Early-life conditions and health at older ages: The mediating role of educational attainment, family and employment trajectories

Heterogeneous associations between early-life religious upbringing and late-life health: Evidence from a machine learning approach

Religious upbringing was common in Europe during the childhood of older adults today. However, studies are still lacking on how early-life religious upbringing is associated with adult health and how this association differs in different population segments. We used cross-national data of 10,346 adults aged 50 or older in Europe. The causal forest approach was applied to capture the complex nonlinear relationships in the data and estimate the average treatment effect (ATE) of early-life religious upbringing on late-life self-rated health and the heterogeneity of this effect across subgroups (early-life circumstances, late-life demographics, and late-life religious involvement) by estimating conditional average treatment effects (CATEs). The results demonstrated that allowing for 19 covariates, early-life religious upbringing was associated with poorer late-life self-rated health with an ATE of -0.10 [95 % confidence interval -0.11, -0.09]. However, the associations varied across different domains of health: religious upbringing was linked to poorer mental health (higher depression levels) and poorer cognitive health (lower numeracy ability) but was associated with better physical health (fewer ADL limitations). CATEs further assess the heterogeneous associations among different subgroups, providing modest evidence that early-life religious upbringing was associated with poorer late-life self-rated health especially among older individuals (65+ years), females, those with low education level, those who were not married or partnered, those who prayed, those who never attended a religious organization, and those with adverse childhood family circumstances. Our results suggest that the association between early-life religious upbringing and late-life health may be modified by both childhood and adulthood social conditions.

Retirement Transition Sequences and Well-Being Among Older Workers Focusing on Gender Differences

This study examines retirement transition patterns and well-being in later life, focusing on gender differences using data from the 2004-2016 Health and Retirement Study (HRS) with 1,653 older workers. Sequence analysis identifies key retirement patterns, showing that men predominantly transitioned from full-time to mid-time voluntary retirement, while women experienced more gradual involuntary retirement. Involuntary retirees, both men and women, had precarious work histories and poorer mental health. The findings highlight gender-specific implications for social policy and emphasize the need for support in promoting successful aging and reducing social inequities among involuntary retirees.

Covering the long shadow: the moderating role of children's education on health disparity by social origin in Japan

This study investigates the moderating role of children's education on health disparity by social origin (origin health gap) in Japan. Previous studies have quantified origin health gap, but few studies have considered how origin health gap is reduced. Filling this lacuna, I focus on the education of children which also has a spillover effect on individuals' health. I examine how much the origin health gap is closed if I hypothetically intervene to equalize children's education. Results from Social Stratification and Mobility survey revealed that about 30.2 % of origin health gap is closed under the hypothetical intervention. The results are 19.4 % for male and 34.9 % for female. This study also has a policy implication in terms of generational equity; closing the educational inequality of children has a spillover effect to the health disparity of older adults by social origin.

Trajectories of satisfaction with work-family reconciliation among midlife employees: the role of family-related factors and quality of life

We studied the developmental trajectories of satisfaction with work-family reconciliation (WFS) and their associations with family-related factors and quality of life measures among municipal employees. The study was based on the Helsinki Health Study of municipal employees of the City of Helsinki in 2001-02 and its follow-up surveys in 2007, 2012, and 2017. Employees aged 40-50 at baseline and working at all timepoints were analysed (n = 1681, 84% women). Growth Mixture Models were applied to identify trajectories of WFS (dissatisfied vs. satisfied). Associations of family-related and quality-of-life factors (physical functioning and emotional well-being) with the WFS trajectories were studied using log-binomial regression models, adjusting for sociodemographic and lifestyle variables. Two WFS trajectories, low (women 45%; men 53%) and high were identified. In a fully adjusted model among women, having ≥1 children aged 0-6 years was associated with increased odds of belonging to the low WFS trajectory (OR 1.52, 95% CI 1.19-1.95). Among men, having ≥1 children aged 7-18 was associated with decreased odds (0.39, 0.19-0.80). High emotional well-being was inversely associated with the low WFS trajectory among both genders (women 0.32, 0.23-0.45; men 0.20, 0.09-0.46). High physical functioning (0.59, 0.42-0.83) was inversely associated with the low WFS trajectory among women only. Less than half of the women and more than half of the men participants belonged to a low WFS trajectory, which associated with the age of children in the family and quality-of-life measures.

The Causal Effect of Adult Height on Late-Life Handgrip Strength: The Singapore Chinese Health Study

BACKGROUND

Adult height has been associated with handgrip strength, which is a surrogate marker of physical frailty. However, it is uncertain if this association is causative or due to confounding bias.

METHODS

We evaluated pairwise associations among handgrip strength, adult height, and genetically determined height (using a polygenic score [PGS] for height in a mediation framework and a 2-sample Mendelian randomization approach) by means of a multivariable regression model using a prospective cohort of Chinese living in Singapore. We additionally evaluated pathway enrichments of height-related genes in relation to increased handgrip strength to discover common biological mechanisms underlying associations of genetically determined height with handgrip strength.

RESULTS

Height PGS exhibited a positive association with handgrip strength at late life after adjusting for midlife body weight and other baseline exposures (cigarette smoking, education, and physical activity status, p = 1.2 × 10-9). Approximately 66.4% of the total effect of height PGS on handgrip strength was mediated through adult height (βindirect-effect = 0.034, pindirect-effect = 1.4 × 10-40). Two-sample Mendelian randomization evaluations showed a consistent causal relationship between increased height and increased handgrip strength in late life (p between 6.6 × 10-4 and 3.9 × 10-18), with insignificant horizontal pleiotropic effects (pMR-Egger intercept = 0.853). Pathway analyses of genes related to both increased adult height and handgrip strength revealed enrichment in ossification and adipogenesis pathways (padj between .034 and 6.8 × 10-4).

CONCLUSIONS

The study highlights a potentially causal effect between increased adult height and increased handgrip strength in late life, which may be explained by related biological processes underlying the preservation of muscle mass and strength in aging.

