Childhood housing conditions and later mortality in the Boyd Orr cohort

Childhood Housing Condition and Old Age Health Among Chinese: The Mediation Role of Adulthood Socioeconomic and Medical History

Guided by the lifecourse perspective and social determinants of health framework, this study examined the association of childhood housing with old age health among Chinese and its midlife mediators. Respondents were middle-aged and older adults (aged 45+) from the China Health and Retirement Longitudinal Study (N = 12,842). They were asked about their childhood housing conditions (e.g., if their houses had clean water, water toilet, and electricity). Adulthood socioeconomic and medical history and middle- and old-age health were measured. Causal mediation analysis showed childhood better housing was directly associated with fewer depressive symptoms and better cognition in middle- and older-age, and indirectly through increasing education level. However, the proportion-mediated estimate had very wide confidence intervals. Our findings suggested the importance of broad infrastructure development and adult continuing education programs among those who grew up in poor housing conditions to promote mental health in older age.

Do early-life circumstances predict late-life suicidal ideation? Evidence from SHARE data using machine learning

Background

A number of studies have demonstrated that suicidal ideation in late life is associated with early-life circumstances. However, the importance of early-life circumstances in predicting suicidal ideation is not entirely clear. This study aims to use a machine learning approach to evaluate the importance of 32 early-life circumstances from six domains in predicting suicidal ideation in old age.

Methods

The data in this study come from a cross-national longitudinal survey, the Survey of Health, Aging and Retirement in Europe (SHARE). Participants recalled information on early-life circumstances in SHARE wave 7 and reported suicidal ideation in SHARE wave 8. The XGBoost model was employed to evaluate the importance of 32 circumstances in six domains (early-life socioeconomic status, early-life health and healthcare, early-life relationship, etc.) in predicting the suicidal ideation of middle-aged and older adults over 50.

Results

There were 46,498 participants in this study, of which 26,672 (57.36%) were females and 19,826 (42.64%) were males. XGBoost showed a strong predictive performance, with an area under the curve of 0.80 and accuracy of 0.77. Top predictors were mainly in the domains of childhood relationship, childhood socioeconomic status, childhood health, and healthcare. In particular, having a group of friends most critically influences suicidal ideation in old age.

Discussion

These findings suggest that early-life circumstances may modestly predict suicidal ideation in late life. Preventive measures can be taken to lower the risk of suicidal ideation in middle-aged and older individuals.

Is Austerity Responsible for the Stalled Mortality Trends Across Many High-Income Countries? A Systematic Review

This article systematically reviews evidence evaluating whether macroeconomic austerity policies impact mortality, reviewing high-income country data compiled through systematic searches of nine databases and gray literature using pre-specified methods (PROSPERO registration: CRD42020226609). Eligible studies were quantitatively assessed to determine austerity's impact on mortality. Two reviewers independently assessed eligibility and risk of bias using ROBINS-I. Synthesis without meta-analysis was conducted due to heterogeneity. Certainty of evidence was assessed using the GRADE framework. Of 5,720 studies screened, seven were included, with harmful effects of austerity policies demonstrated in six, and no effect in one. Consistent harmful impacts of austerity were demonstrated for all-cause mortality, life expectancy, and cause-specific mortality across studies and different austerity measures. Excess mortality was higher in countries with greater exposure to austerity. Certainty of evidence was low. Risk of bias was moderate to critical. A typical austerity dose was associated with 74,090 [-40,632, 188,792] and 115,385 [26,324, 204,446] additional deaths per year. Austerity policies are consistently associated with adverse mortality outcomes, but the magnitude of this effect remains uncertain and may depend on how austerity is implemented (e.g., balance between public spending reductions or tax rises, and distributional consequences). Policymakers should be aware of potential harmful health effects of austerity policies.

Association of race/ethnicity and severe housing problems with COVID-19 deaths in the United States: Analysis of the first three waves

The objective of this study is to assess the associations of race/ethnicity and severe housing problems with COVID-19 death rates in the US throughout the first three waves of the COVID-19 pandemic in the US. We conducted a cross-sectional study using a negative binomial regression model to estimate factors associated with COVID-19 deaths in 3063 US counties between March 2020 and July 2021 by wave and pooled across all three waves. In Wave 1, counties with larger percentages of Black, Hispanic, American Indian and Alaska Native (AIAN), and Asian American and Pacific Islander (AAPI) residents experienced a greater risk of deaths per 100,000 residents of +22.82 (95% CI 15.09, 30.56), +7.50 (95% CI 1.74, 13.26), +13.52 (95% CI 8.07, 18.98), and +5.02 (95% CI 0.92, 9.12), respectively, relative to counties with larger White populations. By Wave 3, however, the mortality gap declined considerably in counties with large Black, AIAN and AAPI populations: +10.38 (95% CI 4.44, 16.32), +7.14 (95% CI 1.14, 13.15), and +3.72 (95% CI 0.81, 6.63), respectively. In contrast, the gap increased for counties with a large Hispanic population: +13 (95% CI 8.81, 17.20). Housing problems were an important predictor of COVID-19 deaths. However, while housing problems were associated with increased COVID-19 mortality in Wave 1, by Wave 3, they contributed to magnified mortality in counties with large racial/ethnic minority groups. Our study revealed that focusing on a wave-by-wave analysis is critical to better understand how the associations of race/ethnicity and housing conditions with deaths evolved throughout the first three COVID-19 waves in the US. COVID-19 mortality initially took hold in areas characterized by large racial/ethnic minority populations and poor housing conditions. Over time, as the virus spread to predominantly White counties, these disparities decreased substantially but remained sizable.

Overcrowded housing during adolescence and future risk of premature mortality: a 28-year follow-up of 556,191 adolescents from Switzerland

Background

Few large-scale studies have examined the health impacts of overcrowded housing in European countries. The aim of this study was to assess whether household crowding during adolescence increases the risk of all-cause and cause-specific mortality in Switzerland.

Methods

Study participants were 556,191 adolescents aged 10-19 years at the 1990 census from the Swiss National Cohort. Household crowding at baseline was measured as the ratio between the number of persons living in the household and the number of available rooms, categorized as none (ratio ≤ 1), moderate (1 < ratio ≤ 1.5), and severe (ratio > 1.5). Participants were linked to administrative mortality records through 2018 and followed for premature mortality from all causes, cardiometabolic disease and self-harm or substance use. Cumulative risk differences between ages 10 and 45 were standardized by parental occupation, residential area, permit status and household type.

Findings

Of the sample, 19% lived in moderately and 5% lived in severely crowded households. During an average follow-up of 23 years, 9766 participants died. Cumulative risk of death from all causes was 2359 (95% compatibility intervals: 2296-2415) per 100,000 persons when living in non-crowded households. Living in moderately crowded households led to 99 additional deaths (-63 to 256) per 100,000 persons and living in severely crowded households 258 additional deaths (-37 to 607) per 100,000 persons. The effect of crowding on mortality from cardiometabolic diseases, self-harm or substance use was negligible.

Interpretation

Excess risk of premature mortality in adolescents living in overcrowded households appears to be small or negligible in Switzerland.

Funding

University of Fribourg Scholarship Programme for foreign post-doctoral researchers.

