Socioeconomic disadvantage in childhood and across the life course and all-cause mortality and physical function in adulthood: evidence from the Alameda County Study

Abstract

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.