Lifetime employment trajectories and cancer

Working life is associated with lifestyle, screening uptake, and occupational health risks that may explain differences in cancer onset. To better understand the association between working life and cancer risk, we need to account for the entire employment history. We investigated whether lifetime employment trajectories are associated with cancer risk. We used data from 6809 women and 5716 men, average age 70 years, from the Survey of Health, Ageing, and Retirement in Europe. Employment history from age 16 to 65 was collected retrospectively using a life calendar and trajectories were constructed using sequence analysis. Associations between employment trajectories and self-reported cancer were assessed using logistic regression. We identified eight employment trajectories for women and two for men. Among women, the risk of cancer was higher in the trajectories "Mainly full-time to home/family", "Full-time or home/family to part-time", "Mainly full-time", and "Other" compared with the "Mainly home/family" trajectory. Among men, the risk of cancer was lower in the "Mainly self-employment" trajectory compared with "Mainly full-time". We could show how employment trajectories were associated with cancer risk, underlining the potential of sequence analysis for life course epidemiology. More research is needed to understand these associations and determine if causal relationships exist.

Lifetime Employment Trajectories and Cancer: A Population-Based Cohort Study

Working life is associated with lifestyle, screening uptake, and occupational health risks that may explain differences in cancer onset. To better understand the association between working life and cancer risk, we need to account for the entire employment history. We investigated whether lifetime employment trajectories are associated with cancer risk. We used data from 6,809 women and 5,716 men, average age 70 years, from the Survey of Health, Ageing, and Retirement in Europe. Employment history from age 16 to 65 was collected retrospectively using a life calendar and trajectories were constructed using sequence analysis. Associations between employment trajectories and self-reported cancer were assessed using logistic regression. We identified eight employment trajectories for women and two for men. Among women, the risk of cancer was higher in the trajectories "Mainly full-time to home/family", "Full-time or home/family to part-time", "Mainly full-time", and "Other" compared with the "Mainly home/family" trajectory. Among men, the risk of cancer was lower in the "Mainly self-employment" trajectory compared with "Mainly full-time". We could show how employment trajectories were associated with cancer risk, underlining the potential of sequence analysis for life course epidemiology. More research is needed to understand these associations and determine if causal relationships exist.

Predicting depression in old age: Combining life course data with machine learning

With ageing populations, understanding life course factors that raise the risk of depression in old age may help anticipate needs and reduce healthcare costs in the long run. We estimate the risk of depression in old age by combining adult life course trajectories and childhood conditions in supervised machine learning algorithms. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we implement and compare the performance of six alternative machine learning algorithms. We analyse the performance of the algorithms using different life-course data configurations. While we obtain similar predictive abilities between algorithms, we achieve the highest predictive performance when employing semi-structured representations of life courses using sequence data. We use the Shapley Additive Explanations method to extract the most decisive predictive patterns. Age, health, childhood conditions, and low education predict most depression risk later in life, but we identify new predictive patterns in indicators of life course instability and low utilization of dental care services.

Physical and mental health among older parents: Does offspring migration and living arrangement matter? Findings from Longitudinal Aging Survey in India (2017-18)

The migration of adult children can have beneficial and adverse effects on the health outcomes of elderly parents left behind. This study examines the effects of adult children's migration on self-rated health and depression among older parents using Longitudinal Ageing Study in India (LASI) 2017-18 with 19,401 individuals aged 60 years or older. Binary logistic regression models were performed to determine the association of self-rated health and depression with adult-child migration status while adjusting for living arrangements and socioeconomic factors. Results show that 36 percent of older parents have at least one migrant child, and 35 percent are empty nesters. Older adults living with their children experience positive impacts on their physical and mental health. Our study reveals that empty-nested elderly have a higher prevalence of poor self-rated health and depression. Irrespective of migrant children, the availability of children in the household matters most regarding parents' health care, as our study suggests no significant difference in physical and mental health among left-behind and non-left-behind older parents. This study aims to draw policymakers' attention to the impact of adult children or youth migration on older parents' physical and mental health. To address this issue, policies should prioritize raising awareness among migrant children of older adults about the importance of maintaining frequent contact and visiting their aging parents.

Non-standard family histories and wellbeing at older ages

The life course approach emphasizes that health and wellbeing at older ages are influenced by experiences occurred in the previous stages of life. We contribute to the literature by focusing on the role of the non-standardness of family histories and argue that individuals who experienced non-standard trajectories have been exposed to social sanctions throughout their life course with negative long-term consequences on wellbeing. In our study, non-standardness of family histories is the extent an individual's family history differs from those of the others within reference groups, defined combining birth cohort, gender and country of residence. Family histories between age of 15 and 49 are analyzed using Sequence Analysis, thus accounting for events related to fertility and union formation (marriage and cohabitation) and dissolution, and their timing. Dissimilarities between family sequences are measured using optimal matching and are standardized within the reference groups. We use retrospective data from the seventh wave of the Survey of Health Ageing and Retirement in Europe (SHARE) and estimate linear regression models to assess the association between non-standardness of family histories and older people's life satisfaction. Quality of life and depressive symptoms are examined in additional analyses. A negative association is found between non-standardness of family histories and wellbeing, which is stronger for lower educated individuals and in Southern European countries. Results are consistent with the idea that uncommon family behaviors may have a long-term negative effect on wellbeing. Individual resources and a more tolerant societal context can reduce or eliminate the negative consequences of engaging in non-standard family behaviors.

Less Is (Often) More: Number of Children and Health Among Older Adults in 24 Countries

OBJECTIVES

Previous evidence about the impact of parenthood on health for older adults is mixed, perhaps due to variation in number of children and context. Higher numbers of children could lead to support or strain, depending on individual and country contexts. Yet, no studies currently exist that examine associations between the number of children and several health indicators among older adults across multiple global regions.

METHODS

We analyze cross-sectional data (1992-2017) of 166,739 adults aged 50+ across 24 countries from the Health and Retirement Study family of surveys to document associations between the number of children, treated as a categorical variable, and 5 health outcomes (self-rated health, activities of daily living limitations, instrumental activities of daily living limitations, chronic conditions, and depression). We perform multivariable analyses by estimating logistic regression models for each country and each outcome.

RESULTS

Multiple comparisons between categories of number of children revealed at least 1 significant difference in each country, and a majority of significant differences indicated those with more children had poorer health. The risk of poorer health for parents of multiple children was observed in 15 countries, but in some countries, fewer children predict poorer health. The greatest number of differences was identified for depression and chronic conditions, and very few for functional limitations.

