RESULTS

Low level of education and never having been in paid work were significantly associated with elevated all-cause mortality. The associations remained significant upon adjustments for age, marital status, biological (systolic blood pressure, body mass index, total cholesterol) and health behavioural (smoking, physical activities) factors. Differences in cardiovascular mortality were related to low level of education and never having been in paid work, though the significant age-adjusted associations only remained significant for education upon adjustments for age, marital, biological and behavioural factors. A raised risk in cardiovascular mortality was found among women previously holding manual jobs (HR1.23, 95% CI 0.99-1.53). The graded association between education, employment and mortality showed a significant trend, except from the occupation gradient in cardiovascular mortality. Widowed and divorced women had an age-adjusted significantly raised all-cause and significant cardiovascular mortality risk compared with married women.

CONCLUSIONS

The socioeconomic and marital differences in mortality in older women could not be explained by biological and behavioural factors, and remains a public health issue.

Hidden Heroines: Lone Mothers Assessing Community Health Using Photovoice

Between 2005 and 2007, a small group of lone mothers in Moncton, New Brunswick, carried out participatory action research within a university—community agency partnership. Applying the method of photovoice, the women took pictures within their community context on topics that they considered important to their health, health promotion, and quality of life. Eight themes that emerged from the process were represented with pictures and captions and presented in numerous public venues and conferences. Themes included finances, stress, support, personal development, violence and abuse, place, and transportation. The visual images and accompanying captions bring to the public arena the voices of those who are often most affected by public policy but have little, if any, input into its creation. Nurses and other health professionals can play a critical role in working toward gender and economic justice, while accompanying marginalized populations in ways that respect their beliefs, perceptions, and experiences.

Intergenerational class mobility and cardiovascular mortality among Swedish women: a population-based register study

Class inequalities in cardiovascular disease (CVD) mortality are well documented, but the impact of intergenerational class mobility on CVD mortality among women has not been studied thoroughly. We examined whether women's mobility trajectories might contribute to CVD mortality beyond what could be expected from their childhood and adult social class position. The Swedish Work and Mortality Data Base provided childhood (1960) and adulthood (1990) social indicators. Women born 1945-59 (N=791 846) were followed up for CVD mortality 1990-2002 (2019 deaths) by means of logistic regression analysis. CVD mortality risks were estimated for 16 mobility trajectories. Gross and net impact of four childhood and four adult classes, based on occupation, were analysed for mortality in ischemic heart disease (IHD), stroke, other CVD, - and all CVD. Differences between the two most extreme trajectories were 10-fold, but the common trajectory of moving from manual to non-manual position was linked to only a slight excess mortality (OR=1.26) compared to the equally common trajectory of maintaining a stable non-manual position (reference category). Moving into adult manual class resulted in an elevated CVD mortality whatever the childhood position (ORs varied between 1.42 and 2.24). After adjustment for adult class, childhood class had some effect, in particular there was a low risk of coming from a self-employed childhood class on all outcomes (all ORs around=0.80). A woman's own education had a stronger influence on the mortality estimates than did household income. Social mobility trajectories among Swedish women are linked to their CVD mortality risk. Educational achievement seems to be a key factor for intergenerational continuity and discontinuity in class-related risk of CVD mortality among Swedish women. However, on mutual adjustment, adult class was much more closely related to CVD mortality than was class in childhood.

Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective

Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the "battered child syndrome" dramatically increased attention to-and prompted new research on-the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.

Childhood and adulthood socioeconomic position across 20 causes of death: a prospective cohort study of 800,000 Norwegian men and women

OBJECTIVE

To assess the impact of childhood and adulthood socioeconomic position (SEP) across 20 causes of death in a large population-wide sample of Norwegian men and women.

METHODS

Census data on parental occupational class from 1960 and data from the tax register on household income in 1990 were linked to the death register for 1990-2001, and 20 causes of death were studied. Relative indices of inequalities were computed. Norwegians in the age group 0-20 years in 1960 and still alive in 1990 were followed for deaths in 1990 to 2001. This follow up involved 795,324 individuals (78%) and 20,887 deaths.

MAIN RESULTS

In men most support for an effect of childhood socioeconomic position was found for stomach cancer, lung cancer, coronary heart disease, "other violent death", and all causes of death. In women similar effects were found for lung cancer, cervical cancer, coronary heart disease, chronic obstructive pulmonary disease, and all causes of death.

CONCLUSIONS

The effect of childhood socioeconomic position relative to adulthood varies by cause of death. Although there are some exceptions, the patterns in men and women are generally similar.

The Power of Personality: The Comparative Validity of Personality Traits, Socioeconomic Status, and Cognitive Ability for Predicting Important Life Outcomes

The ability of personality traits to predict important life outcomes has traditionally been questioned because of the putative small effects of personality. In this article, we compare the predictive validity of personality traits with that of socioeconomic status (SES) and cognitive ability to test the relative contribution of personality traits to predictions of three critical outcomes: mortality, divorce, and occupational attainment. Only evidence from prospective longitudinal studies was considered. In addition, an attempt was made to limit the review to studies that controlled for important background factors. Results showed that the magnitude of the effects of personality traits on mortality, divorce, and occupational attainment was indistinguishable from the effects of SES and cognitive ability on these outcomes. These results demonstrate the influence of personality traits on important life outcomes, highlight the need to more routinely incorporate measures of personality into quality of life surveys, and encourage further research about the developmental origins of personality traits and the processes by which these traits influence diverse life outcomes.

