Disparities in self-rated health across generations and through the life course

Abstract

Extensive evidence leads us to expect that health disparities by race and socioeconomic status found in one generation might be reproduced in the next. To the extent that this occurs it is important to assess life course processes responsible for the reproduction. Prospective evidence concerning such life course processes is hard to come by as it requires long-term follow-up of individuals from childhood through adult life. We present data from the Child Health and Development Disparities study that provides evidence relevant to this issue with respect to self-rated health. Mothers and offspring recruited in California's Bay Area between 1959 and 1967 were assessed during pregnancy with follow-up exams of offspring along with in-person interviews with mothers (at offspring ages 5, 9–11, 15–17) and offspring (at ages 15–17, ~50). Available data allow us to assess the importance of three potential life course pathways in the reproduction of inequalities in self-rated health – socioeconomic pathways, cognitive pathways and pathways involving emerging health itself. As expected we found that race and SES disparities in SRH are reproduced across generations. They are evident in mothers, not strong or significant in offspring at 15–17, but present once again in offspring at age ~50. Concerning potential pathways, we found that indicators of child health were related to adult SRH and played some role in accounting for race but not SES disparities in adult SRH. Cognitive abilities were unrelated to adult SRH with childhood SES controlled. Childhood SES was associated with adult SRH independent of other childhood factors and is reduced to non-significance only when offspring college attainment is controlled. Race and SES disparities in self-reported health in one generation are re-expressed in the next with strongest support for SES pathways in this transmission.

Comparing Observed and Unobserved Components of Childhood: Evidence From Finnish Register Data on Midlife Mortality From Siblings and Their Parents

“…(2010) find that the differences in adult health between different levels of childhood socioeconomic position are completely explained by attained adult social position. Similar results of (almost) complete mediation when investigating adult health instead of adult mortality have been found by several other studies as well (Link et al 2017;Pakpahan et al 2017;Turner et al 2016;Zajacova et al 2015), although there is also some evidence to suggest that neither the effects of childhood socioeconomic conditions, nor the effects of early life health conditions, on adult health can fully be accounted for by adulthood characteristics (O'Rand and Hamil-Luker 2005). A systematic review of the literature on childhood SEP and its association with adult mortality also corroborates the view that a large part of the effects of childhood SEP is mediated via adult characteristics (Galobardes et al 2004(Galobardes et al , 2008.…”

“…Consequently, the total influence of childhood on mortality can be defined as the additive components plus an unknown function of the interactions of the four dimensions: While such a framework is necessarily a strong simplification we can link most previous research to one or more of the four dimensions. Parental education and occupation or the financial or material situation of the household are investigated in several studies (Agahi et al 2014;Case and Paxson 2010;Elo et al 2014;Hayward and Gorman 2004;Link et al 2017;Palloni 2006;Turner et al 2016) and can clearly be thought of as representing factors attributed to fundamental cause theory ( AB ).…”

“…To reduce the complexity of our study we therefore disregard such a pattern of interaction for the remainder of the study and assume that Δ I 7^,_Q`a; = 0. Estimates of the extent to which childhood influences are mediated through adulthood characteristics (Δ d)cdefgh ) have been conducted in many studies, often taking adulthood SEP, health behavior, or health status as ways in which childhood influences mortality or adult health (Hayward and Gorman 2004;Link et al 2017;Pakpahan et al 2017).…”

“…We could not cover many other important factors that we included in our theoretical model. Other studies have shown that childhood health status is especially predictive of adult health, even beyond achieved adulthood characteristics (Case and Paxson 2010;Haas 2008;Link et al 2017;O'Rand and Hamil-Luker 2005;Pakpahan et al 2017;Zajacova et al 2015), which makes it an important stressor that could explain the unobserved family component. We also had only very limited information on family structure and relationships inside the family, which might be important for the development of health and mortality risk in later life (Campbell and Lee 2009).…”

Gender differences in the pathways from childhood disadvantage to metabolic syndrome in adulthood: An examination of health lifestyles

“…Finally, the sample was limited in terms of racial/ethnic diversity (6% non-White); thus, our findings may not be generalizable to other racial/ethnic groups. Growing evidence suggests that SES-driven life course pathways might persist and be reproduced for future cohorts ( Link et al, 2017 ). Such an issue should be tracked with samples collected across generations.…”