DISCUSSION

We observe a greater probability that more children are associated with poorer health in later life, especially for chronic conditions and depression. However, a universal global or regional pattern could not be identified. These findings raise new questions about how country contexts shape fertility and health.

Does early-life migration experience determine health and health-risk behavior in later life? Evidence from elderly returns migrants in Kerala, India

Becoming elderly is an intrinsic part of life, and the burden of disease increases with age. However, the early life migration experience and occupational hazards at the destination can lead to serious health problems later in life. This study aims to understand the association between early life migration and the health and risky behavior of elderly return migrants using data from the Kerala Migration Survey in 2018. The results of bivariate and multivariate analyses show that the majority of migrants return due to retirement and ill health at the average age of 51 and suffer from poor health and multiple diseases. More than half (55%) of elderly returnees reported poor health, and among them, 70% have at least one chronic disease. The early life migration experience and injuries at the destination are the main determinants of poor self-rated health and chronic disease. Furthermore, elderly return migrants have high-risk health behaviours such as smoking and alcohol consumption, as well as less access to health schemes. Despite some shortcomings, this study identifies the most vulnerable groups among the elderly and their health characteristics. This will help to promote healthy aging in Kerala, India, or areas with increasing numbers of elderly and return migrants around the world.

Distinct domains of childhood disadvantage and cognitive performance among older Brazilians: Evidence from ELSI-Brazil

Objective

To investigate the relationship between of distinct domains of childhood disadvantage and cognitive performance among older adults within the context of a middle-income country.

Methods

This study used baseline data (2015/2016) from the Brazilian Longitudinal Study of Aging (ELSI), a nationally representative cohort of 9412 adults aged 50 and over. Nine childhood exposure variables were grouped into three domains (family SES, childhood health, and cultural capital), for which scores were created. Survey-weighted Ordinary Least Squares (OLS) regressions estimated the association childhood disadvantage with cognitive performance as measured by immediate memory, late memory and semantic verbal fluency. Mediation analysis assessed whether adulthood socioeconomic status (SES) mediated this relationship of interest.

Results

Important disparities in cognitive performance were observed, particularly in terms of age, education, income, occupational status. Before controlling for adulthood SES in the multivariable analysis, all domains of childhood disadvantage were found to be associated with lower cognitive performance across all three measures. After inclusion of adulthood SES variables, the observed associations only remained for semantic verbal fluency. Formal mediation analysis indicated that adulthood SES mediates 47.9% (95% CI: 34.3%-78.6%) of the association between later-life verbal fluency and poor childhood health, and 49.9% (95% CI: 43.6%-57.8%) of the association between later-life verbal fluency and low childhood cultural capital.

Conclusions

We found that childhood disadvantage is associated with low performance in memory tests and semantic verbal fluency tests among older Brazilians. Adulthood SES fully mediated the association between all domains of childhood disadvantage and memory performance and only partially mediated its association with verbal fluency. Our findings support policy efforts to enhance early childhood development and improve adulthood SES, and guide additional research to better the mechanisms driving these relationships.

Early life factors associated with the experiences of pain in later life: evidence from a population based study in India

BACKGROUND

The influence of early life factors is becoming increasingly apparent as studies investigate how experiences, resources, and constraints in childhood affect health and well-being later in life. The present study contributes to this literature by examining the association between several early life factors and self-reported pain among older adults in India.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study of India (LASI). The sample size includes 28,050 older adults aged 60 and above (13,509 men and 14,541 women). Pain is a self-reported, dichotomous measure where participants responded to whether they were often troubled with pain and whether this experience interfered with their ability to carry out daily household chores. Early life factors, which are retrospective accounts of experiences, included the respondent's position in birth order, their health status, school absenteeism, being bedridden, family socioeconomic status (SES), and their parent's experience with chronic disease. Logistic regression analysis is employed to examine the unadjusted and adjusted average marginal effects (AME) of selected domains of early life factors associated with the probability of experiencing pain.

RESULTS

22.8% of men and 32.3% of women reported pain that interfered with daily activities. Pain was higher among men (AME: 0.01, confidence interval (CI): 0.01-0.03) and women (AME: 0.02, CI: 0.01-0.04) with third or fourth birth order compared to counterparts with first birth order. Both men (AME: -0.02, CI: -0.04-0.01) and women (AME: -0.07, CI: -0.09 - -0.04) having a fair childhood health status reported a lower probability of pain. The probability of pain was higher among both men (AME: 0.03, CI: 0.01-0.07) and women (AME: 0.07, CI: 0.03-0.13) who were bedridden due to sickness in their childhood. Similarly, the pain likelihood was higher among men who missed school for more than a month due to health problems (AME: 0.04, CI: -0.01-0.09). Men and women with poor financial condition in their childhood reported (AME: 0.04, CI: 0.01-0.07) a higher probability of experiencing pain relative to their peers who reported a more financially advantaged early life.

CONCLUSIONS

Findings of the present study add to the empirical literature on the association between early life factors and later life health and well-being. They also are pertinent to health care providers and practitioners working in pain management, as this knowledge better positions them to identify older adults most susceptible to pain. Moreover, findings of our study underscore that the interventions to ensure health and well-being in later life must start far earlier in the life course.

Childhood Socioeconomic Position, Adulthood Employment Trajectories, and Later Life Functional Limitations in Chile

Relying on a life course perspective, we explored the association between childhood socioeconomic position (SEP), adulthood employment trajectories, and their interactions, with different domains of functional limitations among older people in Chile. We used data from a face-to-face, comprehensive and representative life history survey of older people (N = 802), and weighted bivariate, multivariate, and longitudinal quantitative methods. As a way to address potential problems of reverse causality, we adjust multivariate analyses by lifetime health indicators. Our results show that low childhood SEP and non-standard adulthood employment trajectories characterized by part-time work negatively affect later life functional limitations. The increased risk among people with low childhood SEP is higher if they follow a "part-time employment trajectory" in adulthood. In the conclusion, we emphasize that analyzing life course determinants of functional limitations serves to inform and help design strategies to reduce dependency in later life and promote healthy aging.

