The effect of early-life and adult socioeconomic position on development of lifestyle-related diseases.
Adult
Age Factors
Cardiovascular Diseases
/ epidemiology
Denmark
/ epidemiology
Diabetes Mellitus, Type 2
/ epidemiology
Educational Status
Female
Humans
Income
/ statistics & numerical data
Life Style
Male
Occupations
Pulmonary Disease, Chronic Obstructive
/ epidemiology
Risk Assessment
/ methods
Risk Factors
Social Class
Journal
European journal of public health
ISSN: 1464-360X
Titre abrégé: Eur J Public Health
Pays: England
ID NLM: 9204966
Informations de publication
Date de publication:
01 06 2019
01 06 2019
Historique:
pubmed:
18
11
2018
medline:
8
10
2020
entrez:
17
11
2018
Statut:
ppublish
Résumé
Early-life socioeconomic position (SEP) is associated with lifestyle-related diseases in adulthood. However, evidence is lacking on the extent to which adult SEP mediates this association. Time to either chronic obstructive pulmonary disease (COPD), cardiovascular disease or diabetes were assessed in the Danish population born between 1961 and 1971 (n = 793 674) from age 30 until 2015. Early-life position was assessed in 1981 (by parental) and again at age 30 (own) by four markers; income, occupation, education-divided into high, middle, low-and a combined score for all markers. Using a counterfactual approach, we estimated the total effect of early-life position on disease onset and the degree to which adult position mediated this effect. Results of the time-to-event analysis showed a gradient of all early-life markers on the risk of developing all lifestyle-related diseases. Notably, comparing those in the lowest to the highest educational position, the hazard of COPD was 130% higher for women [hazard ratio = 2.30(95% confidence interval = 2.20-2.41)] and 114% higher for men [2.14 (2.05-2.25)]. About 67%(63-70%) of the effect of educational position was mediated through adult position for COPD, 55% for cardiovascular disease and 50% for diabetes. For the combined score 44, 29 and 33%, respectively, was mediated. About one-tenth to two-thirds of the effect of early-life position is mediated by the position attained in adulthood. The degree mediated depend on the outcome investigated, gender and the social position marker used indicating that alternative pathways may play a key role in developing effective policies targeting early-life behaviours.
Sections du résumé
BACKGROUND
Early-life socioeconomic position (SEP) is associated with lifestyle-related diseases in adulthood. However, evidence is lacking on the extent to which adult SEP mediates this association.
METHODS
Time to either chronic obstructive pulmonary disease (COPD), cardiovascular disease or diabetes were assessed in the Danish population born between 1961 and 1971 (n = 793 674) from age 30 until 2015. Early-life position was assessed in 1981 (by parental) and again at age 30 (own) by four markers; income, occupation, education-divided into high, middle, low-and a combined score for all markers. Using a counterfactual approach, we estimated the total effect of early-life position on disease onset and the degree to which adult position mediated this effect.
RESULTS
Results of the time-to-event analysis showed a gradient of all early-life markers on the risk of developing all lifestyle-related diseases. Notably, comparing those in the lowest to the highest educational position, the hazard of COPD was 130% higher for women [hazard ratio = 2.30(95% confidence interval = 2.20-2.41)] and 114% higher for men [2.14 (2.05-2.25)]. About 67%(63-70%) of the effect of educational position was mediated through adult position for COPD, 55% for cardiovascular disease and 50% for diabetes. For the combined score 44, 29 and 33%, respectively, was mediated.
CONCLUSION
About one-tenth to two-thirds of the effect of early-life position is mediated by the position attained in adulthood. The degree mediated depend on the outcome investigated, gender and the social position marker used indicating that alternative pathways may play a key role in developing effective policies targeting early-life behaviours.
Identifiants
pubmed: 30445458
pii: 5183305
doi: 10.1093/eurpub/cky237
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
562-567Informations de copyright
© The Author 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.