Accumulation of adverse socioeconomic position over the entire life course and the risk of myocardial infarction among men and women: results from the Stockholm Heart Epidemiology Program (SHEEP)

BACKGROUND

Accumulation of adverse socioeconomic position over the life course is assumed to increase the risk of myocardial infarction.

OBJECTIVE

To analyse in detail whether the accumulation of adverse socioeconomic position over the life course increases the risk of myocardial infarction, using yearly information on individual socioeconomic position from birth to disease onset.

DESIGN

Case-control study of risk factors for incident myocardial infarction (Stockholm Heart Epidemiology Program).

SETTING

All Swedish citizens born during 1922-49 and living in Stockholm County during 1992-4.

PARTICIPANTS

550 female and 1204 male patients and 777 female and 1538 male controls. Every year in manual work was added to calculate a proportion of the whole life course spent in adverse socioeconomic position.

RESULTS

With increasing proportion of life spent in adverse socioeconomic position, we found an increasing risk of myocardial infarction. The relative risk of myocardial infarction was 2.36 (95% confidence interval (CI) = 1.79 to 3.11) for men and 2.54 (95% CI = 1.70 to 3.78) for women who, over the entire life course, had always been in adverse socioeconomic position compared with those who had never been in adversity. We also found a strong increase in risk from being in adversity for only a few years, indicating important selection processes.

CONCLUSIONS

Accumulated experience of adverse socioeconomic position over the entire life course increases the risk of myocardial infarction for men and women, but it is not a pure accumulation process as "how" and "when" the accumulation occurs also seems to have a role. The accumulation effect is partly mediated by the acquisition of health-damaging experiences.

Socio-economic position at three points in life in association with type 2 diabetes and impaired glucose tolerance in middle-aged Swedish men and women

BACKGROUND

It has been suggested that low socio-economic position (SEP) during childhood and adolescence predicts risk of adult type 2 diabetes. We investigated the associations between type 2 diabetes and childhood SEP (fathers' occupational position), participants' education and adult SEP (participants' occupational position). To determine possible independent associations between early SEP (fathers' occupational position and participants' education) and disease, we adjusted for adult SEP and factors present in adult life associated with type 2 diabetes.

METHODS

This cross-sectional study comprised 3128 men and 4821 women aged 35-56 years. All subjects have gone through a health examination and answered a questionnaire on lifestyle factors. At the health centre, an oral glucose tolerance test was administered and identified 55 men and 52 women with previously undiagnosed type 2 diabetes. Relative risks (RRs) with 95% CIs were calculated in multiple logistic regression analyses.

RESULTS

The age-adjusted RRs of type 2 diabetes if having a father with middle occupational position were 2.3 [Confidence interval (CI:1.0-5.1) for women and, 2.0 (CI:0.7-5.6) for men]. Moreover, low education was associated with type 2 diabetes in women, RR = 2.5 (CI:1.2-4.9). Low occupational position in adulthood was associated with type 2 diabetes in women, RR = 2.7 (CI:1.3-5.9) and men, RR = 2.9 (CI:1.5-5.7). The associations between early SEP and type 2 diabetes disappeared after adjustment for adult SEP and factors associated with type 2 diabetes.

CONCLUSION

The association between type 2 diabetes and low SEP during childhood and adolescence in middle-aged Swedish subjects disappeared after adjustment for adult SEP and adult risk factors of diabetes.

Early-life and adult socioeconomic status and inflammatory risk markers in adulthood

BACKGROUND

Associations between childhood and adult socioeconomic status (SES) and adult levels of inflammatory markers (C-reactive protein [CRP], fibrinogen, white blood cell count [WBC], and von Willebrand factor [vWF]) were examined in the Atherosclerosis Risk in Communities (ARIC) Study cohort.

METHODS

A total of 12,681 white and African-American participants provided information on SES (via education and social class) and place of residence in childhood and adulthood. Residences were linked to census data for neighborhood SES information. Multiple imputation was used to impute missing data. Hierarchical and linear regression were used to estimate the effects of SES and possible mediation by adult cardiovascular disease (CVD) risk factors.

FINDINGS

Low childhood social class and education were associated with elevated levels of CRP, fibrinogen, WBC, and vWF (increments of 17%, 2%, 4% and 3% for lowest versus highest education in childhood, respectively) among whites. Findings were less consistent among African-Americans. Adult SES was more strongly associated with inflammation than childhood SES. Individual-level SES measures were more consistently associated with inflammation than neighborhood-level measures. Fibrinogen and WBC showed the most consistent associations with SES; the largest changes in inflammation by SES were observed for CRP. Covariate adjustment strongly attenuated these associations. Mediation of the SES-inflammation associations by BMI, smoking and HDL cholesterol (HDL-C) are suggested by these data.

CONCLUSION

Low individual- and neighborhood-level SES in childhood and adulthood are associated with modest increments in adult inflammatory burden. These associations may operate through the influence of low SES on traditional CVD risk factors, especially BMI, smoking and HDL-C.

Lifelong socioeconomic trajectory and premature mortality (35-65 years) in France: findings from the GAZEL Cohort Study

BACKGROUND

Studies conducted in the UK and Scandinavia show an inverse association between lifetime socioeconomic position and adult mortality. However, there are virtually no data from other countries and few investigations have examined non-cardiovascular mortality in men and women.