Early-life exposure to Saharan dust storms and adolescence functional disability: Evidence from Cameroon

The direct link between early-life dust storm exposure and later-in-life outcomes is not fully understood. This study examines the association of functional disability in a large sample of adolescent Cameroonians (N = 112,855) with in-utero and early childhood exposure to Saharan dust storms. Adjusting all estimations for temperature, precipitation, time and location fixed-effects, and person and family sociodemographic characteristics, we documented adverse effects on functional disability in female adolescents due to exposure to dense dust storms during the third gestation trimester and the second postnatal trimester. We also found suggestive evidence that an effect exists for the first as well as the third through fifth postnatal trimesters. In the third trimester of gestation and the second postnatal trimester, exposure to an average length dust storm with PM₁₀ levels beyond 190 μg/m³ increased the likelihood of disability among female adolescents by approximately 229 (95 % CI: 10-464) in 100,000. The size of the adverse effects for the other periods followed similar patterns. These results show the value of creating infrastructures to mitigate or adapt to the effects of dust storms. These endeavors should focus on communities and populations in and around the Sahara where international organizations can play a role. In addition, establishing health data infrastructures not only improves public health but also advances our understanding of the long-term effects of dust storms. This study demonstrates the importance of research on the long-term effects of early-life exposure to dust storms and the need for additional work on this topic.

Work-family trajectories in young adulthood: Associations with mental health problems in adolescence

During young adulthood, several transitions in work and family lives occur, but knowledge of the work-family trajectories of the current generation of young adults, i.e. people born in the 1990s, is lacking. Moreover, little is known about whether the mental health status before the start of the working life may shape work-family trajectories. We used 18-year follow-up data from the TRAILS cohort study of individuals born between 1989 and 1991 (n = 992; 63.2% women). Internalising and externalising problems were measured with the Youth Self-Report at ages 11, 13 and 16 years. Monthly employment, education and parenthood states were recorded between 18 and 28 years. Applying sequence analysis, we identified six work-family trajectories in women and men. The first five trajectories were labelled: long education, continuous education and work, education and work to work, early work, and inactive. The main difference between trajectories of women and men was in the timing of parenthood, thus the remaining trajectory of women was labelled active with children, and the remaining trajectory of men active. Women who experienced externalising problems in adolescence were more likely to belong to the trajectory characterised by parenthood. Men who experienced internalising problems in adolescence were more likely to belong to the trajectory characterised by a long time spent in education. The TRAILS data allowed us to consider timing, duration and ordering of the work and family states in young adulthood, and to use multiple assessments of mental health in adolescence. Further research needs to examine the mechanisms through which early mental health affects later work and family outcomes.

Intergenerational Interdependence of Labour Market Careers

Labour market disadvantages tend to run in families: children who grow up with parents who experience job losses or receive low wages are themselves at higher risk of experiencing labour market difficulties. However, little is known about the intergenerational transmission for those who manage to escape from precariousness, and how the transmission of labour market disadvantage operates depending on the gender structure of parent-child dyads. The present study uses Swedish register data and longitudinal methods that follow a cohort of people born in 1985 (n = 72,409) and their parents across 26 years. Our findings show that children who experienced parental employment disadvantages had the most severe labour market disadvantages later in life. However, if the employment situations of their parents improved, they were somewhat more likely to follow a more stable, high-wage career path compared to children whose parents experienced more persistent forms of disadvantage, such as long-term unemployment or severe labour market instability. We also show that the mother's labour market disadvantages were an important determinant of the future labour market career of her child, regardless of gender. This finding underscores the need to go beyond the analysis of father-son dyads in intergenerational research.

A Scoping Review on Biopsychosocial Predictors of Mental Health among Older Adults

This review aims to map the available evidence on biopsychosocial predictors of elderly mental health. The articles were independently screened in three selected databases, namely Pubmed, Proquest and Google Scholar. The stages consist of identifying the research questions, seeking and selecting relevant evidence, mapping data, and concluding and reporting results. The PRISMA flowchart was used to show the PEOS evidence search flow. A total of 23,722 articles were obtained from all databases during the initial search, where 458 titles fulfilled the eligibility criteria at the title screening stage. Furthermore, 383 articles passed through abstract screening, where 75 met the inclusion criteria and were included for full-text screening. Based on the full-text screening stage, 28 articles were excluded and the remaining 47 articles that matched the search process were included for data extraction. This review creates biopsychosocial variables related to the mental health of the elderly. The biological factors consist of age, biomarkers, female, health conditions, chronic diseases, and physical function. Variables related to psychological factors are affect, personality traits, and subjective well-being. Meanwhile, social factors include smoking, sleep quality, physical activity, daily living, social support, marital status, loneliness, religiosity, spirituality, and early life conditions.

The importance of social participation for life satisfaction among spouse caregivers aged 65 and over

Spouse caregivers report lower levels of life satisfaction. However, social participation generates life satisfaction. The main goal of this study is to analyse the contribution of social participation to the life satisfaction of European and Israeli spouse caregivers aged 65 plus. The study uses cross-sectional data from 17 European countries, plus Israel, which are part of wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The sample was limited to individuals aged 65+, who were classified as non-caregivers (N = 25,313) or spouse caregivers (N = 1977). The mean scores of life satisfaction by country and caregiver status were calculated and tests for a two-group comparison and multilevel logistic regressions were performed. The spouse caregiver group reported lower levels of satisfaction with life. Tests for a two-group comparison show that the group of spouse caregivers reports fewer social activities than the non-caregivers group. Moreover, multilevel linear regressions allowed us to conclude that providing spousal care at older ages (65+) is related to lower life satisfaction but that providing spousal care and reporting having social participation is related to higher life satisfaction than in the group of spouse caregivers who are not involved in social activities, and non-caregivers. Social participation is a key issue in the life satisfaction of spouse caregivers aged 65 years and older. The social participation of spouse caregivers should be a concern to relatives, communities, social and health professionals, as well as public policymakers.

Work-family trajectories and health: A systematic review

BACKGROUND

Work and family lives interact in complex ways across individuals' life courses. In the past decade, many studies constructed work-family trajectories, some also examined the relation with health. The aims of this systematic review were to summarise the evidence from studies constructing work-family trajectories, and to synthesise the evidence on the association between work-family trajectories and health.

