The development of life course epidemiology

Child Maltreatment and Metabolic Syndrome: A Systematic Review

Background

Evidence suggests that child maltreatment (CM) is associated with an elevated risk of adult diseases in later life. Emerging evidence shows that CM in childhood is associated with metabolic syndrome (MetS) in adulthood. However, no study has systematically examined the evidence. Hence, this review aims to synthesise the evidence on the association between forms of CM and MetS in adulthood.

Methods

Electronic databases of CINAHL, Medline, PsychInfo, SOCINDEX, and Scopus were systematically searched using predefined key terms to identify relevant published studies on the association between CM and MetS from the beginning of indexing to 1st January 2024. Studies were included if they met the selection criteria. The quality of studies was appraised using suitable criteria for cross-sectional and prospective studies.

Results

The search revealed a total of 2411 studies. Five studies met the inclusion criteria and were included in the review. The findings revealed that there was an association between physical abuse and MetS in women across two studies and one study in men. In addition, one study reported an association between emotional abuse and the risk of MetS in men, while two studies revealed increased odds with CM. However, no significant associations were reported between MetS and childhood sexual abuse and neglect, respectively.

Conclusion

These findings suggest that some forms of CM may increase a person's risk of having MetS. However, there is a need for methodological improvements due to heterogeneity in studies, mainly on the assessment and definition of CM. Further research is needed on forms of CM and MetS to understand the underlying mechanisms of the associations found and to identify targeted strategies to prevent the impact of CM on MetS and subsequent future health.

How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis

AIMS

To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature.

DESIGN

This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory.

METHODS

Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography.

RESULTS

We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan.

CONCLUSION

Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care.

IMPACT

Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.

A lifecourse approach in examining the association between accumulation of adversity and mental health in older adulthood

BACKGROUND

There is evidence for a cumulative effect of adversities on mental health, however, less is known on the accumulating duration of exposure to adversity across the lifecourse on mental health in older adults.

METHODS

Using data from the 1946 British birth cohort study (N = 2745), we examined associations between the accumulation of adversity (birth-63 years) and mental health (emotional symptom, life satisfaction, affective wellbeing) in older adults (63-69 years). Accumulation of adversity was assessed as the number of adversities and duration of exposure (number of lifecourse stages exposed to any, economic, psychosocial, or physical adversity). Linear regression tested their association with mental health, adjusted for sex, childhood cognition and emotional problems, and educational attainment.

RESULTS

Increased number of adversities was associated with increased emotional symptoms (β = 0.08 [0.06, 0.10]), decreased life satisfaction (β = -0.14 [-0.16, -0.12]) and decreased affective wellbeing (β = -0.08 [-0.10, -0.06]). Each additional duration of exposure was associated with a 0.38 [0.12, 0.65] standard deviation (SD) increase in emotional symptoms, and a - 0.68 [-0.96, -0.39] and -0.43 SD [-0.68, -0.18] decrease in life satisfaction and affective wellbeing, respectively. Life satisfaction showed stronger associations with economic and psychosocial compared to physical adversity.

LIMITATIONS

Some limitations include selective drop-out and lack of ethnic diversity.

CONCLUSIONS

Efforts to improve mental health in older adults should focus on reducing the number of adversities, as well as considering previous exposure across different lifecourse stages, to prevent adversities from becoming chronic. Future research should also consider the clustering and co-occurrence of different adversities across the lifecourse.

Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study

Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages.

A National Strategy for Preventing Substance and Opioid Use Disorders Through Evidence-Based Prevention Programming that Fosters Healthy Outcomes in Our Youth

The recently released National Drug Control Strategy (2022) from the White House Office of National Drug Control Policy (ONDCP) lays out a comprehensive plan to, not only enhance access to treatment and increase harm reduction strategies, but also increase implementation of evidence-based prevention programming at the community level. Furthermore, the Strategy provides a framework for enhancing our national data systems to inform policy and to evaluate all components of the plan. However, not only are there several missing components to the Strategy that would assure its success, but there is a lack of structure to support a national comprehensive service delivery system that is informed by epidemiological data, and trains and credentials those delivering evidence-based prevention, treatment, and harm reduction/public health interventions within community settings. This paper provides recommendations for the establishment of such a structure with an emphasis on prevention. Systematically addressing conditions known to increase liability for behavioral problems among vulnerable populations and building supportive environments are strategies consistently found to avert trajectories away from substance use in general and substance use disorders (SUD) in particular. Investments in this approach are expected to result in significantly lower rates of SUD in current and subsequent generations of youth and, therefore, will reduce the burden on our communities in terms of lowered social and health systems involvement, treatment needs, and productivity. A national strategy, based on strong scientific evidence, is presented to implement public health policies and prevention services. These strategies work by improving child development, supporting families, enhancing school experiences, and cultivating positive environmental conditions.

Life course traumas and cardiovascular disease-the mediating role of accelerated aging

The complex relationship between life course traumas and cardiovascular disease (CVD) and the underpinning pathways are poorly understood. We aimed to (1) examine the associations of three separate assessments including childhood, adulthood (after 16 years of age), and lifetime traumas (childhood or adulthood) with CVD; (2) examine the associations between diverse life course traumatic profiles and CVD; and (3) examine the extent to which PhenoAge, a well-developed phenotypic aging measure, mediated these associations. Using data from 104,939 participants from the UK Biobank, we demonstrate that subgroups of childhood, adulthood, and lifetime traumas were associated with CVD. Furthermore, life course traumatic profiles were significantly associated with CVD. For instance, compared with the subgroup experiencing nonsevere traumas across life course, those who experienced nonsevere childhood and severe adulthood traumas, severe childhood and nonsevere adulthood traumas, or severe traumas across life course had significantly higher odds of CVD (odds ratios: 1.07-1.33). Formal mediation analyses suggested that phenotypic aging partially mediated the above associations. These findings suggest a potential pathway from life course traumas to CVD through phenotypic aging, and underscore the importance of policy programs targeting traumas over the life course in ameliorating inequalities in cardiovascular health.

