Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study

doi:10.1136/bmj.325.7372.1076

BMJ 2002;325:1076-1080 ( 9 November )

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Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study

Diana Kuh, epidemiologist, Rebecca Hardy, medical statistician, Claudia Langenberg, physician, Marcus Richards, psychologist, Michael E J Wadsworth, director.

Medical Research Council National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free and University College London, London WC1E 6BT

Correspondence to: D Kuh d.kuh{at}ucl.ac.uk

Objective: To examine premature mortality in adults inrelation to socioeconomic conditions in childhood andadulthood.
Design: Nationally representative birth cohort studywith prospective information on socioeconomicconditions.
Setting: England, Scotland, andWales.
Study members: 2132 women and 2322 men born in March 1946and followed until age 55years.
Main outcome measures: Deaths between 26 and 54 years of age notifiedby the NHS centralregister.
Results: Study members whose father's occupation wasmanual at age 4, or who lived in the worst housing, or who receivedthe poorest care in childhood had double the death rate duringadulthood of those living in the best socioeconomic conditions.All indicators of socioeconomic disadvantage at age 26 years,particularly lack of home ownership, were associated with a higherdeath rate. Manual origins and poor care in childhood remainedassociated with mortality even after adjusting for social classin adulthood or home ownership. The hazard ratio was 2.6 (95%confidence interval 1.5 to 4.4) for those living in manual householdsas children and as adults compared with those living in non-manualhouseholds at both life stages. The hazard ratio for those frommanual origins who did not own their own home at age 26 yearswas 4.9 (2.3 to 10.5) compared with those from non-manual originswho were homeowners.
Conclusions: Socioeconomic conditions in childhood as wellas early adulthood have strongly influenced the survival of Britishpeople born in the immediate post warera.

What is already known on this topic
Associations between socioeconomic conditions in childhood and mortality in adulthood suggest that risks to survival begin in early life

Studies have been generally retrospective, been unrepresentative, used only one marker of childhood conditions, controlled inadequately for adult conditions, or not included women

What this study adds
The death rate for women and men between 26 and 54 years living in poor socioeconomic conditions in childhood was double that of those living in the best conditions

Those for whom socioeconomic disadvantage continued into early adulthood were between three and five times more likely to die than those in the most advantageous conditions

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