METHODS

We searched MEDLINE, EMBASE, PsycINFO, SocINDEX and Web of Science databases. Key search terms related to work, family and trajectories. Studies that built combined work-family trajectories or examined the relationship between work and family trajectories were included. Risk of bias was assessed independently by two authors. The identified work-family trajectories were summarised and presented for men and women, age cohorts and contexts. The evidence on the association with health as antecedent or consequence was synthesised.

RESULTS

Forty-eight studies, based on 29 unique data sources, were included. Thirty-two studies (67%) were published in 2015 or later, and sequence analysis was the primary analytic technique used to construct the trajectories (n = 43, 90%). Trajectories of women were found to be more diverse and complex in comparison with men. Work-family trajectories differed by age cohorts and contexts. Twenty-three studies (48%) examined the association between work-family trajectories and health and most of these studies found significant associations. The results indicate that work-family trajectories characterised by an early transition to parenthood, single parenthood, and weak ties to employment are associated with worse health outcomes.

CONCLUSIONS

Work-family trajectories differed greatly between men and women, but differences seemed to decrease in the youngest cohorts. Given the current changes in labour markets and family formation processes, it is important to investigate the work and family lives of younger cohorts. Work-family trajectories were associated with health at different life stages. Future research should examine longitudinal associations of work-family trajectories with health and focus on elucidating why and under which circumstances some trajectories are associated with better or worse health compared with other trajectories.

Loneliness among older adults in Europe: The relative importance of early and later life conditions

The aim of this paper is to study the association between childhood circumstances and loneliness in older adults in Europe. Based on rich information collected by the Survey on Health, Ageing, and Retirement in Europe (SHARE) on childhood characteristics and individual characteristics at age 50+, the study is able to control for personality traits, socioeconomic and demographic factors, social support and health in later life, and country-specific characteristics. The analyses show strong correlations between life circumstances in childhood and feeling lonely in older age; these correlations remain significant after adjusting for covariates. While ill health is the main factor correlated with loneliness at 50+, as expected, the analysis of the relative importance of the determinants reveals that personality traits account for more than 10% of the explained variance and that life circumstances during childhood account for 7%. Social support at older ages is the second highest category of factors, accounting for 27%-with, interestingly, support at home and social network characteristics contributing about 10% each, engaging in activities and computer skills accounting for 7% of the explained variance. Demographic and socioeconomic factors account for 6% and country-level characteristics contribute 5%. This paper points out the relevance of early life interventions to tackling loneliness in older age, and it shows that early interventions and interventions aiming at increasing social support in later life need to be adapted to all personality types. Thus, the role of childhood circumstances and the mechanisms explaining the association between loneliness in childhood and loneliness in later life deserve more attention in future research.

Multiple events case-control study in a prospective cohort to identify systemic, cellular, and molecular biomarkers of obesity-induced accelerated aging in 30-years-olds: the ObAGE study protocol

Background

Aging is characterized by a progressive loss of capacities linked to fundamental alterations/damage in multiple cellular and molecular pathways. It is the most significant risk factor for all non-communicable diseases (NCDs). Another contributing factor to the rise in NCDs is obesity. It has been suggested that obesity not only accelerates the onset of metabolic imbalances but also decreases lifespan and impacts cellular and molecular processes in a manner similar to aging. Obesity might accelerate the pace of aging. Guided by a lifecourse approach, we will explore how exposure to obesity in critical developmental stages disrupt homeostatic resilience mechanisms that preserve physiological integrity, inducing an early expression of aging phenotypes. Also, we will determine whether exposure to early psychosocial adversity influences vulnerability to obesity as a risk factor for accelerated aging.

Methods

Multiple events case–control study embedded in a prospective cohort of Chileans at 30-31y, 50% females, of low- to-middle socioeconomic status, who participated in nutrition research since birth. At 23y, 25% had obesity and cardiometabolic risk was high. We will use a multi-layer approach including: anthropometric assessment; DXA scan for body composition; abdominal ultrasound of the liver; stool samples collection and sequencing of the ribosomal RNA 16S gene to characterize the gut microbiome; determination of age-related pro-inflammatory cytokynes and anti-inflammatory miokynes. For the first time in Chile, we will address age-related epigenetic changes using the Horvath´s epigenetic clock. In a subset we will conduct a controlled physical challenge to characterize physical resilience (autophagy).

Discussion

ObAGE is in an excellent position to: approach aging as a process whose expression involves multiple factors from the early stages of a person's life; understand how longitudinal changes in health trajectories impact the biological mechanisms of aging; identify potential resilience mechanisms that help prevent unhealthy aging. Because SLS participants are still young, our research setting combined with advanced scientific techniques may identify individuals or groups at risk of early onset health issues. Results from ObAGE may pave the way to address the contribution of obesity to aging through lifespan from cells to systems and might be instrumental to developing interventions to improve health span in the Chilean population.

Trial registration

The proposed study does not consider any health care intervention on human participants.

Health disparities, and health behaviours of older immigrants & native population in Norway

We aimed to investigate and compare activities of daily living (ADL), instrumental ADL (IADL), poor self-rated health and the health behaviours among immigrants and the native population in Norway. We present results from analysis of two Norwegian surveys, (Living Conditions Survey on Health from 2015, Living Conditions Survey among Immigrants 2016). Using logistic regression models, odds ratios were estimated for functional ability, self-reported health, and health behavior among immigrants, with Norwegian born being the reference category. The first model was controlled for age and gender and the second model was additionally adjusted for educational level. Our analysis included 5343 participants, 2853 men (913 immigrants), and 2481 women (603 immigrants), aged 45–79 years. The age-group 45–66 years includes n = 4187 (immigrants n = 1431, men n = 856; women n = 575) and 67–79 years n = 1147 (immigrants n = 85, men n = 57; women n = 28). The percentage of Norwegians having ≥ 14 years of education was 86%, as compared to 56% among immigrants. The percentage of immigrants with no education at all was 11%. The employment rate among the Norwegian eldest age group was nearly double (14%) as compared to the immigrant group. Adjusted for age, gender and education, immigrants had higher odds than Norwegian of ADL and IADL, chronic diseases and overweight. There were no differences between immigrants and Norwegians in prevalence of poor self-reported health and smoking. Overall elderly immigrants are worse-off than Norwegians in parameters of health and functioning. Knowledge about health and functioning of elderly immigrants can provide a basis for evidence-based policies and interventions to ensure the best possible health for a growing number of elderly immigrants. Furthermore, for a better surveillance, planning of programs, making policies, decisions and improved assessment and implementation, ADL and IADLs limitations should be included as a variable in public health studies.