Life-course socioeconomic conditions, multimorbidity and polypharmacy in older adults: A retrospective cohort study

Socioeconomic conditions across the life course may contribute to differences in multimorbidity and polypharmacy in old age. However, whether the risk of multimorbidity changes during ageing and whether life-course socioeconomic conditions are associated with polypharmacy remain unclear. We investigated whether disadvantaged childhood socioeconomic conditions (CSCs) predict increased odds of multimorbidity and polypharmacy in older adults, whether CSCs remain associated when adjusting for adulthood socioeconomic conditions (ACSs), and whether CSCs and ACSs are associated cumulatively over the life course. We used data for 31,432 participants (multimorbidity cohort, mean [SD] age 66·2[9] years), and 21,794 participants (polypharmacy cohort, mean age 69·0[8.9] years) from the Survey of Health, Ageing, and Retirement in Europe (age range 50-96 years). We used mixed-effects logistic regression to assess the associations of CSCs, ASCs, and a life-course socioeconomic conditions score (0-8; 8, most advantaged) with multimorbidity (≥2 chronic conditions) and polypharmacy (≥5 drugs taken daily). We found an association between CSCs and multimorbidity (reference: most disadvantaged; disadvantaged: odds ratio (OR) = 0·79, 95% confidence interval (CI) 0·70-0·90; middle: OR = 0·60; 95%CI 0·53-0·68; advantaged: OR = 0·52, 95%CI 0·45-0·60, most advantaged: OR = 0·40, 95%CI 0·34-0·48) but not polypharmacy. This multimorbidity association was attenuated but remained significant after adjusting for ASCs. The life-course socioeconomic conditions score was associated with multimorbidity and polypharmacy. We did not find an association between CSCs, life-course socioeconomic conditions, and change in odds of multimorbidity and polypharmacy with ageing. Exposure to disadvantaged socioeconomic conditions in childhood or over the entire life-course could predict multimorbidity in older age.

Family Socioeconomic Position and Lung Cancer Risk: A Meta-Analysis and a Mendelian Randomization Study

Background

Family socioeconomic position (SEP) in childhood is an important factor to predict some chronic diseases. However, the association between family SEP in childhood and the risk of lung cancer is not clear.

Methods

A systematic search was performed to explore their relationship. We selected education level, socioeconomic positions of parents and childhood housing conditions to represent an individual family SEP. Hazard ratios (HRs) of lung cancer specific-mortality were synthesized using a random effects model. Two-sample Mendelian randomization (MR) was carried out with summary data from published genome-wide association studies of SEP to assess the possible causal relationship of SEP and risk of lung cancer.

Results

Through meta-analysis of 13 studies, we observed that to compared with the better SEP, the poorer SEP in the childhood was associated with the increased lung cancer risk in the adulthood (HR: 1.25, 95% CI: 1.10 to 1.43). In addition, the dose-response analysis revealed a positive correlation between the poorer SEP and increased lung cancer risk. Same conclusion was reached in MR [(education level) OR 0.50, 95% CI: 0.39 to 0.63; P &lt; 0.001].

Conclusion

This study indicates that poor family socioeconomic position in childhood is causally correlated with lung cancer risk in adulthood.

Systematic Review Registration

identifier: 159082.

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review

OBJECTIVES

Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues.

METHODS

The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues.

RESULTS

Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services.

CONCLUSION

This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.

Inadequate housing and pulmonary tuberculosis: a systematic review

Background

Tuberculosis (TB) is a global health issue that has long threatened and continues to threaten human health. While previous studies are important in the search for a cure for TB, to eradicate the disease it is also crucial to analyze environmental influences. Therefore, this study determined the potential effect of inadequate housing on TB and the magnitude of the effect.

Methods

This is a systematic review of the effects of inadequate housing on TB. Between Jan 1, 2011 and Oct 25, 2020, we searched four electronic databases using the search terms “housing AND tuberculosis” or “housing AND TB”. The target population comprised residents of inadequate housing and the homeless.

Results

We found 26 eligible studies. The distribution of the studies across continents was uneven, and the housing issues of interest seemed to vary depending on the economic level of the country. The eight steps identified in TB development and the consequences thereof were more strongly associated with housing affordability than with housing quality.

Conclusions

This is the first systematic review to identify the effects of inadequate housing on TB and to categorize inadequate-housing-related exposure to TB in terms of affordability and quality. The steps identified in TB development and the consequences thereof had a greater association with housing affordability than with housing quality. Therefore, public health interventions regarding housing affordability could be more diverse, and interventions that support affordable housing for residents of inadequate housing and the homeless should proceed simultaneously to improve housing quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12879-6.

Early-Life Socioeconomic Circumstances and Physical Activity in Older Age: Women Pay the Price

Health in older age is shaped by early-life socioeconomic circumstances (SECs) and sex. However, whether and why these factors interact is unclear. We examined a cultural explanation of this interaction by distinguishing cultural and material aspects of SECs in the context of physical activity-a major determinant of health. We used data from 56,331 adults between 50 and 96 years old from the Survey of Health, Ageing and Retirement in Europe (SHARE), a 13-year, large-scale, population-based cohort. Confounder-adjusted logistic linear mixed-effects models showed an association between the cultural aspects of early-life SEC disadvantage and physical activity among women, but it was not consistently observed in men. Furthermore, these associations were compensated for only partially by adult-life socioeconomic trajectories. The material aspects of early-life SECs were not associated with adult-life physical activity. These findings highlight the need to distinguish different aspects of SECs because they may relate to health behaviors in diverse ways.

Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review

OBJECTIVE

To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD).

STUDY DESIGN

A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met.

RESULTS

There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD.

CONCLUSIONS

Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.

Chronic pediatric health conditions among youth living in public housing and receiving care in a large hospital system in Bronx, NY

This study compared the prevalence of chronic pediatric health conditions for youth in public housing with youth not in public housing using clinical electronic health record (EHR) and housing data. Youth (ages 2-17 years) in a large urban health system were identified and categorized into two housing types—public housing (n = 10 770) and not in public housing (n = 84 883) by age (young childhood, middle childhood, young adolescence). The prevalence of some pediatric conditions was higher in public housing but varied by age. Disparities in health conditions among youth in public housing were more common in early adolescence: asthma (26.4 vs 18.6; P < .001); obesity (28.5 vs 24.6; P < .001); depression/anxiety (19.2 vs 17.3; P = .008); behavioral disorders (8.1 vs 5.3; P < .001). These results show that chronic pediatric conditions like asthma and obesity that lead to significant morbidity into adulthood are more common among youth living in public housing. However, this pattern is not consistent across all chronic conditions.

The relationship between buildings and health: a systematic review

Background

The built environment exerts one of the strongest directly measurable effects on physical and mental health, yet the evidence base underpinning the design of healthy urban planning is not fully developed.

Method

This study provides a systematic review of quantitative studies assessing the impact of buildings on health. In total, 7127 studies were identified from a structured search of eight databases combined with manual searching for grey literature. Only quantitative studies conducted between January 2000 and November 2016 were eligible for inclusion. Studies were assessed using the quality assessment tool for quantitative studies.

Results

In total, 39 studies were included in this review. Findings showed consistently that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. Prioritization of housing for vulnerable groups led to improved wellbeing. However, the quality of the underpinning evidence and lack of methodological rigour in most of the studies makes it difficult to draw causal links.