Naturopathic patient care during different life stages: an international observational study of naturopathic practitioners and their patients

BACKGROUND

An individual's health status varies with age, with most health problems increasing through different life stages. Yet, a key feature of the majority of conditions contributing burden to society globally, irrespective of life stage, is the predominance of chronic, non-communicable diseases (NCDs). An important response to this growing burden is the increasing recognition of addressing NCD prevention through a life-course perspective through primary care and public health. Naturopathy is a traditional medicine system originating from Europe, and its practitioners commonly provide primary care and focus on prevention and wellness. However, little is known about naturopathic practitioners (NPs) contribution to health care across different life stages.

METHODS

This secondary analysis of a cross-sectional study aimed to describe the approach to the care of NPs based on the life stage of their patients. The primary study recruited NPs from 14 regions or countries, who were invited to complete a short survey about 20 consecutive patients. The multilingual survey included the following domains: patient demographics, reason for visit, prescribed or recommended treatments, and naturopathic interpretation of the health conditions. Descriptive statistics were tabulated as frequencies and percentages and chi square tests were used to test associations and compare groups. Effect size was determined by Cramer's V.

RESULTS

Participant NPs (n = 56) provided consultation details for 854 patients encounters. There were differences in the patient's primary reason for visiting, the additional physiological systems the NP considered important in the management of the patient's health, and the treatments prescribed across all life stages. However, diet (45.1-70.0%) and lifestyle (14.3-60.0%) prescription were the most common categories of treatments across all patient groups.

CONCLUSION

NPs provide care to patients across all life stages, and diverse conditions pertinent to those life stages while also demonstrating a holistic approach that considers broader health concerns and long term treatment practices. While there may be emerging evidence supporting and informing NP clinical outcomes, the breadth and diversity of health conditions, populations and treatments within the scope of naturopathic practice underscores a need for urgent and widescale research investigating naturopathic care across the life course.

Life course socioeconomic conditions and multimorbidity in old age - A scoping review

Multimorbidity disproportionally affects individuals exposed to socioeconomic disadvantage. It is, however, unclear how adverse socioeconomic conditions (SEC) at different periods of the life course predict the occurrence of multimorbidity in later life. In this scoping review, we investigate the association between life course SEC and later-life multimorbidity, and assess to which extent it supports different life course causal models (critical period, sensitive period, accumulation, pathway, or social mobility). We identified four studies (25,209 participants) with the first measure of SEC in childhood (before age 18). In these four studies, childhood SEC was associated with multimorbidity in old age, and the associations were partially or fully attenuated upon adjustment for later-life SEC. These results are consistent with the sensitive period and the pathway models. We identified five studies (91,236 participants) with the first measure of SEC in young adulthood (after age 18), and the associations with multimorbidity in old age as well as the effects of adjustment for later-life SEC differed from one study to the other. Among the nine included studies, none tested the social mobility or the accumulation models. In conclusion, SEC in early life could have an effect on multimorbidity, attenuated at least partly by SEC in adulthood.

Life Course Nature Exposure and Mental Health Outcomes: A Systematic Review and Future Directions

Recently, an emerging body of literature has examined the relationships between early life nature exposure and mental health in later life; however, no critical synthesis yet exists regarding the extent and strength of these relationships. This study presents the first systematic review of studies in this growing area. Following the PRISMA framework, we searched six databases (i.e., Scopus, Web of Science, MEDLINE, Embase, PsycINFO, and CINAHL); conducted identification, screening, eligibility, and inclusion analyses; and identified a final set of 29 articles. The review set comprises primarily longitudinal studies, with several cross-sectional studies using retrospective measures of childhood nature exposure. The majority of included studies were published between 2016 and 2020 and conducted in Europe and North America. Five domains of mental health outcomes are associated with early-life nature exposure: incidence of mental disorders, psychiatric symptoms and emotions, conduct problems in children, cognitive function, and subjective well-being. The evidence lends support to an overall beneficial role of early nature exposure on mental health, although inconsistencies are reported. Taken together, the evidence does not suggest that exposure at any given life stage is more saliently associated with mental health outcomes than at others. We discuss the validity concerns and methodological remedies and offer directions for future research.

Optimising child and adolescent health and development through an integrated ecological life course approach

Fully realising the potential of children and adolescents will require an ecological life course approach, together with multisectoral, coordinated, integrated action for the provision of care and services for children and adolescents, argue Mark Tomlinson and colleagues

Is milk and dairy intake a preventive factor for elderly cognition (dementia and Alzheimer's)? A quality review of cohort surveys

Milk and dairy (M&D) is a longstanding human food with widespread use. Many studies showed the preventive capacity of M&D in several human health disorders, but its utility in others is under discussion. Aging has been associated to elderly cognitive decline including dementia-Alzheimer syndrome (Dem-AD). The absence of a therapy to impede or postpone Dem-AD determines the need for its prevention, including nutritional factors. To evaluate the preventive capacity of M&D consumption in elderly Dem-AD we performed a systematic review in the main biomedical databases and information resources, but we present this study as a narrative review to discuss better the complexity of this subject. The elderly Dem-AD has a long pre-symptomatic period and the M&D intake has a widespread use. These determinants and the quality flaws of published studies impeach us to answer whether M&D consumption is preventive for Dem-AD. Moreover, two long Japanese cohorts suggest that M&D intake could prevent Dem-AD. Prospective cohorts beginning in midlife (or early life) could answer this question in the future.

Inequality of opportunities in health and death: an investigation from birth to middle age in Great Britain

Objective

We assess the existence of unfair inequalities in health and death using the normative framework of inequality of opportunities, from birth to middle age in Great Britain.

