Background: A large part of the socioeconomic
mortality gradient can be statistically accounted for by
social patterning of adult health behaviours. However,
this statistical explanation does not consider the early life
origins of unhealthy behaviours and increased mortality
risk.
Methods: Analysis is based on 2132 members of the
MRC National Survey of Health and Development with
mortality follow-up and complete data. Smoking
behaviour was summarised by pack-years of exposure.
Socioeconomic circumstances were measured in
childhood (father’s social class (age 4), maternal
education (age 6)) and age 26 (education attainment,
home ownership, head of household social class). We
estimated the direct effect of early circumstances, the
indirect effect through smoking and the independent
direct effect of smoking on inequality in all-cause
mortality from age 26 to 66.
Results: Mortality risk was higher in those with lower
socioeconomic position at age 26, with a sex-adjusted
HR (relative index of inequality) of 1.97 (95% CI 1.18 to
3.28). Smoking and early life socioeconomic indicators
together explained 74% of the socioeconomic gradient
in mortality (the gradient). Early life circumstances
explained 47% of the gradient, 23.5% directly and
23.0% indirectly through smoking. The explanatory
power of smoking behaviour for the gradient was
reduced from 50.8% to 28% when early life
circumstances were added to the model.
Conclusions: Early life socioeconomic circumstances
contributed importantly to social inequality in adult
mortality. Our life-course model focusing on smoking
provides evidence that social inequalities in health will
persist unless prevention strategies tackle the
intergenerational transmission of disadvantage and risk.
Presented by:
Eric Brunner (UCL)
Date & time:
January 20, 2014 4:00 pm - January 20, 2014 5:30 pm
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