METHODS

Lifelong socioeconomic trajectories (father's occupation, own occupation in young adulthood and in mid-life) and premature (< or = 65 years) mortality (all-cause, smoking-related cancer, diseases of the circulatory system and external causes) in the French GAZEL Cohort Study (14,972 men and 5,598 women, followed up between 1990 and 2004) were studied. Hazard ratios (HRs) were estimated using Cox's regression models adjusted for age, marital status, tobacco smoking, alcohol consumption, body mass index, and fruit and vegetable consumption.

RESULTS

Men and women who experienced lifelong disadvantage or downward intergenerational mobility were at high risk of dying prematurely compared with those with a favourable trajectory (age-adjusted HRs for all-cause mortality: cumulative disadvantage: HR 1.61, 95% confidence interval (CI) 1.26 to 2.06 in men and HR 1.95, 95% CI 1.10 to 3.47 in women; downward mobility: HR 1.87, 95% CI 1.35 to 2.58 in men and HR 2.05, 95% CI 1.12 to 3.75 in women). Associations were strongest for mortality due to chronic diseases (smoking-related cancers and diseases of the circulatory system). These associations were partly explained by marital status, body mass index, alcohol consumption, cigarette smoking, and fruit and vegetable consumption.

CONCLUSIONS

In France, where the leading cause of premature death is cancer, lifelong socioeconomic position is associated with the risk of dying before the age of 65 years. Adult factors seem more relevant than childhood socioeconomic circumstances.

A life-course approach to measuring socioeconomic position in population health surveillance systems

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring socioeconomic inequalities in health over time. Life-course measures are an innovative way to supplement other SEP indicators in surveillance systems. A literature review examined the indicators of early-life SEP that could potentially be used in population health surveillance systems. The criteria of validity, relevance, reliability and deconstruction were used to determine the value of potential indicators. Early-life SEP indicators used in cross-sectional and longitudinal studies included education level, income, occupation, living conditions, family structure and residential mobility. Indicators of early-life SEP should be used in routine population health surveillance to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations. However, these indicators need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating.

Similar support for three different life course socioeconomic models on predicting premature cardiovascular mortality and all-cause mortality

Background

There are at least three broad conceptual models for the impact of the social environment on adult disease: the critical period, social mobility, and cumulative life course models. Several studies have shown an association between each of these models and mortality. However, few studies have investigated the importance of the different models within the same setting and none has been performed in samples of the whole population. The purpose of the present study was to study the relation between socioeconomic position (SEP) and mortality using different conceptual models in the whole population of Scania.

Methods

In the present investigation we use socioeconomic information on all men (N = 48,909) and women (N = 47,688) born between 1945 and 1950, alive on January, 1^st,1990, and living in the Region of Scania, in Sweden. Focusing on three specific life periods (i.e., ages 10–15, 30–35 and 40–45), we examined the association between SEP and the 12-year risk of premature cardiovascular mortality and all-cause mortality.

Results

There was a strong relation between SEP and mortality among those inside the workforce, irrespective of the conceptual model used. There was a clear upward trend in the mortality hazard rate ratios (HRR) with accumulated exposure to manual SEP in both men (p for trend < 0.001 for both cardiovascular and all-cause mortality) and women (p for trend = 0.01 for cardiovascular mortality) and (p for trend = 0.003 for all-cause mortality). Inter- and intragenerational downward social mobility was associated with an increased mortality risk. When applying similar conceptual models based on workforce participation, it was shown that mortality was affected by the accumulated exposure to being outside the workforce.

Conclusion

There was a strong relation between SEP and cardiovascular and all-cause mortality, irrespective of the conceptual model used. The critical period, social mobility, and cumulative life course models, showed the same fit to the data. That is, one model could not be pointed out as "the best" model and even in this large unselected sample it was not possible to adjudicate which theories best describe the links between life course SEP and mortality risk.

Relationship between childhood socio-economic position and mortality risk in adult males of the Korea Labour and Income Panel Study (KLIPS)

OBJECTIVES

Evidence on the relationship between childhood socio-economic position (SEP) and adult mortality risk is mounting, but is sparse in regions outside Europe and North America. The present study aimed to examine this relationship in South Korea.

STUDY DESIGN

Prospective cohort study.

METHODS

First-round data from the Korea Labour and Income Panel Study were linked to data on mortality. Childhood SEP indicators were father's education, own education, father's occupational class at age 14, own first occupational class after age 15, birth place, and residence at age 14. Adulthood SEP indicators included current occupational class, family income, perceived economic hardships, and current residence.

RESULTS

Mortality differentials according to current occupational class, economic hardship and current residence were statistically significant. Mortality risk tended to increase as household income decreased. For all childhood SEP indicators, inverse relationships between childhood SEP and mortality risk were found. These inverse relationships were attenuated but did not disappear with adjustment for each adulthood SEP indicator. However, the statistically significant association between childhood SEP and mortality risk did not persist after full adjustment for four adulthood SEP indicators.

CONCLUSIONS

Both early- and later-life markers of SEP were related to an increased risk of death in South Korea. Future studies need to examine the relationship between childhood SEP and cause-specific mortality.