Conclusion

This review identified evidence to demonstrate the strong association between certain features of housing and wellbeing such as adequate heating and ventilation. Our findings highlight the need for strengthening of the evidence base in order for meaningful conclusions to be drawn.

Life Course Socioeconomic Conditions and Frailty at Older Ages

OBJECTIVES

This article aimed to assess associations of childhood socioeconomic conditions (CSC) with the risk of frailty in old age and whether adulthood socioeconomic conditions (ASC) influence this association.

METHODS

Data from 21,185 individuals aged 50 years and older included in the longitudinal Survey of Health, Ageing, and Retirement in Europe were used. Frailty was operationalized as a sum of presenting weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyze associations of CSC and ASC with frailty.

RESULTS

While disadvantaged CSC was associated with higher odds of (pre-)frailty in women and men (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.34, 2.24; OR = 1.84, 95% CI 1.27, 2.66, respectively), this association was mediated by ASC. Personal factors and demographics, such as birth cohort, chronic conditions, and difficulties with activities of daily living, increased the odds of being (pre-)frail.

DISCUSSION

Findings suggest that CSC are associated with frailty at old age. However, when taking into account ASC, this association no longer persists. The results show the importance of improving socioeconomic conditions over the whole life course in order to reduce health inequalities in old age.

Early predictors of impaired sleep: a study on life course socioeconomic conditions and sleeping problems in older adults

Objectives: This study aimed to assess how childhood socioeconomic conditions are associated with sleeping problems in older adults and how this association may be mediated by socioeconomic conditions across the lives of individuals using a life course perspective. Since the life course opportunities differ systematically between men and women, attention was given to gender differences in the association.Methods: Data from 23,766 individuals aged over 50 years of the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Logistic mixed-effect models were estimated to examine the associations between childhood socioeconomic conditions and the presence of sleeping problems.Results: For women, the analyses showed an association between childhood socioeconomic conditions and sleeping problems. For men, only current socioeconomic conditions were found to be relevant for sleep. The importance of childhood socioeconomic conditions for sleeping problems did not affect the evolution of sleeping problems over ageing.Conclusion: In this study no empirical support was found for processes of cumulative advantage/disadvantage or age-as-leveler. However, childhood does seem to be a critical period for the sleep of women, because the association with childhood socioeconomic conditions remains even when the circumstances later in life are considered. These findings, in particular the gender differences in the association, underline the importance of tracking life course patterns in the study of sleeping problems in older adults.

Fluctuating asymmetry in brain structure and general intelligence in 73-year-olds

Fluctuating body asymmetry is theorized to indicate developmental instability, and to have small positive associations with low socioeconomic status (SES). Previous studies have reported small negative associations between fluctuating body asymmetry and cognitive functioning, but relationships between fluctuating brain asymmetry and cognitive functioning remain unclear. The present study investigated the association between general intelligence (a latent factor derived from a factor analysis on 13 cognitive tests) and the fluctuating asymmetry of four structural measures of brain hemispheric asymmetry: cortical surface area, cortical volume, cortical thickness, and white matter fractional anisotropy. The sample comprised members of the Lothian Birth Cohort 1936 (LBC1936, N = 636, mean age = 72.9 years). Two methods were used to calculate structural hemispheric asymmetry: in the first method, regions contributed equally to the overall asymmetry score; in the second method, regions contributed proportionally to their size. When regions contributed equally, cortical thickness asymmetry was negatively associated with general intelligence (β = -0.18,p < .001). There was no association between cortical thickness asymmetry and childhood SES, suggesting that other mechanisms are involved in the thickness asymmetry-intelligence association. Across all cortical metrics, asymmetry of regions identified by the parieto-frontal integration theory (P-FIT) was not more strongly associated with general intelligence than non-P-FIT asymmetry. When regions contributed proportionally, there were no associations between general intelligence and any of the asymmetry measures. The implications of these findings, and of different methods of calculating structural hemispheric asymmetry, are discussed.

Low Socioeconomic Status Is Associated with Worse Outcomes After Curative Surgery for Colorectal Cancer: Results from a Large, Multicenter Study

BACKGROUND

Socioeconomic status (SES) has been associated with early mortality in cancer patients. However, the association between SES and outcome in colorectal cancer patients is largely unknown. The aim of this study was to investigate whether SES is associated with short- and long-term outcome in patients undergoing curative surgery for colorectal cancer.

METHODS

Patients who underwent curative surgery in the region of Rotterdam for stage I-III colorectal cancer between January 2007 and July 2014 were included. Gross household income and survival status were obtained from a national registry provided by Statistics Netherlands Centraal Bureau voor de Statistiek. Patients were assigned percentiles according to the national income distribution. Logistic regression and Cox proportional hazard regression were performed to assess the association of SES with 30-day postoperative complications, overall survival and cancer-specific survival, adjusted for known prognosticators.

RESULTS

For 965 of the 975 eligible patients (99%), gross household income could be retrieved. Patients with a lower SES more often had diabetes, more often underwent an open surgical procedure, and had more comorbidities. In addition, patients with a lower SES were less likely to receive (neo) adjuvant treatment. Lower SES was independently associated with an increased risk of postoperative complications (Odds ratio per percent increase 0.99, 95%CI 0.99-0.998, p = 0.004) and lower cancer-specific mortality (Hazard ratio per percent increase 0.99, 95%CI 0.98-0.99, p = 0.009).

CONCLUSION

This study shows that lower SES is associated with increased risk of postoperative complications, and poor cancer-specific survival in patients undergoing surgery for stage I-III colorectal cancer after correcting for known prognosticators.

Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study

INTRODUCTION

A gap exists in the literature regarding dose-response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.

METHODS

A prospective, unmatched case-control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011-2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp-mould subscale. The main outcome was case-control status. Adjusted ORs (aORs) of the association of housing quality measures with case-control status were estimated, along with the population attributable risk of eliminating dampness-mould on hospitalisation for ARI among New Zealand children.

RESULTS

188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp-mould index had a significant, adjusted dose-response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually.

CONCLUSIONS

A dose-response relationship exists between housing quality measures, particularly dampness-mould, and young children's ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness-mould would have a large impact on ARI hospitalisation.

Late Life Employment Histories and Their Association With Work and Family Formation During Adulthood: A Sequence Analysis Based on ELSA

Objectives

To extend research on workforce participation beyond age 50 by describing entire employment histories in later life and testing their links to prior life course conditions.

Methods

We use data from the English Longitudinal Study of Ageing, with retrospective information on employment histories between age 50 and 70 for 1,103 men and 1,195 women (n = 2,298). We apply sequence analysis and group respondents into eight clusters with similar histories. Using multinomial regressions, we then test their links to labor market participation, partnership, and parenthood histories during early (age 20–34) and mid-adulthood (age 35–49).

Results

Three clusters include histories dominated by full-time employees but with varying age of retirement (before, at, and after age 60). One cluster is dominated by self-employment with comparatively later retirement. Remaining clusters include part-time work (retirement around age 60 or no retirement), continuous domestic work (mostly women), or other forms of nonemployment. Those who had strong attachments to the labor market during adulthood are more likely to have histories of full-time work up until and beyond age 60, especially men. Parenthood in early adulthood is related to later retirement (for men only). Continued domestic work was not linked to parenthood. Partnered women tend to work part-time or do domestic work. The findings remain consistent after adjusting for birth cohort, childhood adversity, life course health, and occupational position.