Methods

We use data from the 1958 National Child Development Study, which provides a unique opportunity to observe individual health from birth to the age of 54, including the occurrence of mortality. We measure health status combining self-assessed health and mortality. We compare and statistically test the differences between the cumulative distribution functions of health status at each age according to one childhood circumstance beyond people’s control: the father’s occupation.

Results

At all ages, individuals born to a ‘professional’, ‘senior manager or technician’ father report a better health status and have a lower mortality rate than individuals born to ‘skilled’, ‘partly skilled’ or ‘unskilled’ manual workers and individuals without a father at birth. The gap in the probability to report good health between individuals born into high social backgrounds compared with low, increases from 12 percentage points at age 23 to 26 at age 54. Health gaps are even more marked in health states at the bottom of the health distribution when mortality is combined with self-assessed health.

Conclusions

There is increasing inequality of opportunities in health over the lifespan in Great Britain. The tag of social background intensifies as individuals get older. Finally, there is added analytical value to combining mortality with self-assessed health when measuring health inequalities.

Depression in women and men, cumulative disadvantage and gender inequality in 29 European countries

Macro-sociological theories stress the contribution of gender inequality to this gender gap in depression, while cumulative advantage/disadvantage theory (CAD) reminds us that mental health inequalities accumulate over the life course. We explore the complementarity of both perspectives in a variety of European countries using data of the European Social Survey (2006 2012, 2014, N of countries = 29; N of men = 53,680 and N of women = 63,103) and using an 8-item version of the CES-D. Results confirm that the relevance of gender stratification for the mental health of women and men in Europe depends on age. The gender gap is nearly absent amongst adults in their twenties in the most gender equal countries, while an impressive gender gap is present amongst older adults in gender unequal countries, in accordance with CAD theory. These effects occur on top of the mental health consequences of taking up work and family roles at various life stages. The convergence of the results predicted by gender stratification and cumulative disadvantage theories strengthen the case for the link between gender, disadvantage and depression.

Interventions across the Retirement Transition for Improving Well-Being: A Scoping Review

(1) Background: The work-to-retirement transition involves a process of psychologically and behaviorally distancing oneself from the workforce that is often accompanied by other social changes, which can influence health and well-being. However, research on interventions targeting the work-to-retirement transition to improve health status is limited. Our objective was to summarize and describe interventions aiming to improve well-being across the retirement transition; (2) Methods: We conducted a scoping review following the methodological framework described by Arksey and O'Malley; the Joanna Briggs Institute guidelines as well as the PRISMA-ScR statements; we systematically searched articles and gray literature to identify interventions and policies that aimed to improve well-being across the retirement transition. (3) Results: 15 publications were included, which comprised both experimental designs (n = 10) and systematic reviews (n = 5). (4) Conclusions: More research on how to promote overall well-being during the work-to-retirement transition is needed. The results of this scoping review show that most reported interventions address one single lifestyle behavior, and that relevant social determinants of health have been barely considered in their design. Future investigations need to consider vulnerable groups and country-specific structural conditions. Adopting a patient and public involvement approach will contribute to developing interventions that address the significant needs of those in the transition to retirement.

Income at birth and tooth loss due to dental caries in adulthood: The 1982 Pelotas birth cohort

OBJECTIVE

To estimate the effect of income at birth on adulthood tooth loss due to dental caries in 539 adults from the 1982 Pelotas birth cohort.

METHODS

Family income was collected at birth. Tooth loss was clinically assessed when individuals were aged 31. Dental visit and oral hygiene at age 25 were considered mediators. Confounders included maternal skin color, and individual's skin color, sex, and income in adulthood. Marginal structural modeling was used to estimate the controlled direct effect of income at birth on tooth loss due to dental caries that was neither mediated by the use of dental service nor oral hygiene.

RESULTS

Forty-three percent of the individuals of low income at birth lost one/two teeth, and 23% lost three or more; among those non-poor, the prevalence was 30% and 14%, respectively. Poor individuals at birth had a 70% higher risk for missing teeth in adulthood than those non-poor. The risk of losing one/two (risk ratio 1.68) and three or more teeth (risk ratio 3.84) was also higher among those of low income at birth.

CONCLUSIONS

Economic disadvantage at birth had an effect on tooth loss due to dental caries at age 31 not mediated by individual risk factors.

Social mobility, accumulation of disadvantages and health. An analysis with retrospective data from the GSOEP (2002-14)

BACKGROUND

Socioeconomic position (SEP) in different life stages is related to health-related quality of life (HRQoL). Yet, research on the relevance of life course processes is scarce. This study aims to analyse the association between accumulation of disadvantages, social mobility and HRQoL.

METHODS

Analyses were conducted using population-averaged panel-data models and are based on data from the German Socio-Economic Panel 2002-14, including retrospective biographical information, comprising 25 473 observations from 8666 persons. Intergenerational and intragenerational mobility included the occupational positions in childhood (parental position), first job and middle age. Accumulation of disadvantages was measured using an accumulation index. HRQoL was assessed using the Mental and Physical Component Summary Scores of the SF12v2.

RESULTS

Accumulation of disadvantages was the main predictor for the Physical Component Summary in mid-age. Men and women in a stable low SEP or with a steep downward mobility showed the least favourable physical HRQoL. This holds for intergenerational and intragenerational mobility. Mental HRQoL did not seem to be associated with accumulation or social mobility.

CONCLUSION

The results show that physical HRQoL is related to social mobility and accumulation of (dis-)advantages. Further research is needed thoroughly analysing this association.

Intergenerational educational mobility and health satisfaction across the life course: Does the long arm of childhood conditions only become visible later in life?