Multiple social roles in early adulthood and later mental health in different labour market contexts

Work and family roles entail divergent responsibilities, which can be a source of conflict especially in young adulthood - the so-called "rush-hour" of life. Combining these multiple social roles can result in an accumulation of stress but also be a valuable resource for mental health. The aim of this study is to investigate combined employment, parenthood and partnership trajectories of men and women during early adulthood, and to analyse the relationship of these multiple roles with depressive symptoms at older age. We used harmonised data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) with retrospective information on employment, partnerships and parenthood histories between age 25 and 40 for 18,816 men and 24,686 women (n = 43,502). We applied sequence analysis and clustering to group trajectories into four clusters for women and three clusters for men. We then used multilevel models to analyse the links between combined employment and family roles and later mental health in different historical labour market contexts (indicated by female employment rates). Women and men who did not combine work and family roles between age 25 and 40 report higher levels of depression than those who combined work and family. Results differ by gender and labour market context, with stronger differences between women in countries with higher female employment rates. Overall, combining multiple roles in early adulthood is associated with decreased rather than increased risk for depressive symptoms in older Europeans.

Promoting Postsecondary Education in Low-Income Youth: The Moderating Role of Socio-Behavioral and Academic Skills in the Context of a Major Educational Reform

Governments around the world are pressed to invest in postsecondary education. However, little research exists to document whether large-scale educational reforms aimed at increasing rates of postsecondary attendance benefit youth's developmental outcomes. This study tested whether an educational reform occurring in Québec, Canada, in the 1960s increased educational levels, and whether it benefitted some youth more than others. In the 1970's, 4109 low-income youth (50% females) aged 7-13 years old were recruited at Time 1 from first, fourth, and seventh grade classes (M_age = 10.6, SD = 2.5). Socio-behavioral characteristics and academic skills at Time 1 were examined as predictors of educational attainment at Time 2, three decades later, on 3883 of the same participants. Multinomial logistic regressions were used to examine the likelihood of youth obtaining a diploma from the newly created, accessible, and affordable colleges ("cégeps"). Low-educated groups (high school dropouts and high school graduates) presented a higher early risk profile than did college graduates. Interactions revealed that social withdrawal protected youth from disadvantaged neighborhoods, helping them graduate from college. Likeability helped academically weaker girls go beyond college and access university, and helped academically competent boys graduate from college. Aggressive behavior decreased the odds of university attendance for academically competent boys. Policies promoting higher education for disadvantaged youth should be supplemented with early interventions integrating academic and socio-behavioral objectives.

Association between early life circumstances and depressive symptoms among Chinese older adults: Results from China health and retirement longitudinal study: Early life circumstances and depression

BACKGROUND

A growing body of literature suggests that early life circumstances can influence mental health throughout the lifespan. However, how these early life circumstances cumulatively contribute to depression in old age is not completely understood. The aim of this study was to examine the associations of eight factors with depression among community-dwelling older adults.

METHODS

Data were from the China Health and Retirement Longitudinal Study. We included 8,239 community-dwelling individuals who were ≥60 years, completed the life history questionnaire, and had assessment of depression. An early life disadvantage index was established using risk factors that were significantly associated with depression. Logistic regression was used to examine the association of each early life risk factor and the index with depression.

RESULTS

Of 8239 individuals included, 2,055 (24.9%) had depression. In bivariate analysis, each of eight early life risk factors was significantly associated with depression. Except for maternal and paternal education, all risk factors persisted to be associated with depression after multivariable adjustment. In the multivariable-adjusted model, a one-point higher in the early life disadvantage index (range: 0-6) was associated with a 45% (95% CI: 37%, 53%) higher odds of depression.

LIMITATIONS

Depressive symptoms were measured in our study only by the CES-D scale. Some early life experiences might not be fully reliable due to recall bias.

CONCLUSION

There was a strong association between early life environments and depressive symptoms among Chinese community-dwelling older adults. Adverse early life circumstances could contribute cumulatively to depression in old age.

The intersectional impact of sex and social factors on subjective health: analysis of the Canadian longitudinal study on aging (CLSA)

Background

Self-rated health (SRH) is a widely validated measure of the general health of older adults. Our aim was to understand what factors shape individual perceptions of health and, in particular, whether those perceptions vary for men and women and across social locations.

Methods

We used data from the Canadian Longitudinal Study on Aging (CLSA) of community-dwelling adults aged 45 to 85. SRH was measured via a standard single question. Multiple Poisson regression identified individual, behavioural, and social factors related to SRH. Intersections between sex, education, wealth, and rural/urban status, and individual and joint cluster effects on SRH were quantified using multilevel models.

Results

After adjustment for relevant confounders, women were 43% less likely to report poor SRH. The strongest cluster effect was for groupings by wealth (21%). When wealth clusters were subdivided by sex or education the overall effect on SRH reduced to 15%. The largest variation in SRH (13.6%) was observed for intersections of sex, wealth, and rural/urban status. In contrast, interactions between sex and social factors were not significant, demonstrating that the complex interplay of sex and social location was only revealed when intersectional methods were employed.

Conclusions

Sex and social factors affected older adults’ perceptions of health in complex ways that only became apparent when multilevel analyses were carried out. Utilizing intersectionality analysis is a novel and nuanced approach for disentangling explanations for subjective health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02412-6.

Life-course risk factors are associated with activity of daily living disability in older adults

BACKGROUND

Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

METHODS

Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

RESULTS

In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

CONCLUSIONS

Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.

Joint Family and Work Trajectories and Multidimensional Wellbeing

Informed by the life course perspective, this paper investigates whether and how employment and family trajectories are jointly associated with subjective, relational and financial wellbeing later in life. We draw on data from the Swiss Household Panel which combines biographical retrospective information on work, partnership and childbearing trajectories with 19 annual waves containing a number of wellbeing indicators as well as detailed socio-demographic and social origin information. We use sequence analysis to identify the main family and work trajectories for men and women aged 20-50 years old. We use OLS regression models to assess the association between those trajectories and their interdependency with wellbeing. Results reveal a joint association between work and family trajectories and wellbeing at older age, even net of social origin and pre-trajectory resources. For women, but not for men, the association is also not fully explained by proximate (current family and work status) determinants of wellbeing. Women's stable full-time employment combined with traditional family trajectories yields a subjective wellbeing premium, whereas childlessness and absence of a stable partnership over the life course is associated with lower levels of financial and subjective wellbeing after 50 especially in combination with a trajectory of weak labour market involvement. Relational wellbeing is not associated with employment trajectories, and only weakly linked to family trajectories among men.

