Life-course influences on health in British adults: effects of socio-economic position in childhood and adulthood

TLDR

Early life socioeconomic position has been poorly studied for its impact on adult disease beyond cardiovascular mortality, with most evidence being retrospective. The study aimed to determine whether childhood socioeconomic position independently affects mid‑life disease risk, distinct from adult socioeconomic position, across a range of health outcomes. Using the 1958 British birth cohort, 9,377 adults were followed prospectively to age 45, with measurements of blood pressure, BMI, HbA1c, lipids, fibrinogen, IgE, lung function, hearing, vision, depression, anxiety, and chronic pain to assess associations with childhood and adult social class. After adjusting for both childhood and adult class, each independently predicted poorer health at mid‑life, with childhood class effects as strong as adult class and those with manual class at both stages showing the greatest deficits.

Abstract

Little evidence exists on the role of socio-economic position (SEP) in early life on adult disease other than for cardiovascular mortality; data is often retrospective. We assess whether childhood SEP influences disease risk in mid-life, separately from the effect of adult position, and establish how associations vary across multiple measures of disease risk.Prospective follow-up to adulthood of all born in England, Scotland and Wales during 1 week in 1958, and with medical data at age 45 years (n = 9377). Outcomes include: blood pressure, body mass index (BMI), glycosylated haemoglobin (HbA1c), total and high density lipoprotein (HDL) cholesterol, triglycerides, fibrinogen, total immunoglobulin E (IgE), one-second forced expiratory volume (FEV1), hearing threshold (4 kHz), visual impairment, symptoms of depression and anxiety, chronic widespread pain.Social class in childhood was associated with blood pressure, BMI, HbA1c, HDL cholesterol, triglycerides, fibrinogen, FEV1, hearing threshold, depressive symptoms and chronic widespread pain, with a general trend of deteriorating health from class I to V. Adult social class was also associated with these measures. Mutually adjusted analyses of child and adult social class suggest that both contribute to disease risk in mid-life: in general, associations for childhood class were as strong as for adult class. Individuals with a manual class at both time-points tended to have the greatest health deficits in adulthood.Adverse SEP in childhood is associated with a poorer health profile in mid-adulthood, independently of adult social position, and across diverse measures of disease risk and physical and mental functioning.