Accuracy of adults' recall of childhood social class: findings from the Aberdeen children of the 1950s study

BACKGROUND

Although adult reported childhood socioeconomic position has been related to health outcomes in many studies, little is known about the validity of such distantly recalled information. This study evaluated the validity of adults' reports of childhood paternal social class.

METHODS

Data are drawn from the Aberdeen children of the 1950s study, a cohort of 12 150 people born in Aberdeen (Scotland) who took part in a school based survey in 1962. In this survey, two indices of early life socioeconomic position were collected: occupational social class at birth (abstracted from maternity records) and occupational social class in childhood (reported during the 1962 survey by the study participants). Between 2000 and 2003, a questionnaire was mailed to traced middle aged cohort members in which inquiries were made about their fathers' occupation when they were aged 12 years. The level of agreement between these reports and prospectively collected data on occupational social class was assessed.

RESULTS

In total, 7183 (63.7%) persons responded to the mid-life questionnaire. Agreement was moderate between social class of father recalled in adulthood and that measured in early life (kappa statistics were 0.47 for social class measured at birth, and 0.56 for social class reported by the child). The relation of occupational social class to birth weight and childhood intelligence was in the expected directions, although weaker for adults' reports in comparison with prospectively gathered data.

CONCLUSIONS

In studies of adult disease aetiology, associations between childhood social class based on adult recall of parental occupation and health outcomes are likely to underestimate real effects.

Adverse socioeconomic position across the lifecourse increases coronary heart disease risk cumulatively: findings from the British women's heart and health study

OBJECTIVE

To examine the associations of childhood and adult measurements of socioeconomic position with coronary heart disease (CHD) risk.

METHODS

Cross sectional and prospective analysis of a cohort of 4286 British women who were aged 60-79 years at baseline. Among these women there were 694 prevalent cases of CHD and 182 new incident cases among 13 217 person years of follow up of women who were free of CHD at baseline.

RESULTS

All measurements of socioeconomic position were associated with increased prevalent and incident CHD in simple age adjusted models. There was a cumulative effect, on prevalent and incident CHD, of socioeconomic position across the lifecourse. This effect was not fully explained by adult CHD risk factors. The adjusted odds ratio of prevalent CHD for each additional adverse (out of 10) lifecourse socioeconomic indicator was 1.11 (95% confidence interval: 1.06, 1.16). The magnitude of the effect of lifecourse socioeconomic position was the same in women who were lifelong non-smokers as in those who had been or were smokers.

CONCLUSION

Adverse socioeconomic position across the lifecourse increases CHD risk cumulatively and this effect is not fully explained by adult risk factors. Specifically in this cohort of women cigarette smoking does not seem to explain the association between adverse lifecourse socioeconomic position and CHD risk.

Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood

PURPOSE

Adverse socioeconomic circumstances in childhood may confer a greater risk for adult cardiovascular disease (CVD). The purpose of this review is to systematically evaluate evidence for an association between socioeconomic circumstances during childhood and specific CVD subtypes, independent of adult socioeconomic conditions.

METHODS

We systematically retrieved individual-level studies of morbidity and mortality from CVD and specific CVD subtypes linked to early life influences, including coronary heart disease (CHD), ischemic and hemorrhagic stroke, peripheral vascular disease, markers of atherosclerosis (carotid intima-media thickness and stenosis), and rheumatic heart disease. Indicators of socioeconomic position in childhood varied, although most studies relied on father's occupation.

RESULTS

We located 40 studies (24 prospective, 11 case-control, and 5 cross-sectional) reported in 50 publications. Thirty-one studies (19 prospective, 7 case-control, and all 5 cross-sectional) found a robust inverse association between childhood circumstances and CVD risk, although findings sometimes varied among specific outcomes, socioeconomic measures, and sex. Case-control studies reported mixed results. The association was stronger for stroke and, in particular, hemorrhagic stroke, than for CHD. Childhood socioeconomic conditions remained important predictors of CVD, even in younger cohorts.

CONCLUSION

Childhood and adulthood socioeconomic circumstances are important determinants of CVD risk. The specific contribution of childhood and adulthood characteristics varies across different CVD subtypes. Disease-specific mechanisms are likely to explain the childhood origins of these adult health inequalities.

Whose socioeconomic status influences a woman's obesity risk: her mother's, her father's, or her own?

BACKGROUND

Evidence on the relative influence of childhood vs adulthood socioeconomic conditions on obesity risk is limited and equivocal. The objective of this study was to investigate associations of several indicators of mothers', fathers', and own socioeconomic status, and intergenerational social mobility, with body mass index (BMI) and weight change in young women.

METHODS

This population-based cohort study used survey data provided by 8756 women in the young cohort (aged 18-23 years at baseline) of the Australian Longitudinal Study on Women's Health. In 1996 and 2000, women completed mailed surveys in which they reported their height and weight, and their own, mother's, and father's education and occupation.

RESULTS

Multiple linear regression models showed that both childhood and adulthood socioeconomic status were associated with women's BMI and weight change, generally in the hypothesized (inverse) direction, but the associations varied according to socioeconomic status and weight indicator. Social mobility was associated with BMI (based on father's socioeconomic status) and weight change (based on mother's socioeconomic status), but results were slightly less consistent.