Lifetime employment, tobacco use, and alcohol consumption trajectories and cardiovascular diseases in old age

Despite the great advances of life course epidemiology studies during the last decade in understanding the general health effects of employment trajectories, research has yet to evaluate the effects of employment trajectories along with other major risk factors, such as tobacco and alcohol consumption, on cardiovascular diseases (CVDs)-the main cause of deaths worldwide. This is highly relevant, since health advantages in one domain (e.g., being a permanent formal full-time worker) may offset health disadvantages in other domains (e.g., being a regular smoker or alcohol consumer); conversely, disadvantages in both domains may interact, leading to even greater health risks. Considering these knowledge gaps, this research has two main objectives: (1) to reconstruct simultaneous employment, tobacco use, and alcohol consumption trajectories over the life course (from birth to old age) and (2) to measure the association between these trajectories and CVD in old age. Drawing on a rich and comprehensive life history dataset and using multichannel sequence and regression analyses, we analyzed a cohort of individuals aged 65-75 in Chile, a Latin American country with high social inequalities and scarce research on this matter. Our study shows that following a trajectory of formal employment together with no tobacco and alcohol use reduces CVD risk by 36 percentage points relative to a similar employment trajectory but with regular tobacco and alcohol use. Even with an employment trajectory characterized by constant informal employment or permanent inactivity, a life course free of regular tobacco and alcohol use shows protective effects against CVD. This study stresses the importance of health policies that consider CVD as a condition that strongly depends on individual experiences in multiple life domains and across different life stages.

Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data

This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems.

The Relationship Between Childhood Circumstances and Late Life Physical and Mental Health: The Role of Adult Socioeconomic Status

OBJECTIVES

Socioeconomic status and health in childhood are linked to health outcomes in later life. Health outcomes may also be shaped by socioeconomic circumstances in adulthood and later life. This paper examined the relationship between childhood conditions and later life health and tested whether this relationship was mediated by later life economic living standards.

METHODS

Data from a longitudinal study of aging was combined with retrospective life history data from 787 participants from the New Zealand Health, Work and Retirement Study.

RESULTS

Significant relationships were found between childhood conditions and later life health. These relationships were mediated by economic living standards in older age, but the partial direct effect of childhood conditions on health found in early older age became fully meditated 10 years later.

CONCLUSION

While childhood circumstances are part of this complex relationship, socioeconomic conditions in later life are vital to ensuring ongoing health into older age.

Young people's labour market patterns and later mental health: A sequence analysis exploring the role of region of origin for young people's labour market trajectories and mental health

•

Experiencing early employment disadvantage could lead to long-term labour market instability and labour market exclusion.

•

Migrants showed more turbulent transitions between labour market states than natives.

•

Belonging to a turbulent labour market trajectory is association with poor mental ill health in mid-life.

School health in Europe: a review of workforce expenditure across five countries

Background

Most European countries have implemented a form of school health services (SHS) to provide young children and adolescents with various types of healthcare. No estimations on SHS expenditure for European countries have been published until now. We estimated SHS workforce expenditure in Europe, expected to serve as the main driver of school healthcare costs.

Methods

Using two networks of experts on healthcare provision for children we contacted various country representatives to provide data on the number of professionals working in SHS and salaries. These data were used, together with publicly available data, to estimate annual SHS workforce expenditure on the national level.

Results

We received sufficient data for five European countries, and estimated the SHS workforce expenditure. Nurses were the most widely reported professionals working in this field, followed by doctors and psychologists. Our SHS expenditure estimations ranged from €43,000 for Estonia to €195,300 in Norway (per 1000 pupils). For Norway, Estonia, Finland and Iceland, school nurses were the main drivers of SHS expenditure, mainly due to their large numbers, while in Austria, school doctors played the largest role in SHS expenditure.

Conclusions

We estimated the spending on SHS workforce for five European countries, which comprises relatively minor parts of total healthcare spending (0.16 to 0.69%). Many questions regarding SHS spending in Europe remain, due to a general lack of data on national levels.

Association between leucocyte telomere length and cardiovascular disease in a large general population in the United States

Leucocyte telomere length (LTL) has been reported to be linked to ageing, cancer and cardiovascular disease (CVD). This study aimed to explore the association between LTL and CVD risk in a nationally representative sample of U.S. adults. Complex associations, including nonlinearity and interaction, were also examined. A total of 7,378 subjects from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 were collected. Telomere length was detected from DNA samples and expressed as the mean T/S ratio (telomere repeats per single-copy gene). We performed multiple logistic regression models and interactive analysis to explore the associations between LTL and CVD risk by adjusting for potential confounders. We also performed a sensitivity analysis to investigate the robustness of our results. Among all participants, LTL was associated with the risk of CVD (OR = 0.79, 95% CI: 0.63~0.98, P = 0.033) in a linear manner rather than in a nonlinear manner (P = 0.874). Interaction effects of LTL with both education (P = 0.017) and hypertension (P = 0.007) were observed. Furthermore, using subgroup analyses, protective effects of LTL on CVD risk were found in females and in individuals who were college graduates or above, had serum cotinine >10 ng/ml, did not have hypertension, or had normal white blood cell levels. LTL is linearly inversely associated with CVD risk in the general population of the United States.

Work–family lifecourses and later-life health in the United Kingdom

Socio-economic inequalities in physical and mental health persist at older ages and previous studies have shown that partnership and parenthood histories are also associated with differentials in later-life health. These domains of adult life interact, and both may be influenced by earlier life circumstances, indicating a need for a holistic approach to understanding lifecourse influences on health at older ages. In this paper, we identify classes of lifecourse types for a United Kingdom (UK) cohort born 1933–1945 and investigate differences between the latent classes identified in physical and mental health, and changes in health over a five-year follow-up period. Data were drawn from Waves 1–5 (2009–2013) of the nationally representative UK Household Longitudinal Study. Multi-level models were used to analyse associations with summary indicators of physical and mental health measured using the SF-12, and changes in health, controlling for childhood circumstances and taking account of support from family and friends in later life. Lifecourses characterised by lower socio-economic position, early parenthood and large family size were associated with worse physical and mental health in later life, with respondents who had combined a high socio-economic position and two children being the most advantaged. The study indicates that socio-economic disparities in later-life health vary depending on the way in which individuals combine work and family life.

