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European Journal of Epidemiology

, Volume 28, Issue 2, pp 139–147 | Cite as

Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50–87 years: results from a Swedish birth cohort

  • Gita Devi MishraEmail author
  • Flaminia Chiesa
  • Anna Goodman
  • Bianca De Stavola
  • Ilona Koupil
MORTALITY

Abstract

Both child and adult socio-economic position (SEP) predict adult mortality, but little is known about the variation in the impact of SEP across the life course. The Uppsala Birth Cohort Study is a representative birth cohort born 1915–1929 in Uppsala, Sweden. For the 5,138 males and 5,069 females alive in 1980, SEP was available at birth; in adulthood (age 31–45); and in later life (age 51–65). Follow-up for mortality (all-cause, and circulatory disease) was from 1980 to 2002. To test which life course model best described the association between SEP and mortality, we compared the fit of a series of nested Cox proportional hazards regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. For all-cause mortality in both genders, the sensitive period model best described the influence of SEP across the life course with a heightened effect in later adult life (males: Hazard Ratio (95 % CI) for advantaged SEP: 0.89 (0.81–0.97) at birth, 0.90 (0.81–0.98) in adulthood, 0.74 (0.67–0.82) in later life; females: 0.87 (0.78–0.98), 0.95 (0.86–1.06), 0.73 (0.64–0.83)). The effect of SEP on circulatory diseases mortality in males was cumulative (HR: 0.84 (0.80–0.87) per unit time in advantaged SEP). For circulatory disease mortality among females, a sensitive period model was selected due to SEP in later adult life (HR: 0.64 (0.52–0.80)). These findings suggest that reducing inequality throughout the life course might reduce all-cause and circulatory disease mortality.

Keywords

Socio-economic position Life course Mortality Sweden 

Notes

Acknowledgments

We are grateful to Rawya Mohsen, Bitte Modin and Reidar Österman for help with data management, and to Marit Gisselmann for her input into the classifications of socio economic position. Swedish Research Council and Swedish Council for Working Life and Social Research for funding this project.

Conflict of interest

None declared.

Supplementary material

10654_2013_9777_MOESM1_ESM.doc (30 kb)
Supplementary material 1 (DOC 31 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Gita Devi Mishra
    • 1
    Email author
  • Flaminia Chiesa
    • 2
  • Anna Goodman
    • 2
    • 3
  • Bianca De Stavola
    • 3
  • Ilona Koupil
    • 2
  1. 1.School of Population HealthUniversity of QueenslandBrisbane, HerstonAustralia
  2. 2.Centre for Health Equity Studies (CHESS)Stockholm University/Karolinska InstitutetStockholmSweden
  3. 3.Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK

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