CONCLUSIONS

Results suggest lasting effects of childhood socioeconomic status on young women's weight status, independent of adult socioeconomic status, although the effect may be attenuated among those who are upwardly socially mobile. While the mechanisms underlying these associations require further investigation, public health strategies aimed at preventing obesity may need to target families of low socioeconomic status early in children's lives.

Keynote Presentation at the Eight International Congress of Behavioral Medicine: the Pittsburgh common cold studies: psychosocial predictors of susceptibility to respiratory infectious illness

This article provides a selected overview of 20 years of research on the role of psychosocial factors in susceptibility to upper respiratory infections. We present evidence from our laboratory that psychological stress is associated with increased risk for developing respiratory illness for persons intentionally exposed to a common cold virus, that the longer the duration of the stressor the greater the risk, and that stress association with susceptibility may be mediated by stress-induced disruption of the regulation of proinflammatory cytokines. We further provide evidence that social relationships (social integration and social support) are also associated with risk for respiratory illness: Social integration is associated with reduced risk irrespective of stress level and social support protects persons from the pathogenic influences of stress. Finally, we report recent evidence that lower levels of early childhood socio-economic status (SES) are associated with greater risk of viral-induced illness during adulthood, independent of adult SES.

Childhood socioeconomic position, educational attainment, and adult cardiovascular risk factors: the Aberdeen children of the 1950s cohort study

OBJECTIVES

We assessed the associations of childhood socioeconomic position with cardiovascular disease risk factors (smoking, binge alcohol drinking, and being overweight) and examined the roles of educational attainment and cognitive functioning in these associations.

METHODS

Data were derived from a cohort study involving 7184 individuals who were born in Aberdeen, Scotland, between 1950 and 1956; had detailed records on perinatal characteristics, childhood anthropometry, and cognitive functioning; and responded to a mailed questionnaire when they were aged 45 to 52 years.

RESULTS

Strong graded associations existed between social class at birth and smoking, binge drinking, and being overweight. Adjustment for educational attainment completely attenuated these associations. However, after control for adult social class, adult income and other potential confounding or mediating factors, some association remained.

CONCLUSIONS

Educational attainment is an important mediating factor in the relation between socioeconomic adversity in childhood and smoking, binge drinking, and being overweight in adulthood.

Lifetime socioeconomic position and twins' health: an analysis of 308 pairs of United States women twins

BACKGROUND

Important controversies exist about the extent to which people's health status as adults is shaped by their living conditions in early life compared to adulthood. These debates have important policy implications, and one obstacle to resolving them is the relative lack of sufficient high-quality data on childhood and adult socioeconomic position and adult health status. We accordingly compared the health status among monozygotic and dizygotic women twin pairs who lived together through childhood (until at least age 14) and subsequently were discordant or concordant on adult socioeconomic position. This comparison permitted us to ascertain the additional impact of adult experiences on adult health in a population matched on early life experiences.

METHODS AND FINDINGS

Our study employed data from a cross-sectional survey and physical examinations of twins in a population-based twin registry, the Kaiser Permanente Women Twins Study Examination II, conducted in 1989 to 1990 in Oakland, California, United States. The study population was composed of 308 women twin pairs (58% monozygotic, 42% dizygotic); data were obtained on childhood and adult socioeconomic position and on blood pressure, cholesterol, post-load glucose, body mass index, waist-to-hip ratio, physical activity, and self-rated health. Health outcomes among adult women twin pairs who lived together through childhood varied by their subsequent adult occupational class. Cardiovascular factors overall differed more among monozygotic twin pairs that were discordant compared to concordant on occupational class. Moreover, among the monozygotic twins discordant on adult occupational class, the working class twin fared worse and, compared to her professional twin, on average had significantly higher systolic blood pressure (mean matched difference = 4.54 mm Hg; 95% confidence interval [CI], 0.10-8.97), diastolic blood pressure (mean matched difference = 3.80 mm Hg; 95% CI, 0.44-7.17), and low-density lipoprotein cholesterol (mean matched difference = 7.82 mg/dl; 95% CI, 1.07-14.57). By contrast, no such differences were evident for analyses based on educational attainment, which does not capture post-education socioeconomic position.

CONCLUSION

These results provide novel evidence that lifetime socioeconomic position influences adult health and highlight the utility of studying social plus biological aspects of twinship.

Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort

OBJECTIVES

We sought to establish whether women's childhood socioeconomic position influenced their risk of mortality separately from the effects of adult socioeconomic position.

METHODS

We examined 11855 British women aged 14 to 49 years, with mortality follow-up over a 45-year period.

RESULTS

Trends according to childhood social class were observed for all-cause mortality, circulatory disease, coronary heart disease, respiratory disease, chronic obstructive pulmonary disease, stroke, lung cancer, and stomach cancer, with higher death rates among members of unskilled manual groups. Associations attenuated after adjustment for adult social class, smoking, and body mass index. No trend was seen for breast cancer or accidents and violence. Adverse social conditions in both childhood and adulthood were associated with higher death rates from coronary heart disease and respiratory disease. Stomach cancer was influenced primarily by childhood conditions and lung cancer by factors in adult life.

CONCLUSIONS

Socioeconomic position in childhood was associated with adult mortality in a large sample of British women.