Discussion

Policies aimed at increasing the proportion of older workers not only need to address later stages of the life course but also early and mid-adulthood.

Childhood socioeconomic circumstances and disability trajectories in older men and women: a European cohort study

Background

We observed a lack of population-based longitudinal research examining the association of disadvantaged childhood socioeconomic circumstances (CSC) and disability [activities of daily living (ADL) and instrumental activities of daily living (IADL)] in older age, and whether socioeconomic attainments in adulthood can compensate for a poor socioeconomic start in life.

Methods

Data on 24 440 persons aged 50-96 in 14 European countries (Survey of Health, Ageing and Retirement in Europe) were used to measure the associations between CSC and limitations with ADL and with IADL, using mixed-effects logistic regression models. Models stratified by gender were adjusted for education during young adulthood, main occupation during middle age, ability to make ends meet during old age and potential confounding and control variables.

Results

Risks of ADL and IADL limitations increased with age and were different between women and men. For women, a gradient across CSC strata was observed, showing that the more disadvantaged the CSC, the higher the risk of ADL and IADL limitations in old age, even after adjustment for adult socioeconomic indicators. For men, the association between CSC and disability was mediated by the main occupation in middle age and the ability to make ends meet at older age.

Conclusion

Women who grew up in socioeconomically disadvantaged households were at higher risk of disability in older age and this disadvantage was not attenuated by favourable adult socioeconomic conditions. Men were more likely to make up for a disadvantaged start in adulthood.

The role of adult socioeconomic and relational reserves regarding the effect of childhood misfortune on late-life depressive symptoms

Background

Childhood misfortune is associated with late-life depressive symptoms, but it remains an open question whether adult socioeconomic and relational reserves could reduce the association between childhood misfortune and late-life depressive symptoms.

Methods

Using the Survey of Health, Ageing and Retirement in Europe (SHARE), data from 8'357 individuals (35'260 observations) aged 50–96 years and living in 11 European countries were used to examine associations between three indicators of childhood misfortune (adverse childhood events, poor childhood health, and childhood socioeconomic circumstances) and late-life depressive symptoms. Subsequently, we tested whether these associations were mediated by education, occupational position, the ability to make ends meet, and potential or perceived relational reserves; that is family members or significant others who can provide help in case of need, respectively. Analyses were stratified by gender and adjusted for confounding and control variables.

Results

Adult socioeconomic reserves partly mediated the associations between adverse childhood events, poor childhood health and late-life depressive symptoms. The associations with the third indicator of childhood misfortune (childhood socioeconomic circumstances) were fully mediated by adult socioeconomic reserves in men, and partly mediated in women. None of the associations were mediated by relational reserves. However, perceived relational reserves were associated with fewer late-life depressive symptoms.

Conclusion

Childhood socioeconomic disadvantage can be mitigated more easily over the life course than adverse childhood events and poor childhood health, especially in men. Perceived relational reserves work primarily as a protective force against late-life depressive symptoms and may be particularly important in the context of the cumulative effect of childhood adversities.

•

Socioeconomic reserves can mediate the effect of childhood socioeconomic disadvantage on late-life depressive symptoms.

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Education turned out to be the strongest mediator.

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Findings showed a lasting effect of adverse childhood experiences and poor childhood health on late-life depressive symptoms.

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Relational reserves did not mediate the effect of any of the childhood misfortune indicators on late-life depressive symptoms.

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Relational reserves were associated with fewer late-life depressive symptoms suggesting a potential protective function.

Migrant mortality differences in the 2000s in Belgium: interaction with gender and the role of socioeconomic position

Background

Belgium has a long history of migration. As the migrant population is ageing, it is crucial thoroughly to document their health. Many studies that have assessed this, observed a migrant mortality advantage. This study will extend the knowledge by probing into the interaction between migrant mortality and gender, and to assess the role of socioeconomic position indicators in this paradox.

Methods

Individually linked data of the 2001 Belgian Census, the National Register and death certificates for 2001–2011 were used. Migrant origin was based on both own and parents’ origin roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Absolute and relative mortality differences by migrant origin were calculated for the most common causes of death. Moreover, the Poisson models were adjusted for educational attainment, home ownership and employment status.

Results

We observed a migrant mortality advantage for most causes of death and migrant groups, which was strongest among men. Adjusting for socioeconomic position generally increased the migrant mortality advantage, however with large differences by gender, migrant origin, socioeconomic position indicator and causes of death.

Conclusions

Adjusting for socioeconomic position even accentuated the migrant mortality advantage although the impact varied by causes of death, migrant origin and gender. This highlights the importance of including multiple socioeconomic position indicators when studying mortality inequalities. Future studies should unravel morbidity patterns too since lower mortality not necessarily implies better health. The observed migrant mortality advantage suggests there is room for improvement. However, it is essential to organize preventative and curative healthcare that is equally accessible across social and cultural strata.

Impact of Low-Income Home Energy-Efficiency Retrofits on Building Air Tightness and Healthy Home Indicators

We studied 226 low-income households as a part of the Colorado Home Energy Efficiency and Respiratory Health (CHEER) study to investigate the relationship between energy-efficiency retrofits (EERs) specific to air sealing of residential building envelopes, annual average infiltration rates (AAIR), and qualitative indicators of “healthy” homes. Blower door tests quantified the leakage area in each home, which was used to estimate the AAIR. Walk-through inspections were used to record observations of air-sealing retrofits conducted as part of Colorado’s Weatherization Assistance Program and indirect indicators of poor indoor environmental quality (IEQ) in the homes, such as visible mold or stains, visible dust on hard surfaces, vapor condensation on windows, dampness, and perceived air quality. Results showed that building characteristics like age and volume affected AAIR more significantly than air-sealing EERs. Among the air-sealing EERs, homes with the air-handler ductwork sealed and windows weather-stripped were found to have significantly lower AAIR compared to the homes without these features. Mold growth, wall stains, notably higher levels of dust, and unacceptable odor levels were more frequently reported in homes with higher AAIR, showing that leakier homes do not necessarily have better IEQ.

Trends in Belgian cause-specific mortality by migrant origin between the 1990s and the 2000s

Background

Belgium has a large migrant community that is increasingly ageing. As migrants may have faced environmental and social exposures before, during and after migration, they may have experienced an accelerated epidemiological transition. Studying mortality differentials between the migrant and native population may therefore allow for a better understanding of the aetiology of diseases. While many studies have assessed migrant mortality, few have looked into the role of gender or the trend over time. Therefore, this study aims to probe into mortality differences between the native and migrant population for all major causes of death (COD) during the 1990s and 2000s. We will discriminate between all major migrant groups and men and women as they have different migration histories.

Methods

Individually linked data of the Belgian Census, the National Register and death certificates for the periods 1991–1997 and 2001–2008 were used. Migrant origin was based on both own and parents’ origin, hereby maximizing the population with migrant roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Both absolute and relative mortality differences by migrant origin were calculated for the most common COD.

Results

We generally observed a migrant advantage for overall, cause-specific and cancer-specific mortality, with infection-related cancer mortality being the only exception. The effect was particularly strong for lifestyle-related COD, non-western migrants, and men. Over time, mortality declined among native Belgian men and women, yet remained stable for several migrant groups. This converging trend was largely due to smoking and reduced reproductive behaviour among migrants.