The contemporaneous association of socioeconomic status (SES) with health is well-established, whereas much less is known about the health-related effects of social mobility (i.e., movements across different SES). This study investigates the impact of SES in childhood and adulthood on health satisfaction across the life course. Using data from the German Socio-Economic Panel (SOEP) and education as a central marker of SES, we test whether parental education (i.e., childhood SES) affects adult health satisfaction, directly and/or indirectly through own educational attainment (i.e., adult SES) as a mediating variable. Moreover, we apply diagonal reference models to disentangle the independent effect of intergenerational educational mobility. Our findings show that parental education has both direct and indirect effects. Yet, the relative weight of parents' education as a predictor of health satisfaction is found to depend on when in the life course health satisfaction is measured: parental education shows an increasing relevance as a predictor of health satisfaction at higher ages. On top of (additive) effects of parental and own education, we find significant mobility effects in earlier adulthood: upward educational mobility is conducive to health satisfaction and the reverse for downward educational mobility.

Neighbourhood social capital and obesity: a systematic review of the literature

Social capital, defined as the resources accessed by individuals and groups through social connections, has been posited to be a social determinant of obesity. However, empirical evidence for this association has been inconsistent - namely, some studies have found a protective association while others have reported no correlation. We sought to conduct a systematic review on the relation between neighbourhood social capital and obesity, considering potential differences on the results based on the measures used and the covariates and mediators included in the studies. PRISMA statement guidelines were followed. Our results indicate that an association between neighbourhood social capital and obesity exists, but that it depends on the measures and covariates used in the study design. Understanding the role of social capital in the development and/or maintenance of obesity will require the use of strong methodological designs and a thorough conceptualization of how this relationship may arise.

The developmental origins of health and disease in international perspective

The developmental origins of health and disease and the comparative international approach are two important strands of research exploring population health. Despite the potential insights to be gained from integrating the two approaches, their nexus remains an underexplored frontier. The current study investigates international variation in the early life origins of health among aging cohorts in 13 countries. We examine cross-national differences in exposure to poor childhood health and socioeconomic disadvantage, whether the long-term health associations with those exposures vary across contexts, and whether they persist in the face of subsequent accumulation of socioeconomic and behavioral risk. Finally, we investigate whether childhood health and socioeconomic circumstances help explain between-country differences in later life health. The findings suggest substantial international variation in the exposure to early life health and socioeconomic insults. We also find variation in their association with later life health. However, early life factors appear to play a modest role in explaining international differences in later life health in the contexts examined here.

Differential impact of socioeconomic position across life on oral cancer risk in Kerala, India: An investigation of life-course models under a time-varying framework

OBJECTIVES

The incidence of oral cancer has been rapidly increasing in India, calling for evidence contributing to a deeper understanding of its determinants. Although disadvantageous life-course socioeconomic position (SEP) is independently associated with the risk of these cancers, the explanatory mechanisms remain unclear. Possible pathways may be better understood by testing which life-course model most influences oral cancer risk. We estimated the association between life-course SEP and oral cancer risk under three life-course models: critical period, accumulation and social mobility.

METHODS

We recruited incident oral cancer cases (N = 350) and controls (N = 371) frequency-matched by age and sex from two main referral hospitals in Kozhikode, Kerala, India, between 2008 and 2012. We collected information on childhood (0-16 years), early adulthood (17-30 years) and late adulthood (above 30 years) SEP and behavioural factors along the life span using interviews and a life-grid technique. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between life-course SEP and oral cancer risk using inverse probability weighted marginal structural models.

RESULTS

Relative to an advantageous SEP in childhood and early adulthood, a disadvantageous SEP was associated with oral cancer risk [(OR = 2.76, 95% CI: 1.99, 3.81) and (OR = 1.84, 95% CI: 1.21, 2.79), respectively]. In addition, participants who were in a disadvantageous (vs advantageous) SEP during all three periods of life had an increased oral cancer risk (OR = 4.86, 95% CI: 2.61, 9.06). The childhood to early adulthood social mobility model and overall life-course trajectories indicated strong influence of exposure to disadvantageous SEP in childhood on the risk for oral cancer.

CONCLUSIONS

Using novel approaches to existing methods, our study provides empirical evidence that disadvantageous childhood SEP is critical for oral cancer risk in this population from Kerala, India.

How to use sequence analysis for life course epidemiology? An example on HIV-positive Sub-Saharan migrants in France

BACKGROUND

Life course epidemiology is now an established field in social epidemiology; in sociodemography, the quantitative analysis of biographies recently experienced significant trend from event history analysis to sequence analysis. The purpose of this article is to introduce and adapt this methodology to a social epidemiology question, taking the example of the impact of HIV diagnosis on Sub-Saharan migrants' residential trajectories in the Paris region.

METHODS

The sample consists of 640 migrants born in Sub-Saharan Africa receiving HIV care. They were interviewed in healthcare facilities in the Paris region within the PARCOURS project, conducted from 2012 to 2013, using life event history calendars, which recorded year by year their health, family and residential histories. We introduce a two-step methodological approach consisting of (1) sequence analysis by optimal matching to build a typology of migrants' residential pathways before and after diagnosis, and (2) a Cox model of the probability to experience changes in the residential situation.

RESULTS

The seven-clusters typology shows that for a majority, the HIV diagnosis did not entail changes in residential situation. However 30% of the migrants experienced a change in their residential situation at time of diagnosis. The Cox model analysis reveals that this residential change was in fact moving in with one's partner (HR 2.99, P<0.000) rather than network rejection.

CONCLUSION

This original combination of sequence analysis and Cox models is a powerful process that could be applied to other themes and constitutes a new approach in the life course epidemiology toolbox.

TRIAL REGISTRATION NUMBER

NCT02566148.

