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

BMJ 1998; 316 doi: (Published 30 May 1998) Cite this as: BMJ 1998;316:1631
  1. George Davey Smith (zetkin{at}, professor of clinical epidemiologya,
  2. Carole Hart, statisticianb,
  3. David Blane, reader lecturer in medical sociologyc,
  4. David Hole, principal epidemiologistd
  1. a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR
  2. b Department of Public Health, University of Glasgow, Glasgow G12 8RZ
  3. c Division of Neurosciences, Imperial College of Science, Technology and Medicine, London W6 8RP
  4. d West of Scotland Cancer Surveillance Unit, Ruchill Hospital, Glasgow G20 9NB
  1. Correspondence to: Professor Davey Smith
  • Accepted 4 February 1998


Objective: To investigate the association between social circumstances in childhood and mortality from various causes of 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 manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all P<0.05), generally increasing from men whose fathers had professional and managerial occupations (social class I and II) to those whose fathers had semiskilled and unskilled manual occupations (social class IV and V). Relative rates of mortality adjusted for age for men with fathers in manual versus non-manual occupations were 1.52 (95% confidence interval 1.24 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 to 4.57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratory disease. Mortality from other cancers and accidental and violent death showed no association with fathers' social class. Adjustment for adult socioeconomic circumstances and risk factors did not alter results for mortality from stroke and stomach cancer, attenuated the 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 and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by 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


    • Accepted 4 February 1998
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