Conclusions

The migrant mortality advantage stresses that there is room for improvement in the area of health in Belgium. Since the largest differences between native Belgians and migrants were observed for lifestyle-related diseases, and there is a tendency towards convergence of mortality over time, primary prevention tackling the most vulnerable groups remains crucial. Moreover, efforts should be made to ensure equal access to health care among the social and cultural strata.

Advantaged socioeconomic conditions in childhood are associated with higher cognitive functioning but stronger cognitive decline in older age

There is increasing evidence that socioeconomic conditions early in life have an impact on cognitive functioning in later life. Based on the large longitudinal sample from SHARE we find a clear pattern in cognitive functioning in old age, related to childhood socioeconomic conditions: Those from more affluent households show higher levels of fluid intelligence in old age and experience stronger decline over time in executive functions. The latter phenomenon is not often documented. Although modifications in cognitive functioning with aging are inevitable, life course socioeconomic circumstances impact the timing of this process. We conclude that the etiology of cognitive aging is the result of multiple social processes, defined by the socioeconomic conditions in childhood and all along the life course.

Cognitive aging is characterized by large heterogeneity, which may be due to variations in childhood socioeconomic conditions (CSC). Although there is substantial evidence for an effect of CSC on levels of cognitive functioning at older age, results on associations with cognitive decline are mixed. We examined by means of an accelerated longitudinal design the association between CSC and cognitive trajectories from 50 to 96 years. Cognition included two functions generally found to decline with aging: delayed recall and verbal fluency. Data are from six waves of the Survey of Health, Aging, and Retirement in Europe (SHARE), conducted between 2004 and 2015 (n = 24,066 at baseline; 56% female, age 50+). We found a consistent CSC pattern in levels of cognitive functioning in later life. Older people with disadvantaged CSC had lower levels of cognitive functioning than those with more advantaged CSC. We also find that decline is almost 1.6 times faster in the most advantaged group compared with the most disadvantaged group. The faster decline for people with more advantaged CSC becomes less pronounced when we additionally control for adulthood socioeconomic conditions and current levels of physical activity, depressive symptoms, and partner status. Our findings are in line with the latency, pathway, and cumulative model and lend support to theories of cognitive reserve, stating that neuronal loss can no longer be repaired in people with more cognitive reserve once the underlying pathology is substantial and speed of decline is accelerated.

Effect of Early- and Adult-Life Socioeconomic Circumstances on Physical Inactivity

PURPOSE

This study aimed to investigate the associations between early- and adult-life socioeconomic circumstances and physical inactivity (level and evolution) in aging using large-scale longitudinal data.

METHODS

This study used the Survey of Health Ageing and Retirement in Europe, a 10-yr population-based cohort study with repeated measurements in five waves, every 2 yr between 2004 and 2013. Self-reported physical inactivity (waves 1, 2, 4, and 5), household income (waves 1, 2, 4, and 5), educational attainment (wave of the first measurement occasion), and early-life socioeconomic circumstance (wave 3) were collected in 22,846 individuals 50 to 95 yr of age.

RESULTS

Risk of physical inactivity was increased for women with the most disadvantaged early-life socioeconomic circumstances (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.20-1.86). With aging, the risk of physical inactivity increased for both sexes and was strongest for those with the most disadvantaged early-life socioeconomic circumstances (OR, 1.04 (95% CI, 1.02-1.06) for women; OR, 1.02 (95% CI, 1.00-1.05) for men), with the former effect being more robust than the latter one. The association between early-life socioeconomic circumstances and physical inactivity was mediated by adult-life socioeconomic circumstances, with education being the strongest mediator.

CONCLUSIONS

Early-life socioeconomic circumstances predicted high levels of physical inactivity at older ages, but this effect was mediated by socioeconomic indicators in adult life. This finding has implications for public health policies, which should continue to promote education to reduce physical inactivity in people at older ages and to ensure optimal healthy aging trajectories, especially among women with disadvantaged early-life socioeconomic circumstances.

Effect of childhood socioeconomic conditions on cancer onset in later life: an ambidirectional cohort study

Objectives

Living in low socioeconomic conditions during childhood is associated with poor health outcomes in later life. Whether this link also applies to cancer is unclear. We examined whether childhood socioeconomic conditions (CSCs) are associated with cancer risk in later life and whether this effect remained after adjusting for adulthood socioeconomic conditions (ASCs).

Methods

Data for 26,431 individuals ≥ 50 years old included in SHARE were analysed. CSCs were constructed by using indicators of living conditions at age 10. ASC indicators were education, main occupation, and household income. Gender-stratified associations of CSCs with cancer onset (overall and by site) were assessed by Cox regression.

Results

In total, 2852 individuals were diagnosed with cancer. For both men and women, risk of overall cancer was increased for advantaged CSCs and remained so after adjusting for ASCs (hazard ratio = 1.36, 95% CI 1.10, 1.63, and 1.70, 95% CI 1.41, 2.07).

Conclusions

Advantaged CSCs are associated with an increased risk of overall cancer at older age, but results vary by cancer sites and sex. Participation in cancer screening or exposure to risk factors may differ by social conditions.

Electronic supplementary material

The online version of this article (10.1007/s00038-018-1111-9) contains supplementary material, which is available to authorized users.

Affordable housing and health: a health impact assessment on physical inspection frequency

OBJECTIVES

To characterize the prevalence of health-related housing quality exposure for the vulnerable populations that live in affordable housing.

DESIGN

Retrospective cross-sectional study.

SETTING

Affordable housing properties in Ohio inspected between 2007 and 2011.

PARTICIPANTS

Stratified random sample of physical inspection reports (n = 370), including a case study of properties receiving multiple inspections (n = 35).

MAIN OUTCOME MEASURES

Health-related housing factors, including mold, fire hazard, and others.

RESULTS

The majority of affordable housing property inspections (85.1%) included at least 1 health-related housing quality issue. The prevalence of specific health-related violations was varied, with appliance and plumbing issues being the most common, followed by fire, mold, and pest violations. Across funding agencies, the actual implementation of inspection protocols differed.

CONCLUSIONS

The majority of physical inspections identified housing quality issues that have the potential to impact human health. If the frequency of physical inspections is reduced as a result of inspection alignment, the most health protective inspection protocol should be selected for funding agency inspections; a standardized physical inspection tool is recommended to improve the consistency of inspection findings between mandatory physical inspections in order to promote optimum tenant health.

Housing conditions in childhood and cause-specific adult mortality: The effect of sanitary conditions and economic deprivation on 55,761 men in Oslo

Aims: To examine indices of two plausible pathways linking housing conditions in childhood and adult cause-specific mortality: sanitary conditions and economic deprivation. To investigate if the effects of these are explained by education. Methods: Linked register study (housing information from the 1960 Census, the educational register in 1990 and the death register 1990—998). A Sanitary Conditions Index (SCI) and an Economic Deprivation Index (EDI) were constructed from the housing conditions variables. Participants: All men aged 30—54 years (n=55,761) who were residents in Oslo on 1 January 1990 with complete information on housing conditions (80%). Results: Both SCI and EDI were related to all-cause mortality independently of each other. Education explained to a large extent these effects. In a sub-sample, 24% of the effects could be explained by parental education and 31% by own education. The effects found for causes of death failed to give a heterogeneous pattern between the two indices. In the fully adjusted model psychiatric causes of death appeared to be more related to EDI than SCI. Conclusions: The two indices of childhood social circumstances, sanitary conditions and economic deprivation, appeared to be independently associated with all-cause mortality. The effect of both could to a large extent be explained by parental and own education.