Social influences on adolescents' dietary behavior in Catalonia, Spain: A qualitative multiple-cases study from the perspective of social capital

Adolescence has been referred to as the last best chance to prevent adult non-communicable diseases. Gaining further evidence on the psychosocial determinants of health behaviors, particularly the impact of peers, social networks and media on diet, is necessary to develop appropriate preventive strategies. Based on a multiple-cases study, our aim was to discuss the social influences on adolescents' dietary behavior from a social capital perspective. Participants were reached through four high-schools in different Catalan rural-urban and socioeconomic contexts. Our results confirm the different layout of social capital in the community, school, peers and family. In our sample, family and peers are the most influent sources of social capital in relation to dietary behaviors, inducing both protective and damaging effects.

The Life Course, Cohort Dynamics, and International Differences in Aging Trajectories

In recent years, population health research has focused on understanding the determinants of later-life health. Two strands of that work have focused on (1) international comparisons of later-life health and (2) assessing the early-life origins of disease and disability and the importance of life course processes. However, the less frequently examined intersection of these approaches remains an important frontier. The present study contributes to the integration of these approaches. We use the Health and Retirement Study family of data sets and a cohort dynamic approach to compare functional health trajectories across 12 high-income countries and to examine the role of life course processes and cohort dynamics in contributing to variation in those trajectories. We find substantial international variation in functional health trajectories and an important role of cohort dynamics in generating that variation, with younger cohorts often less healthy at comparable ages than the older cohorts they are replacing. We further find evidence of heterogeneous effects of life course processes on health trajectories. The results have important implications for future trends in morbidity and mortality as well as public policy.

Early socioeconomic conditions and severe tooth loss in middle-aged Costa Ricans

OBJECTIVE

A wide literature shows a strong social gradient in tooth loss according to income, education and occupation, in both developed and developing countries. It has been shown associations between tooth loss and parental education and occupation, independently of adult conditions. To explore the role of early socioeconomic circumstances on tooth loss, we used a lifecourse model. We analysed the direct and indirect links between early socioeconomic conditions and severe adult tooth loss.

METHODS

We used the Costa Rican Longevity and Healthy Aging Study 1945-1955 Retirement Cohort, a nationally representative longitudinal survey of Costa Rican residents born between 1945 and 1955. We used imputed data on 2796 individuals. Principal component analyses were run to integrate measures approaching the material circumstances during childhood and adulthood. We additionally examined the role of adult health behaviours and education level as potential mediators in the multivariable regression.

RESULTS

Early socioeconomic conditions were found strongly associated with severe tooth loss; 72.4% of the people who experienced the most deprived socioeconomic conditions during childhood (quartile 1) had severe tooth loss at the time of the interview; vs 43.3% in quartile 4 (most advantaged). This link diminished after adjustment for adult mediators. However, it remained a significant determinant of severe tooth loss in the final model.

CONCLUSION

The lifecourse model allowed to highlight that early socioeconomic conditions could have long-term consequences on severe tooth loss in middle ages via both direct and indirect mechanisms.

Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany

Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute's cross-sectional German Health Update study. The sample was restricted to participants aged 50-85 years (n = 11,811). Socioeconomic status (SES) was measured based on education, (former) occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.

Childhood socioeconomic conditions and teeth in older adulthood: Evidence from SHARE wave 5

OBJECTIVES

Dental diseases are the most common chronic diseases worldwide. Healthy teeth are vital for quality of life, particularly diet and nutrition. However, little information exists to inform health policymakers about potentially long-lasting influences of early-life conditions. The purpose of this study was to investigate the relation between early-life socioeconomic conditions and number of natural teeth at age 50 and above.

METHODS

Analyses were conducted on cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE wave 5), which includes information on 41 560 respondents aged 50 years or older from 14 European countries and Israel. Using SHARE life history information, a series of regression models (OLS, Tobit) were estimated to analyse the relationship between socioeconomic conditions in earlier life and the number of teeth at age 50+.

RESULTS

Childhood socioeconomic background was associated with the number of natural teeth at age 50 and above, even after controlling for current determinants of oral health. Respondents who had had more than 25 books in their childhood household had a mean 1.4 (95% CI: 1.2-1.5) more teeth than respondents with fewer books. Respondents who reported poor financial conditions during childhood had a mean 0.6 (95% CI: 0.3-0.9) fewer teeth than respondents who reported better financial conditions in childhood.

CONCLUSION

These findings substantiate the association between socioeconomic conditions in the early years of life and tooth retention to older adulthood and highlight the long-lasting relation between childhood living conditions and oral health through the lifecourse.

Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention

BACKGROUND

Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: (i) short duration and low intensity; (ii) late timing of implementation, when children are already overweight or obese; (iii) intervention delivery limiting their accessibility and sustainability; and (iv) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes.

OBJECTIVE

This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention.

CONCLUSION

The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (i) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health because of socio-economic and structural conditions; (ii) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (iii) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention.

Relationship of Lifetime Exposure to Tobacco, Alcohol and Second Hand Tobacco Smoke with Upper aero-digestive tract cancers in India: a Case-Control Study with a Life-Course Perspective

Background:

Squamous cell carcinomas of the upper aero-digestive tract (UADTSCC) are a multifaceted public health problem. Effects of lifestyle risk factors, including tobacco (chewing and smoking), alcohol drinking and exposure to second hand tobacco smoke (SHS) at home and their association with UADT cancers was assessed in a case-control study with a life-course perspective. The study was conducted at two different hospitals in Pune, India.

Material and methods:

The total sample size (N=480) included 240 histopathologically confirmed cases of UADT cancers and an equal number of controls frequency matched with cases by gender and age distribution (+5 years). All the patients were interviewed face-face using structured questionnaires. Self-reported information on socio-demographic and lifestyle risk factors from childhood to the date of diagnosis of disease/cancer was obtained. Frequency, duration and age of initiation of habits were also recorded to study dose-response relationships. Odds ratios and their 95% confidence intervals were calculated through unconditional logistic regression, adjusting for relevant potential confounders.