Labor market trajectories and health: a four-year follow-up study of initially fixed-term employees

With the growth of atypical employment, there is increasing concern about the potential health-damaging effects of unstable employment. This prospective study of Finnish public-sector employees in 1998-2002 examined labor market trajectories and changes in health. At entry, all participants had a fixed-term job contract. Trajectories were measured by exposure to unstable employment during follow-up, destination employment status at the end of follow-up, and the way in which these elements were combined. Nonoptimal self-rated health at baseline was associated with high exposure to unstable employment and unemployment as the destination. After adjustment for health and psychological distress at baseline, a trajectory with stable employment as the destination was associated with a decreased risk of psychological distress at follow-up (odds ratio = 0.68, 95% confidence interval: 0.46, 0.98), whereas a trajectory toward the labor market periphery was related to increased risk of nonoptimal health (odds ratio = 2.54, 95% confidence interval: 1.47, 4.39) when compared with remaining in fixed-term employment. A significant dose-response relation was seen between the measure combining exposure to instability with destination employment status and nonoptimal health. This longitudinal study provides evidence of health-related selection into employment trajectories and suggests that the trajectories themselves carry different health risks.

Cardiovascular risk at age 53 years in relation to the menopause transition and use of hormone replacement therapy: a prospective British birth cohort study

OBJECTIVES

To investigate cardiovascular risk factors and changes in risk factor levels in relation to menopausal stage, hysterectomy status and hormone replacement therapy use in a cohort of women aged 53 years with prospective data on smoking, lifetime socio-economic circumstances, and blood pressure and obesity at age 43 years.

DESIGN

A prospective study.

SETTING

England, Scotland and Wales.

POPULATION

A cohort of women from the Medical Research Council Survey of Health and Development.

METHODS

A total of 1303 women, aged 53 years, from a UK birth cohort study with measures of cardiovascular risk factors were classified by five menopausal status groups (premenopause, perimenopause, postmenopause, hysterectomy and hormone replacement therapy user). Body mass index, glycosolated haemoglobin, blood pressure, high density lipoprotein, low density lipoprotein and total cholesterol measurements were taken, and analysed within the groups taking confounding variables into account. Changes in body mass index and blood pressure measurement in the same women obtained when 43 years of age were also compared.

MAIN OUTCOME MEASURES

Body mass index, glycosolated haemoglobin, blood pressure, high density lipoprotein, low density lipoprotein and total cholesterol.

RESULTS

At 53 years, body mass index, waist circumference, total and low density lipoprotein cholesterol, and glycosolated haemoglobin (HbA1c) varied by menopausal status group, but blood pressure did not. Levels of total cholesterol and HbA1c increased across the natural menopause transition, before and after adjustment for body mass index, smoking and lifetime socio-economic circumstances. After adjustment for confounders, levels of risk factors for hysterectomised women were similar to those of naturally postmenopausal women. Women on hormone replacement therapy had lower levels of total and low density lipoprotein cholesterol, HbA1c, and were less obese than postmenopausal women. The lower obesity levels were partly due to these women already being less obese at age 43 years.

CONCLUSIONS

This study showed that naturally postmenopausal or hysterectomised women had higher levels of metabolic risk factors compared with premenopausal or perimenopausal women of the same age. The long term stability of these differences and their translation into variations in incidence of cardiovascular disease remain to be seen. The lower levels of metabolic risk factors for women on hormone replacement therapy may protect against future cardiovascular disease or may be overwhelmed by other adverse, and as yet unknown, effects of hormone replacement therapy.

Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review

Background

A relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD). More recently, researchers have proposed various life course SES hypotheses, which posit that the combination, accumulation, and/or interactions of different environments and experiences throughout life can affect adult risk of CVD. Different life course designs have been utilized to examine the impact of SES throughout the life course. This systematic review describes the four most common life course hypotheses, categorizes the studies that have examined the associations between life course SES and CVD according to their life course design, discusses the strengths and weaknesses of the different designs, and summarizes the studies' findings.

Methods

This research reviewed 49 observational studies in the biomedical literature that included socioeconomic measures at a time other than adulthood as independent variables, and assessed subclinical CHD, incident CVD morbidity and/or mortality, and/or the prevalence of traditional CVD risk factors as their outcomes. Studies were categorized into four groups based upon life course design and analytic approach. The study authors' conclusions and statistical tests were considered in summarizing study results.

Results

Study results suggest that low SES throughout the life course modestly impacts CVD risk factors and CVD risk. Specifically, studies reviewed provided moderate support for the role of low early-life SES and elevated levels of CVD risk factors and CVD morbidity and mortality, little support for a unique influence of social mobility on CVD, and consistent support for the detrimental impact of the accumulation of negative SES experiences/conditions across the life course on CVD risk.

Conclusions

While the basic life course SES study designs have various methodologic and conceptual limitations, they provide an important approach from which to examine the influence of social factors on CVD development. Some limitations may be addressed through the analysis of study cohorts followed from childhood, the evaluation of CVD risk factors in early and middle adulthood, and the use of multiple SES measures and multiple life course analysis approaches in each life course study.

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

BACKGROUND

Our objective was to investigate the contribution of childhood and adult socioeconomic position (SEP) to adult obesity and smoking behaviour, in particular to establish the role of childhood circumstances across different studies in Europe and the US.

METHODS

Seven population-based surveys in six Western countries (Britain, Denmark, Finland, Netherlands, Sweden, US) were examined, with participants aged 30-50 yr and born between 1910 and 1960. Adult smoking was analysed using three outcomes (ever, current, or ex-) and adult obesity was defined as body mass index (kg/m(2)) > or =30.