A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors?

Emerging literature emphasises the association between neighbourhood conditions and late life depression. Childhood experiences, crucial for life course development of mental health, may modify how neighbourhood affects subsequent depression. This study assessed the longitudinal associations of access to services and neighbourhood nuisance with depression among older adults, and tested whether these associations varied by exposure to childhood stressors. Data were drawn from the cross-national Survey of Health, Ageing and Retirement in Europe, a prospective cohort study between 2004/2005 and 2015, representative for European adults over the age of 50. Individual perceptions of neighbourhood were measured at baseline; childhood stressors, defined as socioeconomic conditions, adverse experiences and health problems, were collected retrospectively. Multilevel logistic regression estimated the risk of depression (n = 10,328). Access to services were negatively (OR = 0.78, 95% CI 0.68-0.90) and neighbourhood nuisance positively (OR = 1.36, 95% CI 1.18-1.56) associated with the probability of depression during follow-up. We found interactions between neighbourhood and childhood socioeconomic conditions, but not with adverse experiences and health problems. While older adults who grew up in better childhood socioeconomic conditions benefited more from living in a residential area with good access to services, they were at higher risk of developing depression when residing in areas with more neighbourhood nuisances. Older adults' mental health can benefit from better access to public transportation and neighbourhood amenities, while physical and social problems in the local area increase the risk of depression. Importantly, socioeconomic circumstances in early life may influence vulnerability to neighbourhood effects in older age.

Decomposing the effects of childhood adversity on later-life depression among Europeans: a comparative analysis by gender

The aims of the present study are twofold: first, to examine the importance of socio-economic disadvantage, adverse experiences and poor health in childhood on later-life depression by sex and, second, to discern the direct and indirect effects of childhood circumstances using a decomposition technique. Data are derived from Waves 2 and 3 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The methods involve use of logistic regression models and a decomposition approach. The findings indicate that childhood socio-economic status (SES) for both genders and cognitive function for men have only a significant direct effect, consistent with the critical period model. Childhood health for men and poor parental mental health for women are nearly fully mediated by adulthood and later-life circumstances, a fact in line with the pathway model. Poor childhood health, parental excessive alcohol consumption and cognitive function for women and adverse experiences for men have both significant direct and indirect effects, consistent with both models. Mediating factors include poor adulthood and later-life health, socio-economic adversity and stress; adulthood and later-life SES mediate early life health and adverse experiences more strongly for men, whereas stress seems to mediate early life adverse experiences to a greater extent among women. Intervening policies should address childhood adversity while considering the differential vulnerability of men and women.

The role of adult socioeconomic and relational reserves regarding the effect of childhood misfortune on late-life depressive symptoms

Background

Childhood misfortune is associated with late-life depressive symptoms, but it remains an open question whether adult socioeconomic and relational reserves could reduce the association between childhood misfortune and late-life depressive symptoms.

Methods

Using the Survey of Health, Ageing and Retirement in Europe (SHARE), data from 8'357 individuals (35'260 observations) aged 50–96 years and living in 11 European countries were used to examine associations between three indicators of childhood misfortune (adverse childhood events, poor childhood health, and childhood socioeconomic circumstances) and late-life depressive symptoms. Subsequently, we tested whether these associations were mediated by education, occupational position, the ability to make ends meet, and potential or perceived relational reserves; that is family members or significant others who can provide help in case of need, respectively. Analyses were stratified by gender and adjusted for confounding and control variables.

Results

Adult socioeconomic reserves partly mediated the associations between adverse childhood events, poor childhood health and late-life depressive symptoms. The associations with the third indicator of childhood misfortune (childhood socioeconomic circumstances) were fully mediated by adult socioeconomic reserves in men, and partly mediated in women. None of the associations were mediated by relational reserves. However, perceived relational reserves were associated with fewer late-life depressive symptoms.

Conclusion

Childhood socioeconomic disadvantage can be mitigated more easily over the life course than adverse childhood events and poor childhood health, especially in men. Perceived relational reserves work primarily as a protective force against late-life depressive symptoms and may be particularly important in the context of the cumulative effect of childhood adversities.

•

Socioeconomic reserves can mediate the effect of childhood socioeconomic disadvantage on late-life depressive symptoms.

•

Education turned out to be the strongest mediator.

•

Findings showed a lasting effect of adverse childhood experiences and poor childhood health on late-life depressive symptoms.

•

Relational reserves did not mediate the effect of any of the childhood misfortune indicators on late-life depressive symptoms.

•

Relational reserves were associated with fewer late-life depressive symptoms suggesting a potential protective function.

Examining social determinants of health: the role of education, household arrangements and country groups by gender

Background

The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health.

Methods

Our data source is the 2014 cross-sectional data from the European Survey of Living Conditions (EU-SILC). We calculate the predicted probabilities of poor self-perceived health for the middle-aged European population (30–59 years) as a function of the combination of the two SDHs. This is done separately for five European country groups (dual-earner; liberal; general family support; familistic; and post-socialist transition) and gender.

Results

We observe a double health gradient in all the country groups: first, there is a common health gradient by education (the higher the education, the lower the probability of poor health); second, household arrangements define a health gradient within each educational level according to whether or not the individual lives with a partner (living with a partner is associated with a lower probability of poor health). We observe some specificity in this general pattern. Familistic and post-socialist transition countries display large differences in the predicted probabilities according to education and household arrangements when compared with the other three country groups. Familistic and post-socialist transition countries also show the largest gender differences.

Conclusions

Health differences in European populations seem to be defined, first, by education and, second, by living or not living with a partner. Additionally, different social contexts (gender inequalities, educational profile, etc.) in European countries change the influences on health of both the SDHs for both women and men.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7054-0) contains supplementary material, which is available to authorized users.