Results:

Chewing tobacco emerged as the strongest predictor for UADT cancers (OR=7.61; 95% CI 4.65-12.45) in comparison to smoking and drinking alcohol. Exposure to SHS during childhood (<16 years) rather than ≥16 years increased the risk (OR=4.05; 95% CI 2.06-7.95). Combined effects of tobacco and alcohol consumption habits elevated the risk by twelve fold (OR=12.05; 95% 4.61-31.49) in comparison to never users of these habits. Furthermore, the combination of these lifestyle risk factors accounted for 86.8% of population attributable risk.

Conclusions:

Early exposure to various modifiable lifestyle risk factors has a strong positive association with UADT cancer incidence. Effective future public health interventions with focus on vital time points in life targeting these risk factors could possibly be a major step in primary prevention and control of this cancer at the population level.

Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models

BACKGROUND

Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of "being" in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories.

METHOD

The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grace theory indicates that downward mobility is especially stressful. In contrast, the acculturation theory holds that the health implications of social mobility is not due to the movement itself but attributed to the class contexts in which people find themselves. Diagonal Reference Models were used on a sample of 924 individuals who in 1981 graduated from 9^th grade in the municipality of Luleå, Sweden. Social mobility was operationalized as change in occupational class between age 30 and 42 (measured in 1995 and 2007). The health outcome was functional somatic symptoms at age 42, defined as a clustering self-reported physical symptoms, palpitation and sleeping difficulties during the last 12 months.

RESULTS

Overall mobility was not associated with higher levels of functional somatic symptoms compared to being immobile (p = 0.653). After controlling for prior and current class, sex, parental social position, general health, civil status, education and unemployment, the association between downward mobility was borderline significant (p = 0.055) while upward mobility was associated with lower levels of functional somatic symptoms (p = 0.03).

CONCLUSION

The current study did not find unanimous support for any of the theories. Nevertheless, it sheds light on the possibility that upward mobility may be beneficial to reduce stress-related health problems in mid-life over and above the exposure to prior and current class, while downward mobility can be of less importance for middle-age health complaints.

Exploring the Life Course Perspective in Maternal and Child Health through Community-Based Participatory Focus Groups: Social Risks Assessment

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents' health risks were childhood obesity, lack of physical activity, and low self-esteem. Women's health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.

Biological embedding: evaluation and analysis of an emerging concept for nursing scholarship

AIM

The purpose of this paper was to report the analysis of the concept of biological embedding.

BACKGROUND

Research that incorporates a life course perspective is becoming increasingly prominent in the health sciences. Biological embedding is a central concept in life course theory and may be important for nursing theories to enhance our understanding of health states in individuals and populations. Before the concept of biological embedding can be used in nursing theory and research, an analysis of the concept is required to advance it towards full maturity.

DESIGN

Concept analysis.

DATA SOURCES

PubMed, CINAHL and PsycINFO were searched for publications using the term 'biological embedding' or 'biological programming' and published through 2015.

METHODS

An evaluation of the concept was first conducted to determine the concept's level of maturity and was followed by a concept comparison, using the methods for concept evaluation and comparison described by Morse.

RESULTS

A consistent definition of biological embedding - the process by which early life experience alters biological processes to affect adult health outcomes - was found throughout the literature. The concept has been used in several theories that describe the mechanisms through which biological embedding might occur and highlight its role in the development of health trajectories. Biological embedding is a partially mature concept, requiring concept comparison with an overlapping concept - biological programming - to more clearly establish the boundaries of biological embedding.

CONCLUSIONS

Biological embedding has significant potential for theory development and application in multiple academic disciplines, including nursing.

The Association of Levels of and Decline in Grip Strength in Old Age with Trajectories of Life Course Occupational Position

Background

The study of the influence of life course occupational position (OP) on health in old age demands analysis of time patterns in both OP and health. We study associations between life course time patterns of OP and decline in grip strength in old age.

Methods

We analyze 5 waves from the Survey of Health Ageing and Retirement in Europe (n = 5108, ages 65–90). We use a pattern-mixture latent growth model to predict the level and decline in grip strength in old age by trajectory of life course OP. We extend and generalize the structured regression approach to establish the explanatory power of different life course models for both the level and decline of grip strength.

Results

Grip strength declined linearly by 0.70 kg (95% CI -0.74;-0.66) for men and 0.42 kg (95% CI -0.45;-0.39) for women per year. The level of men’s grip strength can best be explained by a critical period during midlife, with those exposed to low OP during this period having 1.67 kg (95% CI -2.33;-1.00) less grip strength. These differences remain constant over age. For women, no association between OP and levels of or decline in grip strength was found.

Conclusions

Men’s OP in midlife seems to be a critical period for the level of grip strength in old age. Inequalities remain constant over age. The integration of the structured regression approach and latent growth modelling offers new possibilities for life course epidemiology.

Changes in the labour market and health inequalities during the years of the recent economic downturn in Italy

There is widespread concern that episodes of unemployment and unstable working conditions adversely affect health. We add to the debate by focusing on the relationship between work trajectory and the self-reported health of Italian men and women during the present economic downturn. Relying on Italian data in the EU-SILC project (from 2007 to 2010), our sample includes all individuals aged 30 to 60 in 2010, and uses multivariate binomial regression models for preliminary analyses and the Structural Equations modelling (SEM) to observe the cumulative effects of health status according to different job trajectories. Our main findings show similar pictures for men and women. Individuals who are unemployed, ejected or in precarious occupational positions have a higher risk of worsening their health status during these years.

Outcome-based health equity across different social health insurance schemes for the elderly in China

BACKGROUND

Against the achievement of nearly universal coverage for social health insurance for the elderly in China, a problem of inequity among different insurance schemes on health outcomes is still a big challenge for the health care system. Whether various health insurance schemes have divergent effects on health outcome is still a puzzle. Empirical evidence will be investigated in this study.