Socioeconomic position in childhood and cancer in adulthood: a rapid-review

Background

The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes.

Methods and results

We performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest.

Conclusions

Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented.

Does labour market disadvantage help to explain why childhood circumstances are related to quality of life at older ages? Results from SHARE

There is robust evidence that childhood circumstances are related to quality of life in older ages, but the role of possible intermediate factors is less explored. In this paper, we examine to what extent associations between deprived childhood circumstances and quality of life at older ages are due to experienced labour market disadvantage during adulthood. Analyses are based on the Survey of Health Ageing and Retirement in Europe (SHARE), with detailed retrospective information on individual life courses collected among 10,272 retired men and women in 13 European countries (2008-2009). Our assumption is that those who have spent their childhood in deprived circumstances may also have had more labour market disadvantage with negative consequences for quality of life beyond working life. Results demonstrate that advantaged circumstances during childhood are associated with lower levels of labour market disadvantage and higher quality of life in older ages. Furthermore, results of multivariate analyses support the idea that part of the association between childhood circumstances and later quality of life is explained by labour market disadvantage during adulthood.

Updating indicators for scaling the socioeconomic level of families for health research

BACKGROUND

Socioeconomic position is a community-used concept in health research. The social level is related to numerous exposures, resources, and susceptibilities that may affect health.

AIM

To update and validate a tool for scaling the socioeconomic level of families for health research.

PARTICIPANTS AND METHODS

A multistage stratified cluster sampling technique was used to select 900 families (one index person per family) from urban and rural areas in the Alexandria governorate using the proportional allocation method. Ten variables reflecting parental education, parental occupation, family characteristics, financial status as well as home sanitation were reduced to a single socioeconomic status (SES) index using two methods: the Sigma scoring method and factor analysis. Reliability and validity were assessed for the developed scale. Factor scores were classified into three categories (low, medium, high) using cluster analysis, and then different cut-off points for the Sigma scoring method were used and compared with the cluster solution using the κ statistic.

RESULTS

Results showed that the developed scale was both reliable (Cronbach's α coefficient α=0.79) and valid [8 out of the 10 items had high loading (>0.5) for SES]. The best cut-off points for SES classification using the proposed scoring system that yielded the highest agreement with the cluster solution (κ=0.77) were less than 40%, 40 to <70%, and at 70% or more, with an overall correct classification of 84.7%.

CONCLUSION AND RECOMMENDATION

The new scale proved to be valid and reliable. This scale is recommended for use for scaling the socioeconomic level of families for health research.

Proximal and distal determinants of stressful work: framework and analysis of retrospective European data

Background

While robust evidence on associations of stressful work with health exists, less research is available on determinants of stressful work in terms of respondents' characteristics (proximal factors) and in terms of national labour market policies (distal factors). In this article we analyse proximal (childhood circumstances and labour market disadvantage) and distal determinants (national compensation and integration policies) of stressful work in a comprehensive framework.

Methods

We use data from the third wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), with retrospective information on individual life courses collected among 11181 retired men and women in 13 European countries (2008–2009). To test our hypotheses we estimate multilevel regression models.

Results

Results show that stressful work is related to disadvantaged circumstances during childhood. To some extent this association is explained by labour market disadvantage during adulthood. Additionally, well developed labour market integration policies are related to lower overall levels of stressful work at national level.

Conclusion

This analysis provides first evidence of important determinants of stressful work, both in terms of pre-employment conditions (childhood circumstances) and in terms of contextual macro-social policies.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-849) contains supplementary material, which is available to authorized users.

Surveillance of social and geographic inequalities in housing-related issues: the case of the Eastern Townships, Quebec (Canada)

Even though health inequalities are conditioned by many aspects of the environment, much of the existing research focuses on the social environment. This emphasis has the effect to neglect other environmental aspects such as its physical dimension. The physical environment, which is linked to housing conditions, may contribute to the uneven distribution of health. In this study, we examined 19 housing-related issues among a representative sample of 2,000 adults residing in a Quebec (Canada) health region characterized by a mix of rural, semi-rural, and urban areas. The distribution of these issues was examined according to socioeconomic and geographic indicators of social position. Summary measures of inequalities were assessed. Our results showed that the prevalence of nearly all housing-related issues was higher among low-income households compared to more affluent ones. Highly educated individuals showed better housing conditions, whereas different issues tended to cluster in deprived or densely populated areas. To conclude, we observed steep gradients between social class and poor housing conditions. This may explain a substantial part of health inequality on the regional scale. The surveillance of housing-related issues is therefore essential to properly inform and mobilize local stakeholders and to develop interventions that target vulnerable groups on this level.

Improving the state of health hardware in Australian Indigenous housing: building more houses is not the only answer

BACKGROUND

This article outlines a program of applied research and development known as Housing for Health that, over the period 1999-2012, targeted health-related improvements in housing for Indigenous householders in communities across regional and remote Australia. In essence, the program focuses on measuring the functionality of key appliances and structures (we term this "health hardware") against clear criteria and ensuring identified faults are fixed.

METHODS

Detailed survey and assessment of all aspects of housing was undertaken, particularly focusing on the function of health hardware. All results were entered into a database and analyzed.

RESULTS

The results demonstrate extremely poor initial performance of the health hardware. A key finding is that attention to maintenance of existing houses can be a cost-effective means of improving health outcomes and also suggests the need to superintend the health-conferring qualities of new infrastructure. We briefly outline the early foundations of the Housing for Health program, major findings from data gathered before and after improvements to household amenities, and our efforts to translate these findings into broader policy.

CONCLUSIONS

These data demonstrate that simply injecting funds into housing construction is not sufficient for gaining maximum health benefit.

Country-level economic disparity and child mortality related to housing and injuries: a study in 26 European countries

OBJECTIVE

Adverse living standards are associated with poorer child health and safety. This study investigates whether adverse housing and neighbourhood conditions contribute to explain country-level associations between a country's economic level and income inequality and child mortality, specifically injury mortality.

DESIGN

Ecological, cross-sectional study.

SETTING/SUBJECTS

Twenty-six European countries were grouped according to two country-level economic measures from Eurostat: gross domestic product (GDP) and income inequality. Adverse country-level housing and neighbourhood conditions were assessed using data from the 2006 European Union Income Social Inclusion and Living Conditions Database (n=203 000).

MAIN OUTCOME MEASURE

Child mortality incidence rates were derived for children aged 1-14 years for all causes, all injuries, road traffic injuries and unintentional injuries excluding road traffic. Linear regression analysis was applied to measure whether housing or neighbourhood conditions have a significant association with child mortality and whether a strain modified the association between GDP/income inequality and mortality.

RESULTS

Country-level income inequality and GDP demonstrated a significant association with child mortality for all outcomes. A significant association was also found between housing strain and all child mortality outcomes, but not for neighbourhood strain. Housing strain partially modified the relationship between income inequality and GDP and all child mortality outcomes, with the exception of income inequality and road traffic injury mortality showing full mediation by housing strain.

CONCLUSIONS

Adverse housing conditions are a likely pathway in the country-level association between income inequality and economic GDP and child injury mortality.

Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper

Much has been written about the measurement of socio-economic position (SEP) in high-income countries (HIC). Less has been written for an epidemiology, health systems and public health audience about the measurement of SEP in low- and middle-income countries (LMIC). The social stratification processes in many LMIC-and therefore the appropriate measurement tools-differ considerably from those in HIC. Many measures of SEP have been utilized in epidemiological studies; the aspects of SEP captured by these measures and the pathways through which they may affect health are likely to be slightly different but overlapping. No single measure of SEP will be ideal for all studies and contexts; the strengths and limitations of a given indicator are likely to vary according to the specific research question. Understanding the general properties of different indicators, however, is essential for all those involved in the design or interpretation of epidemiological studies. In this article, we describe the measures of SEP used in LMIC. We concentrate on measures of individual or household-level SEP rather than area-based or ecological measures such as gross domestic product. We describe each indicator in terms of its theoretical basis, interpretation, measurement, strengths and limitations. We also provide brief comparisons between LMIC and HIC for each measure.

Socio-economic disadvantage from childhood to adulthood and locomotor function in old age: a lifecourse analysis of the Boyd Orr and Caerphilly prospective studies

BACKGROUND

Socio-economic influences over a lifetime impact on health and may contribute to poor physical functioning in old age.

METHODS

The authors examined the impact of both childhood and adulthood socio-economic factors on locomotor function at 63-86 years (measured with the get up and go timed walk and flamingo balance test) in the UK-based Boyd Orr (n=405) and Caerphilly (n=1196) prospective cohorts.

RESULTS

There was a marked reduction in walking speed and balance time with increasing age. Each year of age was associated with a 1.7% slower walk time and a 14% increased odds of poor balance. Participants who moved from a low socio-economic position in childhood to a high socio-economic position in adulthood had 3% slower walking times (95% CI -2% to 8%) than people with a high socio-economic position in both periods. Participants who moved from a high socio-economic position in childhood to a low adulthood socio-economic position had 5% slower walking times (95% CI -2% to 12%). Participants with a low socio-economic position in both periods had 10% slower walking times (95% CI 5% to 16%; p for trend <0.001). In Boyd Orr, low socio-economic position in childhood was associated with poor balance in old age (OR per worsening category=1.26; 95% CI 1.01 to 1.57; p=0.043), as was socio-economic position in adulthood (OR=1.71; 95% CI 1.20 to 2.45; p=0.003). Similar associations were not observed in Caerphilly.

CONCLUSION

Accumulating socio-economic disadvantage from childhood to adulthood is associated with slower walking time in old age, with mixed results for balance ability.

The effect of housing on the mental health of older people: the impact of lifetime housing history in Whitehall II

BACKGROUND

This study describes differences in trajectories of self-reported mental health in an ageing cohort, according to their housing, while controlling for confounders.

METHODS

The General Health Questionnaire was measured on six occasions as part of Whitehall II cohort study of office-based British civil servants (1985-2009); 10,308 men and women aged 35-55 at baseline.

RESULTS

Home-ownership was the predominant tenure at baseline and increased over the life-course, but the social gradient remained. In the bivariate analysis, by phase nine, renters had higher (poorer mental health) GHQ scores (55.48) than owner occupiers (51.98). Those who reported difficulty paying bills or problems with housing had higher GHQ scores at baseline (financial difficulties 57.70 vs 54.34; house problems 58.06 vs 53.99) and this relative difference increased by phase nine (financial difficulties 59.64 vs 51.67; house problems 56.68 vs 51.22). In multivariate models, the relative differences in GHQ scores by tenure increased with age, but were no longer significant after adjusting for confounders. Whereas GHQ scores for those with housing problems and financial difficulties were still significantly higher as participants grew older.

CONCLUSION

The social gradient in the effect of home ownership on mental health, which is evident at baseline, diminishes as people get older, whereas housing quality and financial problems become relatively more important in explaining older people's health. Inequalities in housing quality and ability to deal with household financial problems will become increasingly important mental health issues as the population ages.

Socioeconomic status and subclinical atherosclerosis in older adults

OBJECTIVE

This study investigated the long-term effects of socioeconomic status (SES) on atherosclerosis.

METHODS

Data from the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study (Beaver Dam, WI, 1998-2000), were used to examine adult SES (education, household income, and longest-held job) and childhood SES (household density and parental home ownership at age 13) associations with carotid intima-media thickness (IMT) and carotid plaque in a cohort of 2042 men and women aged 53 to 94 years.

RESULTS

For education, income, and occupation (women), those in the lowest SES group had statistically larger age-sex-adjusted IMT than those in the highest SES group (<12 vs. >12 years education: 0.92 vs. 0.86 mm respectively, P<0.0001), (<$10,000 vs. >$45,000: 0.97 vs. 0.87 mm, P<0.0001), (operator/fabricator/labor vs. manager/professional: 0.89 vs. 0.82 mm, P<0.001). Associations were similar using carotid plaque as the outcome. Participants with low levels of both adult and childhood SES measures had age-sex-adjusted IMT greater than those with persistently high levels of SES (0.93 vs. 0.84 mm, P<0.0001).

CONCLUSIONS

Measures of SES at two points in the life-span were associated with subclinical atherosclerosis.

Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid atherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study

BACKGROUND

Socioeconomic gradients in health persist despite public health campaigns and improvements in healthcare. The Psychosocial and Biological Determinants of Ill-health (pSoBid) study was designed to uncover novel biomarkers of chronic disease that may help explain pathways between socioeconomic adversity and poorer physical and mental health.

METHODS

We examined links between indicators of early life adversity, possible intermediary phenotypes, and markers of ill health in adult subjects (n = 666) recruited from affluent and deprived areas. Classical and novel risk factors for chronic disease (lung function and atherosclerosis) and for cognitive performance were assessed, and associations sought with early life variables including conditions in the parental home, family size and leg length.

RESULTS

Associations were observed between father's occupation, childhood home status (owner-occupier; overcrowding) and biomarkers of chronic inflammation and endothelial activation in adults (C reactive protein, interleukin 6, intercellular adhesion molecule; P < 0.0001) but not number of siblings and leg length. Lung function (forced expiratory volume in 1 second) and cognition (Choice Reaction Time, the Stroop test, Auditory Verbal Learning Test) were likewise related to early life conditions (P < 0.001). In multivariate models inclusion of inflammatory variables reduced the impact and independence of early life conditions on lung function and measures of cognitive ability. Including variables of adult socioeconomic status attenuated the early life associations with disease biomarkers.

CONCLUSIONS

Adverse levels of biomarkers of ill health in adults appear to be influenced by father's occupation and childhood home conditions. Chronic inflammation and endothelial activation may in part act as intermediary phenotypes in this complex relationship. Reducing the 'health divide' requires that these life course determinants are taken into account.

