Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study

BMJ 1998;316:1631-1635 ( 30 May )

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Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study

George Davey Smith, professor of clinical epidemiology, ^a Carole Hart, statistician, ^b David Blane, reader lecturer in medical sociology, ^c David Hole, principal epidemiologist. ^d

^a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR, ^b Department of Public Health, University of Glasgow, Glasgow G12 8RZ, ^c Division of Neurosciences, Imperial College of Science, Technology and Medicine, London W6 8RP, ^d West of Scotland Cancer Surveillance Unit, Ruchill Hospital, Glasgow G20 9NB

Correspondence to: Professor Davey Smith zetkin{at}bristol.ac.uk

Objective: To investigate the association between social circumstances in childhood and mortality from various causesof death in adulthood.
Design: Prospective observational study.
Setting: 27 workplaces in the west of Scotland.
Subjects: 5645 men aged 35-64 years at the time of examination.
Main outcome measures: Death from various causes.
Results: Men whose fathers had manual occupations when they were children were more likely as adults to have manualjobs and be living in deprived areas. Gradients in mortality fromcoronary heart disease, stroke, lung cancer, stomach cancer, andrespiratory disease were seen (all P<0.05), generally increasingfrom men whose fathers had professional and managerial occupations(social class I and II) to those whose fathers had semiskilledand unskilled manual occupations (social class IV and V). Relativerates of mortality adjusted for age for men with fathers in manualversus non-manual occupations were 1.52 (95% confidence interval1.24 to 1.87) for coronary heart disease, 1.83 (1.13 to 2.94)for stroke, 1.65 (1.12 to 2.43) for lung cancer, 2.06 (0.93 to4.57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratorydisease. Mortality from other cancers and accidental and violentdeath showed no association with fathers' social class. Adjustmentfor adult socioeconomic circumstances and risk factors did notalter results for mortality from stroke and stomach cancer, attenuatedthe increased risk of coronary heart disease and respiratory disease,and essentially eliminated the association with lung cancer.
Conclusions: Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke andstomach cancer in adulthood, which is not due to the continuityof social disadvantage throughout life. Deprivation in childhoodinfluences risk of mortality from coronary heart disease and respiratorydisease in adulthood, although an additive influence of adulthoodcircumstances is seen in these cases. Mortality from lung cancer,other cancer, and accidents and violence is predominantly influencedby risk factors that are related to social circumstances in adulthood.

Key messages

Adverse socioeconomic conditions in childhood are associated with mortality in later life
Mortality from stroke and stomach cancer is particularly dependent on social circumstances in childhood
Mortality from coronary heart disease and respiratory disease is dependent on social circumstances in both adulthood and childhood
Mortality from accidents and violence and from lung cancer is mainly dependent on factors acting in adulthood
The increases in child poverty seen in Britain and elsewhere over the past 20 years may herald unfavourable future trends in adult health

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