Midlife: Data from a Nationally-Representative Study of

Social Science & Medicine, 2006

Research shows that lifetime socioeconomic circumstances are associated with adult health. Yet most studies to date have focused on mortality and additional data on morbidity outcomes are needed. Additionally, most research in this area was based in the Northern European countries or the United States, and little is known about the extent of socioeconomic inequalities in health in other industrialized countries with different health and labour market characteristics. In this study, we examined the relationship between the socioeconomic trajectory from childhood to adulthood and functional limitations in midlife in France. We used data from a nationally-representative sample of French men and women (the Life History survey) conducted in 2002-2003. Participants (n=4798) were 35-64 years of age at the time of the survey. Father"s occupation when the participant was 15 years of age, lifelong job histories and functional limitations were reported to trained interviewers. Standardized Morbidity Ratios (SMRs) associated with different lifelong trajectories were estimated using indirect age standardisation. Overall, the socioeconomic trajectory from childhood to adulthood was associated with functional limitations in midlife in both men and women. The experience of lifelong socioeconomic disadvantage was associated with SMRs of 1.44, p=<0.0001 in men and 1.21, p=0.0207 in women. In men, the prevalence of functional limitations was low among those who experienced an upward intergenerational mobility (SMR: 0.67, p=0.015) and high among those who experienced a downward career trajectory (SMR: 1.79, p=0.007). Additionally, the prevalence of functional limitations was elevated among men and women who experienced unemployment. These findings indicate that in French men and women, lifetime socioeconomic circumstances are associated with functional limitations in midlife. Understanding the mechanisms that underlie these health disparities will require additional studies of specific health outcomes.

Objective: To measure the childhood and life course socioeconomic exposures of people born between 1871 and 1949, and then to estimate the probability of death between 1965 and 1994, the probability of functional limitation in 1994, and the combined probability of dying or experiencing functional limitation during this period. Setting, participants and design: Data were from the Alameda County Study (California) and pertained to people aged 17-94 years (n = 6627) in 1965 (baseline). Socioeconomic position (SEP) in childhood was based on respondent's reports of their father's occupation, and life course disadvantage was measured by cross-classifying childhood SEP and the respondent's education and household income in 1965. The health outcomes were all-cause mortality (n = 2420) and functional limitation measured using the Nagi index (n = 453, 17.4% of those alive in 1994). Relationships were examined before and after adjustment for changed socioeconomic circumstances after 1965. Results: Those from a low SEP in childhood, and those exposed to a greater number of episodes of disadvantage over the life course before 1965, were subsequently more likely to die, to report functional limitation and to experience the greatest health-related burden. Conclusions: All-cause mortality, functional limitation and overall health-related burden in middle and late adulthood are shaped by socioeconomic conditions experienced during childhood and cumulative disadvantage over the life course. The contributions made to adult health by childhood SEP and accumulated disadvantage suggest that each constitutes a distinct socioeconomic influence that may require different policy responses and intervention options.

The Journals …, 2006

Background. Socioeconomic status (SES) affects health outcomes at all stages of life. Relating childhood socioeconomic environment to midlife functional status provides a life course perspective on childhood factors associated with poor and good health status later in life. Methods. The British 1946 birth cohort was prospectively evaluated with periodic examinations from birth through age 53 years, when physical performance tests assessing strength, balance, and rising from a chair were administered. Early childhood socioeconomic factors were examined as predictors of low, middle, or high function at midlife. We tested the hypothesis that adulthood behavioral risk factors would explain the childhood SES-midlife physical function associations.

Objective: To measure the childhood and life course socioeconomic exposures of people born between 1871 and 1949, and then to estimate the probability of death between 1965 and 1994, the probability of functional limitation in 1994, and the combined probability of dying or experiencing functional limitation during this period. Setting, participants and design: Data were from the Alameda County Study (California) and pertained to people aged 17-94 years (n = 6627) in 1965 (baseline). Socioeconomic position (SEP) in childhood was based on respondent's reports of their father's occupation, and life course disadvantage was measured by cross-classifying childhood SEP and the respondent's education and household income in 1965. The health outcomes were all-cause mortality (n = 2420) and functional limitation measured using the Nagi index (n = 453, 17.4% of those alive in 1994). Relationships were examined before and after adjustment for changed socioeconomic circumstances after 1965. Results: Those from a low SEP in childhood, and those exposed to a greater number of episodes of disadvantage over the life course before 1965, were subsequently more likely to die, to report functional limitation and to experience the greatest health-related burden. Conclusions: All-cause mortality, functional limitation and overall health-related burden in middle and late adulthood are shaped by socioeconomic conditions experienced during childhood and cumulative disadvantage over the life course. The contributions made to adult health by childhood SEP and accumulated disadvantage suggest that each constitutes a distinct socioeconomic influence that may require different policy responses and intervention options.