METHODS

This study employs a nationally representative survey database, the National Survey of the Aged Population in Urban/Rural China, to compare the changes of health outcomes among the elderly before and after the reform. A one-way ANOVA is utilized to detect disparities in health care expenditures and health status among different health insurance schemes. Multiple Linear Regression is applied later to examine the further effects of different insurance plans on health outcomes while controlling for other social determinants.

RESULTS

The one-way ANOVA result illustrates that although the gaps in insurance reimbursements between the Urban Employee Basic Medical Insurance (UEBMI) and the other schemes, the New Rural Cooperative Medical Scheme (NCMS) and Urban Residents Basic Medical Insurance (URBMI) decreased, out-of-pocket spending accounts for a larger proportion of total health care expenditures, and the disparities among different insurances enlarged. Results of the Multiple Linear Regression suggest that UEBMI participants have better self-reported health status, physical functions and psychological wellbeing than URBMI and NCMS participants, and those uninsured. URBMI participants report better self-reported health than NCMS ones and uninsured people, while having worse psychological wellbeing compared with their NCMS counterparts.

CONCLUSIONS

This research contributes to a transformation in health insurance studies from an emphasis on the opportunity-oriented health equity measured by coverage and healthcare accessibility to concern with outcome-based equity composed of health expenditure and health status. The results indicate that fragmented health insurance schemes generate inequitable health care utilization and health outcomes for the elderly. This study re-emphasizes the importance of reforming health insurance systems based on their health outcome rather than entitlement, which will particularly benefit the most vulnerable older groups.

Adverse childhood experiences and health-related quality of life in adulthood: revelations from a community needs assessment

BACKGROUND

Adverse childhood experiences (ACE) have been previously linked to quality of life, health conditions, and life expectancy in adulthood. Less is known about the potential mechanisms which mediate these associations. This study examined how ACE influences adult health-related quality of life (HRQoL) in a low-income community in Florida.

METHODS

A community-based participatory needs assessment was conducted from November 2013 to March 2014 with 201 residents of Tampa, Florida, USA. HRQoL was measured by an excessive number of unhealthy days experienced during the previous 30-day window. Mediation analyses for dichotomous outcomes were conducted with logistic regression. Bootstrapped confidence intervals were generated for both total and specific indirect effects.

RESULTS

Most participants reported 'good to excellent health' (76%) and about a fourth reported 'fair to poor health' (24%). The mean of total unhealthy days was 9 days per month (SD ± 10.5). Controlling for demographic and neighborhood covariates, excessive unhealthy days was associated with ACE (AOR = 1.23; 95% CI: 1.06, 1.43), perceived stress (AOR = 1.07; 95% CI: 1.03, 1.10), and sleep disturbance (AOR = 8.86; 3.61, 21.77). Mediated effects were significant for stress (β = 0.08) and sleep disturbances (β = 0.11) as they related to the relationship between ACE and excessive unhealthy days.

CONCLUSION

ACE is linked to adult HRQoL. Stress and sleep disturbances may represent later consequences of childhood adversity that modulate adult quality of life.

Socioeconomic inequalities in health trajectories in Switzerland: are trajectories diverging as people age?

Do socioeconomic differences in health status increase as people age, reflecting cumulative advantage or disadvantage in health trajectories? Life course research hypothesises that cumulative advantage/disadvantage (CAD) is an important underlying social process that shape inequalities as people age. The objective of this study is to examine whether health trajectories are diverging as people age across socioeconomic positions (education, employment status and income). In a random sample of 3,665 respondents living in Switzerland (Swiss Household Panel 2004-2011), trajectories of self-rated health, body mass index, depression and medicated functioning were examined with multilevel regression models. The results showed that employment status and income were associated with diverging health trajectories among men; however, only a few associations supported the CAD hypothesis. Education was rarely associated with diverging health trajectories. In conclusion, little evidence was found to support the CAD model.

Life course models for upper aero-digestive tract cancer

Upper aero-digestive tract (UADT) cancers are collectively cancers of various human body sites, such as the oral cavity, pharynx, oesophagus and larynx. Worldwide, they are the fourth most frequent cancer type and the fourth most common cause of mortality from cancer. Many studies have shown that several chronic diseases, such as cancer, which occur more commonly in later adulthood, are influenced by social and psychological circumstances during birth, childhood, adolescence and early adult life. It is suggested that the build up of problematic circumstances throughout life is the cause of disease, rather than circumstances that happen at one point in time. UADT cancer is a chronic disease of complex multifactorial origin and most of the underlying exposures/risks cannot be considered as individual factors or in isolation, as they act at different levels, which differ from time to time. Thus, life-course epidemiology, rather than drawing false dichotomies between different risk factors of the underlying disease, attempts to integrate biological and social risk processes that cause the chronic disease. It studies how socially patterned exposures during all stages of life--childhood, adolescence and early adult--influence disease risk in adulthood and socio-economic position and hence may account for social inequalities in adult health and mortality. Furthermore, varying health effects, according to the timing or duration of exposure to socio-economic circumstances, may indicate important traces to the causes of cancer. In this paper, we have attempted to draw a conceptual framework on the relationships between socio-economic inequalities, oral health risk factors along the life-course of an individual and incidence of UADT cancer.

Which life course model better explains the association between socioeconomic position and periodontal health?

AIM

To assess whether the relationship between socioeconomic position (SEP) and periodontal health fitted the Critical Period or the Social Mobility life course models.

METHODS

A nationally representative sample of 5570 Korean adults from KNHANES IV study. Log-binomial regression models adjusting for adulthood or childhood socioeconomic (SES) variables was used to assess independent effects of socioeconomic differences for childhood, adulthood and period of transition from child to adult in periodontal health.

RESULTS

In the Critical Period model, poorer periodontal status was associated with SES disadvantage in adulthood and not predicted by SES disadvantage in childhood. For the intergenerational Social Mobility model, prevalence of current periodontal disease was only different for females aged 30-39 and 40-49 years, after adjustment. Prevalence of periodontal disease in females was highest in the downwardly mobile group.