RESULTS

A strong effect of adult social position was observed for smoking outcomes and obesity. For example, manual SEP in adulthood increased the risk of ever smoking (adjusted odds ratio (OR) 1.47-2.00 for men; 0.94-1.81 for women), and obesity (adjusted OR 1.06-2.24 for men, 1.21-3.26 for women). In most studies, childhood position was not associated with ever-smoking. For current smoking, manual childhood position was associated among women (adjusted OR 1.09-1.54), but no consistent pattern was seen for men. For ex-smoking, manual childhood origins lowered the chance of quitting among women (adjusted OR 0.64-0.81) except in the US (OR = 1.17); among men this association was seen in fewer studies (adjusted OR 0.74-1.09). For obesity, manual origins increased the risk for women (adjusted OR 0.96-2.50); effects were weaker among men but mostly in the same direction (adjusted OR 0.79-1.42).

CONCLUSIONS

As expected, adult SEP was an important influence on smoking behaviour and obesity. In addition, factors related to disadvantaged social origins appeared to increase the risk of obesity and reduce the probability of quitting smoking in adulthood, particularly in women.

Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study

PURPOSE

While socioeconomic inequalities in cardiovascular disease have been observed in most industrialized countries, available information in Israel centers on ethnic variations and the role of education has yet to be investigated. This study examines educational differentials in cardiovascular mortality in Israel for both men and women aged 45 to 69 and 70 to 89 years.

METHODS

Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 152,150 individuals and the number of cardiovascular deaths was 14,651. Educational differentials were assessed for mortality of diseases of the circulatory system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases, and sudden death.

RESULTS

Substantial mortality differentials were found among individuals aged 45 to 69 years, with larger inequalities among women. The age-adjusted relative risk for mortality of cardiovascular diseases among those with elementary education (< or =8 years) compared with those with high education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95% CI: 1.76-2.41) for women. Differentials among the elderly were markedly narrower than those for younger adults. Similar trends were observed for mortality of subgroups of causes including cerebrovascular diseases and ischemic heart diseases. Educational differentials were not affected by adjustment for ethnic origin and car ownership.

CONCLUSIONS

Those with 8 years of education or less suffer higher risk of cardiovascular mortality compared with adults with 13 or more years of education. Young, less educated women are more vulnerable, and health and social policies oriented towards this group are needed.

Association between childhood socioeconomic status and coronary heart disease risk among postmenopausal women: findings from the British Women's Heart and Health Study

OBJECTIVES

We assessed the association between childhood socioeconomic status (SES) and coronary heart disease among postmenopausal women.

METHODS

We conducted a cross-sectional analysis of 3444 women aged 60 to 79 years.

RESULTS

There was an independent linear association between childhood and adult SES and coronary heart disease. The association between childhood SES and coronary heart disease was attenuated when we adjusted for insulin resistance syndrome, adult smoking, physical activity, biomarkers of childhood nutrition, and passive smoking.

CONCLUSIONS

The association between adverse childhood SES and coronary heart disease is in part mediated through insulin resistance, which may be influenced by poor childhood nutrition, and in part through the association between childhood SES and adult behavioral risk factors.

Childhood socioeconomic status and host resistance to infectious illness in adulthood

OBJECTIVE

Low childhood socioeconomic status (SES) is a risk factor for adult morbidity and mortality primarily attributable to cardiovascular disease. Here, we examine whether childhood SES is associated with adult host resistance to infectious illness, and whether the effect is limited to a critical period of low SES exposure, can be undone by changes in childhood SES, and is explained by adult SES.

METHODS

Three hundred thirty-four healthy volunteers reported their own and their parents' level of education and the ages during their childhood when their parents owned their homes. Volunteers' current home ownership was recorded from real estate records. Subsequently, they were given nasal drops containing 1 of 2 rhinoviruses and were monitored in quarantine for infection and signs/symptoms of a common cold.

RESULTS

For both viruses, susceptibility to colds decreased with the number of childhood years during which their parents owned their home (odds ratios by tertiles adjusted for demographics, body mass, season, and prechallenge viral-specific immunity were 3.7 for fewest years, 2.6 and 1). This decreased risk was attributable to both lower risk of infection and lower risk of illness in infected subjects. Moreover, those whose parents did not own their home during their early life but did during adolescence were at the same increased risk as those whose parents never owned their home. These associations were independent of parent education level, adult education and home ownership, and personality characteristics.

CONCLUSIONS

A marker of low income and wealth during early childhood is associated with decreased resistance to upper respiratory infections in adulthood. Higher risk is not ameliorated by higher SES during adolescence and is independent of adult SES.

Association between self-reported childhood socioeconomic position and adult lung function: findings from the British Women's Heart and Health Study

BACKGROUND

A study was undertaken to assess the associations between indicators of early life socioeconomic position and lung function in older adulthood.

METHODS

The associations of self-reported indicators of childhood socioeconomic position with adult lung function (forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and forced expiratory flow rate during mid expiration (FEF(25-75)), all measured using standard procedures) were assessed in a cross sectional study of 3641 British women aged 60-79 years.

