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.
Similar content being viewed by others
References
Davey Smith G, Hart C, Blane D, Gillis C, Hawthorne V. Lifetime socioeconomic position and mortality: prospective observational study. BMJ. 1997;314(7080):547–52.
Galobardes B, Lynch JW, Smith GD. Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review. J Epidemiol Community Health. 2008;62(5):387–90.
Beebe-Dimmer J, Lynch JW, Turrell G, Lustgarten S, Raghunathan T, Kaplan GA. Childhood and adult socioeconomic conditions and 31-year mortality risk in women. Am J Epidemiol. 2004;159(5):481–90.
Claussen B, Davey SG, Thelle D. Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo mortality Study. J Epidemiol Community Health. 2003;57(1):40–5.
Pollitt RA, Rose KM, Kaufman JS. Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review. BMC Public Health. 2005;5:7.
Kuh D, Ben Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003;57(10):778–83.
Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges, and interdisciplinary perspectives. Int J Epidemiol. 2002;31:285–93.
Rosvall M, Chaix B, Lynch J, Lindstrom M, Merlo J. Similar support for three different life course socioeconomic models on predicting premature cardiovascular mortality and all-cause mortality. BMC Public Health. 2006;6:203.
Hallqvist J, Lynch J, Bartley M, Lang T, Blane D. Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Soc Sci Med. 2004;58(8):1555–62.
Mishra G, Nitsch D, Black S, De Stavola B, Kuh D, Hardy R. A structured approach to modelling the effects of binary exposure variables over the life course. Int J Epidemiol. 2009;38(2):528–37.
Koupil I. The Uppsala studies on developmental origins of health and disease. J Intern Med. 2007;261(5):426–36.
Koupil I, Modin B, Byberg L, Fritzell J, Vagero D. Early and adult life social influences on circulatory disease mortality. Eur J Public Health. 2004;14(Suppl. 4):45.
Vagero D, Modin B. Prenatal growth, subsequent marital status, and mortality: longitudinal study. BMJ. 2002;324(7334):398.
Goodman A, Koupil I. Social and biological determinants of reproductive success in Swedish males and females born 1915–1929. Evol Hum Behav. 2009;30(5):329–41.
Statistics Sweden. Meddelanden i samordningsfrŒgor [Report on co-ordination issues] 5. Stockholm: Statistics Sweden; 1989.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.
Naess O, Claussen B, Thelle DS, Davey SG. Cumulative deprivation and cause specific mortality. A census based study of life course influences over three decades. J Epidemiol Community Health. 2004;58(7):599–603.
Naess O, Strand BH, Smith GD. Childhood and adulthood socioeconomic position across 20 causes of death: a prospective cohort study of 800,000 Norwegian men and women. J Epidemiol Community Health. 2007;61(11):1004–9.
Strand BH, Kunst A. Childhood socioeconomic position and cause-specific mortality in early adulthood. Am J Epidemiol. 2007;165(1):85–93.
Turrell G, Lynch JW, Leite C, Raghunathan T, Kaplan GA. Socioeconomic disadvantage in childhood and across the life course and all-cause mortality and physical function in adulthood: evidence from the Alameda county study. J Epidemiol Community Health. 2007;61(8):723–30.
Kuh D, Hardy R, Langenberg C, Richards M, Wadsworth ME. Mortality in adults aged 26–54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study. BMJ. 2002;325(7372):1076–80.
Power C, Hypponen E, Smith GD. Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort. Am J Public Health. 2005;95(8):1396–402.
Tiikkaja S, Hemstrom O, Vagero D. Intergenerational class mobility and cardiovascular mortality among Swedish women: a population-based register study. Soc Sci Med. 2009;68(4):733–9.
Claussen B, Smits J, Naess O, Davey SG. Intragenerational mobility and mortality in Oslo: social selection versus social causation. Soc Sci Med. 2005;61(12):2513–20.
Naess O, Claussen B, Davey SG. Relative impact of childhood and adulthood socioeconomic conditions on cause specific mortality in men. J Epidemiol Community Health. 2004;58(7):597–8.
Pensola TH, Martikainen P. Cumulative social class and mortality from various causes of adult men. J Epidemiol Community Health. 2003;57(9):745–51.
Davey Smith G, Hart C, Blane D, Hole D. Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study. BMJ. 1998;316(7145):1631–5.
Erokson R. Social class assignment and mortality in Sweden. Soc Sci Med. 2006;62(9):2151–60.
Gendell M. Trends in retirement age in four countries, 1965–95. Monthly labour review 1998; August 20–30.
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.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mishra, G.D., Chiesa, F., Goodman, A. et al. 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. Eur J Epidemiol 28, 139–147 (2013). https://doi.org/10.1007/s10654-013-9777-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-013-9777-z