2006

Objective: To measure the childhood and life course socioeconomic exposures of people born between 1871 and 1949, and then to estimate the probability of death between 1965 and 1994, the probability of functional limitation in 1994, and the combined probability of dying or experiencing functional limitation during this period. Setting, participants and design: Data were from the Alameda County Study (California) and pertained to people aged 17-94 years (n = 6627) in 1965 (baseline). Socioeconomic position (SEP) in childhood was based on respondent's reports of their father's occupation, and life course disadvantage was measured by cross-classifying childhood SEP and the respondent's education and household income in 1965. The health outcomes were all-cause mortality (n = 2420) and functional limitation measured using the Nagi index (n = 453, 17.4% of those alive in 1994). Relationships were examined before and after adjustment for changed socioeconomic circumstances after 1965. Results: Those from a low SEP in childhood, and those exposed to a greater number of episodes of disadvantage over the life course before 1965, were subsequently more likely to die, to report functional limitation and to experience the greatest health-related burden. Conclusions: All-cause mortality, functional limitation and overall health-related burden in middle and late adulthood are shaped by socioeconomic conditions experienced during childhood and cumulative disadvantage over the life course. The contributions made to adult health by childhood SEP and accumulated disadvantage suggest that each constitutes a distinct socioeconomic influence that may require different policy responses and intervention options.

Social Science & Medicine, 2009

This study examines the joint and separate contribution of social class in early and adult life to differences in health and physical function in middle-aged men. We use data from the Metropolit project which includes men born in 1953 in Copenhagen and a study of middle-aged Danish twins (MADT). In total 6292 Metropolit participants in a follow-up survey on health in 2004 were included in the study together with 2198 male twins of which 1294 were part of a male twin pair (N = 647 pairs). Logistic regression was used to investigate the association between social class in early and adult life, respectively and health in midlife, measured as limitations in running 100 m, poor dental status, poor self-rated health, and fatigue. In both datasets, men with low childhood or adult social class had a higher risk of being unable to run 100 m, having poor dental status, having poor selfrated health and fatigue than men from the highest social classes. When childhood and adult social class were mutually adjusted, the estimates for both measures were attenuated. Adjustment for living without a partner, body mass index (BMI) and smoking in midlife, which were also related to the four outcomes, had marginal effects on the estimates for childhood social class, but attenuated the effect of adult social class somewhat. Among male twin pairs discordant on adult social class, the twin in the lowest class seemed to be unable to run 100 m, rate own health poorer and being fatigued more often than the high class co-twin, while there seemed to be no twin pair difference in dental status. This suggests that the associations of adult social class with functional limitations, poor selfrated health and fatigue may partly be due to causal effects related to adult social class exposures, while social class differences in dental status might be consistent with an effect of factors mainly operating early in life.

International Journal of Epidemiology, 2003

International Journal for Equity in Health, 2012

Introduction: Health and functional capacity have improved especially in Western countries over the past few decades. Nevertheless, the positive secular trend has not been able to decrease an uneven distribution of health. The main aim of this study was to follow-up changes in functional capacity among the same people in six years time and to detect whether the possible changes vary according to socioeconomic position (SEP). In addition, it is of interest whether health behaviours have an effect on these possible changes. Methods: This longitudinal follow-up study consisted of 1,898 individuals from three birth cohorts (1926-1930, 1936-40, 1946-50) who took part in clinical checkups and answered to a survey questionnaire in 2002 and 2008. A sub-scale of physical functioning from the RAND-36 was used to measure functional capacity. Education and adequacy of income were used as indicators of socioeconomic position. Repeated-measures ANOVA was used as a main method of analysis. Results: Physical functioning in 2002 and 2008 was poorest among those men and women belonging to the oldest cohort. Functional capacity deteriorated in six years among men in the oldest cohort and among women in all three cohorts. Socioeconomic disparities in functional capacity among ageing people existed. Especially lower adequacy of income was most consistently associated with poorer functional capacity. However, changes in functional capacity by socioeconomic position remained the same or even narrowed independent of health behaviours. Conclusion: Socioeconomic disparities in physical functioning are mainly incorporated in the level of functioning at the baseline. No widening socioeconomic disparities in functional capacity exist. Partly these disparities even seem to narrow with ageing.

International Journal of Epidemiology, 2004

Background Recent research in social epidemiology has established the importance of considering the accumulation of advantage and disadvantage across the life course when examining adult health outcomes. This paper examines (1) accumulation across trichotomous categories of socioeconomic position (SEP), and (2) accumulation in analysis stratified by adult SEP.

The Journals of Gerontology: Series B, 2014

Objectives. Using data from the Wisconsin Longitudinal Study, we examine (a) how socioeconomic status (SES) at age 18 affects all-cause mortality at ages 54-72, and (b) whether the effect of early-life SES is consistent with the critical period, accumulation of risks, social mobility, and pathway models. We also explore gender differences in the effect of early-life SES and life-course mechanisms.