RESULTS

In confounder adjusted analyses, each individual indicator of childhood circumstances was inversely associated with each measure of lung function. In the fully adjusted models (including mutual adjustment for each of the other indicators of childhood socioeconomic circumstances), only childhood occupational social class and access to a car were associated with lung function in adulthood. However, there were strong linear trends of worsening lung function with greater numbers of indicators of childhood poverty (all p values <0.001).

CONCLUSIONS

Childhood poverty is associated with poorer lung function in women aged 60-79 years. Adverse childhood circumstances that affect both lung growth and development and cardiovascular disease in later life may explain some of the well known associations between poor lung function and cardiovascular disease, or lung function may be an important mediating factor in this association.

Effects of childhood socioeconomic circumstances on persistent smoking

OBJECTIVES

We investigated whether socioeconomic circumstances at different life stages influence persistent smoking.

METHODS

We followed a British birth cohort (all births between March 3 and 9, 1958) for 41 years to examine the influence of childhood and adulthood socioeconomic position on persistent smoking in adulthood (n = 6541).

RESULTS

Persistent smoking (19% of participants, n = 1216) showed strong social gradients with both childhood and adulthood socioeconomic measures. Among men, the association with childhood socioeconomic circumstances was no longer significant after we adjusted for adulthood socioeconomic circumstances; however, among women, the adjusted odds of persistent smoking increased by 8% for each unit increase across a 16-point childhood score.

CONCLUSIONS

Childhood socioeconomic circumstances predicted persistent smoking among women in our cohort, a finding that highlights the importance of influences on the development of persistent smoking across the life course.

Central and total obesity in middle aged men and women in relation to lifetime socioeconomic status: evidence from a national birth cohort

STUDY OBJECTIVE

To investigate the influence of social class in childhood, young adulthood and middle age, and intergenerational mobility, on adult central and total obesity.

DESIGN

Prospective, population based, birth cohort study.

PARTICIPANTS AND SETTING

1472 men and 1563 women born in 1946 in England, Scotland, and Wales.

OUTCOME MEASURES

Waist-hip ratio, waist-height ratio, waist circumference, and body mass index at age 53 years.

MAIN RESULTS

Father's social class at participant's age 4 years was inversely associated with adult central and total obesity at age 53 years in men and women. For example, the mean difference of waist-hip ratio (95% confidence intervals) between father's professional social class I and unskilled manual social class V was 2.6% (0.7 to 4.6) for men and 2.5% (0.5 to 4.4) for women. The effect of father's social class remained after adjustment for participant's own social class in young adulthood and middle age. Both adult social classes were inversely related to obesity among women, but not men, after adjustment for childhood circumstances. Upwardly mobile men and women were less obese than participants remaining in their father's social class and their levels of obesity tended to be between the class they left and the class they joined.

CONCLUSIONS

The effect of social class on adult obesity differed according to the stage in the life course at which social class was measured, and gender. Childhood circumstances had enduring influences on adult obesity, although our results on intergenerational mobility indicate potential reversibility of early life disadvantage.

Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective

Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the "battered child syndrome" dramatically increased attention to-and prompted new research on-the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.

Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study

OBJECTIVE

To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood.

DESIGN

Nationally representative birth cohort study with prospective information on socioeconomic conditions.

SETTING

England, Scotland, and Wales. STUDY MEMBERS: 2132 women and 2322 men born in March 1946 and followed until age 55 years.

MAIN OUTCOME MEASURES

Deaths between 26 and 54 years of age notified by the NHS central register.

RESULTS

Study members whose father's occupation was manual at age 4, or who lived in the worst housing, or who received the poorest care in childhood had double the death rate during adulthood of those living in the best socioeconomic conditions. All indicators of socioeconomic disadvantage at age 26 years, particularly lack of home ownership, were associated with a higher death rate. Manual origins and poor care in childhood remained associated with mortality even after adjusting for social class in adulthood or home ownership. The hazard ratio was 2.6 (95% confidence interval 1.5 to 4.4) for those living in manual households as children and as adults compared with those living in non-manual households at both life stages. The hazard ratio for those from manual origins who did not own their own home at age 26 years was 4.9 (2.3 to 10.5) compared with those from non-manual origins who were home owners.

CONCLUSIONS

Socioeconomic conditions in childhood as well as early adulthood have strongly influenced the survival of British people born in the immediate post war era.

Socioeconomic position in childhood and adulthood and insulin resistance: cross sectional survey using data from British women's heart and health study

OBJECTIVE

To assess the associations between childhood and adulthood social class and insulin resistance.

DESIGN

Cross sectional survey.

SETTING

23 towns across England, Scotland, and Wales.

PARTICIPANTS

4286 women aged 60-79 years.

MAIN OUTCOME MEASURES

Insulin resistance and other cardiovascular disease risk factors.

RESULTS

Belonging to manual social classes in childhood and in adulthood was independently associated with increased insulin resistance, dyslipidaemia, and general obesity. The association between childhood social class and insulin resistance was stronger than that for adult social class. The effect, on insulin resistance and other risk factors, of belonging to a manual social class at either stage in the life course was cumulative, with no evidence of an interaction between childhood and adult social class. Women who were in manual social classes in childhood remained at increased risk of insulin resistance, dyslipidaemia, and obesity--even if they moved into non-manual social classes in adulthood--compared with women who were in non-manual social classes at both stages.

CONCLUSIONS

Adverse social circumstances in childhood, as well as adulthood, are strongly and independently associated with increased risk of insulin resistance and other metabolic risk factors.