Influence of life-course socioeconomic position on incident heart failure in blacks and whites: the Atherosclerosis Risk in Communities Study

The influence of early-life socioeconomic position (SEP) on incident heart failure in blacks and whites is unknown. The authors examined the relation between early-life SEP and incident, hospitalized heart failure among middle-aged US participants (2,503 black and 8,519 white) in the Atherosclerosis Risk in Communities (ARIC) Study. Early-life SEP indicators assessed included parental education, occupation, and home ownership. From 1987 to 2004, 221 and 537 incident heart failure events were identified in blacks and whites, respectively. In Cox proportional hazards regression, early-life SEP was inversely related to incident heart failure after adjustment for age, gender, and study center (for blacks, hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.00, 1.95; for whites, HR = 1.32, 95% CI: 1.06, 1.64). Additional adjustment for young and mid-to-older adulthood SEP and established heart failure risk factors attenuated this association towards the null in both blacks and whites. Of the SEP measures, mid-to-older adulthood SEP showed the strongest association with incident heart failure in both blacks (HR = 1.32, 95% CI: 0.90, 1.96) and whites (HR = 1.39, 95% CI: 1.11, 1.75). SEP over the life course is related to the risk of incident heart failure, with SEP later in adulthood having a more prominent role than earlier SEP.

Childhood economic conditions and length of life: evidence from the UK Boyd Orr cohort, 1937-2005

We study the importance of childhood socioeconomic conditions in predicting differences in life expectancy using data from a large sample of children collected in 16 locations in England and Scotland in 1937-39, who have been traced through official death records up to 2005. We estimate a number of duration of life models that control for unobserved family heterogeneity. Our results confirm that childhood conditions such as household income and the quality of the home environment are significant predictors of longevity. Importantly, however, the role of socioeconomic status appears to differ across cause of death, with household income being a significant predictor of death from smoking-related cancer. Moreover, we find that (1) poor housing conditions in childhood is associated with reduced longevity, that (2) early doctor-assessed childhood health conditions significantly predict a reduced length of life, that (3) children born in a location with relatively high infant mortality rates live significantly fewer years, and that (4) there is a high correlation in longevity across children from the same family across all causes of death. We estimate that the difference in life expectancy between those with the 'best' and 'worst' observable characteristics is about 9 years, which increases to 20 years when we take into account the 'best' and 'worst' observable and unobservable household characteristics.

The state of health hardware in Aboriginal communities in rural and remote Australia

INTRODUCTION

Many of the health problems faced by rural and remote Aboriginal people have been attributed to a poor living environment. In the mid 1980s we began a process of defining problems with the immediate living environment that would affect health. These related particularly to safety, washing and hygiene practice.

METHODS

Between January 1999 and November 2006 we undertook a standardised and detailed assessment of housing in Aboriginal communities. This involved an initial assessment of 250 items in each house and living area, focusing on performance and their impact on these healthy living practices. At the first survey-fix we implemented a limited cost repair of non-functioning health hardware and then six months later returned to the communities for a repeat assessment to examine improvement in performance.

RESULTS

Between January 1999 and November 2006 we assessed 4,343 houses in 132 communities in four States and the Northern Territory during survey-fix 1 (SF1) and have repeated that survey-fix assessment (SF2) in 3,448 houses in 112 of those communities. This survey demonstrates extraordinarily poor performance of Aboriginal houses. In the survey period, 71,869 items referred for repair by survey teams were inspected by licensed electricians or plumbers and 49,499 of these have so far been fixed. Only 10% of these house items requiring repair were due to vandalism or misuse.

CONCLUSION

Improvements in the living environment for Aboriginal people will require a sustained commitment to the planning, funding and implementation of maintenance programs in addition to adherence to the design, construction and supervision detail outlined in the National Indigenous Housing Guide.

Life-course approaches to inequalities in adult chronic disease risk

A life-course approach to chronic-disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular manner in which timing in relation to physical growth, reproduction, infection, social mobility, behavioural transitions etc. can influence various adult chronic diseases in different ways, and more ambitiously by how these temporal processes are interconnected and manifested in health inequalities within a population and in population-level disease trends. The paper will discuss some historical background to life-course epidemiology and theoretical models of life-course processes, and will review some of the empirical evidence linking life-course processes to CHD, haemorrhagic stroke, stomach cancer and other chronic diseases in adulthood. It will also underscore that a life-course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life-course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

Lifelong socioeconomic trajectory and premature mortality (35-65 years) in France: findings from the GAZEL Cohort Study

BACKGROUND

Studies conducted in the UK and Scandinavia show an inverse association between lifetime socioeconomic position and adult mortality. However, there are virtually no data from other countries and few investigations have examined non-cardiovascular mortality in men and women.

METHODS

Lifelong socioeconomic trajectories (father's occupation, own occupation in young adulthood and in mid-life) and premature (< or = 65 years) mortality (all-cause, smoking-related cancer, diseases of the circulatory system and external causes) in the French GAZEL Cohort Study (14,972 men and 5,598 women, followed up between 1990 and 2004) were studied. Hazard ratios (HRs) were estimated using Cox's regression models adjusted for age, marital status, tobacco smoking, alcohol consumption, body mass index, and fruit and vegetable consumption.

RESULTS

Men and women who experienced lifelong disadvantage or downward intergenerational mobility were at high risk of dying prematurely compared with those with a favourable trajectory (age-adjusted HRs for all-cause mortality: cumulative disadvantage: HR 1.61, 95% confidence interval (CI) 1.26 to 2.06 in men and HR 1.95, 95% CI 1.10 to 3.47 in women; downward mobility: HR 1.87, 95% CI 1.35 to 2.58 in men and HR 2.05, 95% CI 1.12 to 3.75 in women). Associations were strongest for mortality due to chronic diseases (smoking-related cancers and diseases of the circulatory system). These associations were partly explained by marital status, body mass index, alcohol consumption, cigarette smoking, and fruit and vegetable consumption.

CONCLUSIONS

In France, where the leading cause of premature death is cancer, lifelong socioeconomic position is associated with the risk of dying before the age of 65 years. Adult factors seem more relevant than childhood socioeconomic circumstances.

When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity

The influence of physical housing quality on childhood asthma expression, especially the effect of exposure to moulds, allergens, and pollutants, is well documented. However, attempts to explain increasing rates and severity of childhood asthma solely through physical environmental factors have been unsuccessful, and additional exposures may be involved. Increasing evidence has linked psychological stress and negative affective states to asthma expression. At the same time, recent scholarship in the social sciences has focused on understanding how social environments, such as housing, "get under the skin" to influence health, and suggests that psychological factors play a key role. While there is relevant overlapping research in social science, psychology, economics, and health policy in this area, findings from these disciplines have not yet been conceptually integrated into ongoing asthma research. We propose to expand the dimensions of housing considered in future asthma research to include both physical and psychological aspects which may directly and indirectly influence onset and severity of disease expression. This synthesis of overlapping research from a number of disciplines argues for the systematic measure of psychological dimensions of housing and consideration of the interplay between housing stress and physical housing characteristics in relation to childhood asthma.

Early-life origins of the race gap in men's mortality

Using a life course framework, we examine the early life origins of the race gap in men's all-cause mortality. Using the National Longitudinal Survey of Older Men (1966-1990), we evaluate major social pathways by which early life conditions differentiate the mortality experiences of blacks and whites. Our findings indicate that early life socioeconomic conditions, particularly parental occupation and family structure, explain part of the race gap in mortality. Black men's higher rates of death are associated with lower socioeconomic standing in early life and living in homes lacking both biological parents. However these effects operate indirectly through adult socioeconomic achievement processes, as education, family income, wealth, and occupational complexity statistically account for the race gap in men's mortality. Our findings suggest that policy interventions to eliminate race disparities in mortality and health should address both childhood and adult socioeconomic conditions.