American Journal of Epidemiology Advance Access originally published online on July 19, 2007
American Journal of Epidemiology 2007 166(8):966-974; doi:10.1093/aje/kwm155
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ORIGINAL CONTRIBUTIONS |
Why Do Children from Socioeconomically Disadvantaged Families Suffer from Poor Health When They Reach Adulthood? A Life-Course Study
1 MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
2 Departments of Psychology and Neuroscience and Psychiatry and Behavioral Sciences and Institute for Genome Sciences and Policy, Duke University, Durham, NC
3 INSERM U687-IFR69, Hôpital National de Saint-Maurice, Saint-Maurice, France
4 Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Correspondence to Professor Terrie E. Moffitt, MRC Social, Genetic and Developmental Psychiatry Centre, 10P, Box P080, De Crèspigny Park, Denmark Hill, London SE5 8AF, United Kingdom (e-mail: terrie.moffitt{at}iop.kcl.ac.uk).
Received for publication January 4, 2007. Accepted for publication April 23, 2007.
The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972–1973, who were followed from birth to age 32 years (2004–2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55–67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.
cardiovascular system; cohort studies; health; social class; socioeconomic factors; substance-related disorders; tobacco use disorder
Abbreviations: CI, confidence interval; IQ, intelligence quotient; RR, relative risk; SES, socioeconomic status