CONCLUSIONS

The Critical Period model was better at explaining association between socioeconomic position and periodontal health, such as the adulthood socioeconomic variables (SEP), had a stronger effect than childhood factors on periodontal disease. The Social Mobility model explained more of the variation in the association between SEP and periodontal health among women than among men.

Length of unemployment and health-related outcomes: a life-course analysis

BACKGROUND

Most previous studies on the effects of length of unemployment on health have focused on the duration of continuous spells of unemployment rather than on the cumulative length of intermittent spells. This study analysed the relationship between the cumulative length of intermittent spells of unemployment and different health-related outcomes using data from a longitudinal study of school leavers.

METHODS

All pupils who completed compulsory schooling in 1981 in a medium-sized town in northern Sweden (N = 1083) were followed for 14 years with repeated questionnaires including questions about unemployment, health and health behaviour.

RESULTS

Men tended to react with a steady state or a levelling off of health symptoms with increased unemployment, whereas women showed deteriorating health symptoms. For health behaviour the reverse occurred. Women's health behaviour was less connected with increased unemployment while men's health behaviour tended to deteriorate.

CONCLUSION

Cumulative length of unemployment is correlated with deteriorated health and health behaviour. Long-term unemployment, even as a result of cumulated shorter employment spells over a number of years should be an urgent target for policy makers.

Social capital across the life course and functional somatic symptoms in mid-adulthood

Aim: To examine social capital across life and functional somatic symptoms in middle-age, according to life-course models of cumulative risk and sensitive periods. Methods: Data from the 26-year prospective study the Northern Swedish Cohort enabled complete case analyses on 940 individuals (451 women and 489 men) participating in questionnaire surveys at ages 16, 21, 30 and 42. Social capital was operationalized at the individual level, comprising items on social participation, social influence and social support. Functional somatic symptoms were a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties occuring during the 12 months prior to the data collection. Linear regression was used as the main statistical method, examining the relationship between functional somatic symptoms at age 42 and social capital across life. Results: Lower levels of social capital accumulated over the life course were associated with higher levels of functional somatic symptoms at age 42, for both women and men. Social capital was, especially among adolescent men, related to functional somatic symptoms at age 42, independently of social capital later in life and baseline material circumstances. Conclusions: The health impact of poor social capital may be due to accumulation across the life course and to adolescence being a particularly sensitive period. It is relevant for preventive work to acknowledge effects of social capital throughout life.

Early life conditions, adverse life events, and chewing ability at middle and later adulthood

OBJECTIVES

We sought to determine the extent to which early life conditions and adverse life events impact chewing ability in middle and later adulthood.

METHODS

Secondary analyses were conducted based on data from waves 2 and 3 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in the years 2006 to 2009 and encompassing information on current chewing ability and the life history of persons aged 50 years or older from 13 European countries. Logistic regression models were estimated with sequential inclusion of explanatory variables representing living conditions in childhood and adverse life events.

RESULTS

After controlling for current determinants of chewing ability at age 50 years or older, certain childhood and later life course socioeconomic, behavioral, and cognitive factors became evident as correlates of chewing ability at age 50 years or older. Specifically, childhood financial hardship was identified as an early life predictor of chewing ability at age 50 years or older (odds ratio = 1.58; 95% confidence interval = 1.22, 2.06).

CONCLUSIONS

Findings suggest a potential enduring impact of early life conditions and adverse life events on oral health in middle and later adulthood and are relevant for public health decision-makers who design strategies for optimal oral health.

Factors of change and cumulative factors in self-rated health trajectories: a systematic review

In Western societies, self-rated health (SRH) inequalities have increased over the past decades. Longitudinal studies suggest that the SRH trajectories of disadvantaged populations are declining at a faster rate than those of advantaged populations, resulting in an accumulation of (dis)advantages over the life course, as postulated by the Cumulative Advantage/Disadvantage (CAD) model. The objectives of this study are to conduct a systematic review of the factors influencing SRH trajectories in the adult population and to assess to what extent the findings support the CAD model. Based on the inclusion criteria, 36 articles, using 15 nationally representative databases, were reviewed. The results show that young age, high socioeconomic position and marital transitions (entering a partnership) are advantageous factors of change in SRH trajectories. However, evidence for cumulative influences supporting the CAD model remains limited: gender, ethnicity, education and employment status are only moderately associated with growing influences over time, and the cumulative influences of income, occupation, age and marital status are weak. In conclusion, this systematic review provides consolidated evidence on the factors influencing SRH trajectories, though the inclusion of only 15 nationally representative databases may limit the generalization of the results.

Physical occupational exposures during working life and quality of life after labour market exit: results from the GAZEL study

OBJECTIVE

To investigate variations in quality of life at older ages, we take a life course perspective to analyse long-term effects of physical working conditions upon quality of life after retirement. In doing so, we study to what extent these associations are explained by individuals' health at older ages.

METHOD

We use administrative data and self-administered questionnaire responses from the French GAZEL cohort. Quality of life was assessed with CASP-19 in 2009 and related to three types of physical working conditions during previous working life: (1) ergonomic strain, (2) physical danger and (3) exposures to chemicals. Health was assessed in 2007 with the SF-36 Health Survey. Multiple regressions were calculated in retired men only, controlling for important confounders including social position.

RESULTS

In contrast to men, few women were exposed to strenuous and dangerous working conditions in this cohort and were not included in subsequent analyses. Negative effects on retired men's quality of life were found for the physical occupational exposures of ergonomic strain and physical danger, but not for chemical exposures. Effects were attenuated after the introduction of physical and mental health to the models, indicating an indirect effect of physical working conditions upon quality of life via health.

CONCLUSION

Adverse physical working conditions have long-term consequences for health and quality of life at older ages. Improvements to physical working conditions may improve individuals' quality of life over the long term.