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Cumulative Childhood Adversity, Educational Attainment, and Active Life Expectancy Among U.S. Adults

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Demography

Abstract

Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998–2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50–100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels.

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Notes

  1. Comparisons of the deaths uncovered via the HRS tracker files and deaths uncovered via the NDI matching algorithm in the HRS found that the algorithm fails to capture some deaths and depresses mortality rates, especially among minority status women at older ages.

  2. Although the three experiences—childhood health, childhood SES, and educational attainment—are correlated, the magnitude did not cause collinearity concerns. Kendall Tau’s correlation using the person-year file was .09 (p < .0001) between childhood health and SES, –.06 (p < .0001) between childhood health and educational attainment, and –.32 (p < .0001) between childhood SES and educational attainment.

  3. Our data structure assumes that all transitions—functional and deaths—occur at the end of each year, except when death censors a functional transition. In that case, death is assumed to occur midyear. For example, suppose the transition of interest is from healthy to functional limitations between the 1998 and 2000 waves. Among respondents who were healthy in 1998 but reported limitations in 2000, we randomly assign one-half to transition at the end of 1998 (exposure = 1 and transition = 1 in 1998, and exposure = 0 and transition = 0 in 1999) and the other half to transition at the end of 1999 (exposure = 1 and transition = 0 in 1998, and exposure = 1 and transition = 1 in 1999). Respondents who were healthy in 1998 but died in 1999 were assigned exposure = 1 and transition = 0 in 1998, and exposure = 0.5 and transition = 0 in 1999. If they died in 1998, they were assigned exposure = 0.5 and transition = 0 in 1998.

  4. We tested a variety of functional forms of the association between age and the risk of disability incidence and mortality. For all transitions, a (ln)linear specification was the best fitting functional form.

  5. For example, white women from disadvantaged childhoods could expect to live an additional 28.8 years if they had 0–11 years of education versus 32.9 years if they had a college degree, which is a gain of 4.1 years. The gain among white women from advantaged childhoods was 6.4 years. Thus, a college degree conferred 2.3 more years of life for white women from advantaged childhoods compared with their peers from disadvantaged childhoods. The gains were 2.1 for black women, 1.2 for white men, and 1.4 for black men. The differential gains for active life expectancy were 3.3 for white women, 3.5 for black women, 2.1 for white men, and 2.0 for black men.

  6. The total life expectancy gap between the upwardly and downwardly mobile was also slightly smaller for women (3.8 years for white men, 4.2 years for black men, 2.9 years for white women, and 3.7 years for black women).

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Acknowledgments

Jennifer Karas Montez thanks the Robert Wood Johnson Foundation Health & Society Scholars program for its financial support. This study was also supported by Grant 1 R01-HD053696 (PI Robert A Hummer) and Grant 5 R24 HD042849 awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors thank the Editor and two anonymous reviewers for thoughtful critiques and suggestions. A previous version of this article was presented at the 2012 annual meeting of the Population Association of America, and the 2012 Aging with Disability Conference supported by Grants P30 AG034464 awarded to Syracuse University and P30 AG012846 awarded to the University of Michigan from the National Institute on Aging.

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  1. Department of Sociology, Case Western Reserve University, 223 Mather Memorial Building, Cleveland, OH, 44106, USA

    Jennifer Karas Montez

  2. Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX, USA

    Mark D. Hayward

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  1. Jennifer Karas Montez
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Correspondence to Jennifer Karas Montez.

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Montez, J.K., Hayward, M.D. Cumulative Childhood Adversity, Educational Attainment, and Active Life Expectancy Among U.S. Adults. Demography 51, 413–435 (2014). https://doi.org/10.1007/s13524-013-0261-x

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