Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.     

The Importance of Early Childhood Poverty

Most poor children achieve less, exhibit more problem behaviors and are less healthy than children reared in more affluent families. We look beyond correlations such as these to a recent set of studies that attempt to assess the causal impact of childhood poverty on adult well-being. We pay particular attention to the potentially harmful effects of poverty early in childhood on adult labor market success (as measured by earnings), but also show results for other outcomes, including out-of-wedlock childbearing, criminal arrests and health status. Evidence suggests that early poverty has substantial detrimental effects on adult earnings and work hours, but on neither general adult health nor such behavioral outcomes as out-of-wedlock childbearing and arrests. We discuss implications for indicators tracking child well-being as well as policies designed to promote the well-being of children.     

Early life exposures and the occurrence and timing of heart disease among the older adult Puerto Rican population

Few studies have examined the effects of early life conditions on the timing of the onset of heart disease. We use the remarkable example of a representative sample of the population of older Puerto Ricans aged 60– 74 who lived in the countryside during childhood (n = 1,438) to examine the effects of seasonal exposures to poor nutrition and infectious diseases during late gestation on the timing of the onset and the probability of ever experiencing adult heart disease. Cox and log logistic hazard models controlling for childhood conditions (self-reported childhood health status and socioeconomic status [SES], rheumatic fever, and knee height) and adult risk factors (adult SES, obesity, smoking, texercise, and self-reported diabetes) showed that the risk of onset of heart disease was 65% higher among those born during high-exposure periods compared with unexposed individuals. However, there were no significant differences in median time of onset for those ever experiencing heart disease. As a comparison, we found that there were no significant seasonality effects for those who lived in urban areas during childhood. We conclude that early exposures in utero have important ramifications for adult heart disease among the older Puerto Rican population. We show, however, that while exposure is associated with the probability of ever experiencing adult heart disease, it is not associated with the timing of onset among those who do experience it.     

The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China

Based on unique data from the largest-ever sample of the Chinese oldest-old aged 80 and older, our multivariate logistic regression analyses show that either receiving adequate medical service during sickness in childhood or never/rarely suffering from serious illness during childhood significantly reduces the risk of being ADL (activities of daily living) impaired, being cognitively impaired, and self-reporting poor health by 18%-33% at the oldest-old ages. Estimates of effects for five other indicators of childhood conditions are similarly positive but mostly not statistically significant. Multivariate survival analysis shows that better childhood socioeconomic conditions in general tend to reduce the four-year period mortality risk among the oldest-old. But after additional controls for 14 covariates are put into the model, the effects are not statistically significant, thus suggesting that most of the effects of childhood conditions on oldest-old mortality are indirect-at least to the point of affecting current health status at the oldest-old ages, which itself is strongly associated with mortality. While acknowledging limitations of the present analyses due to a lack of information on childhood illness, the oldest-olds'recollection errors, and other data problems, we conclude, based on this and other studies, that policies that enhance childhood health care and children's socioeconomic well-being can have large and long-lasting benefits up to the oldest-old ages.     

Reproducing inequalities: Luck, wallets, and the enduring effects of childhood health

In this article, I argue that research on social stratification, on intergenerational transmission of inequalities, and on the theory of factor payments and wage determination will be strengthened by studying the role played by early childhood health. I show that the inclusion of such a factor requires researchers to integrate theories in each of these fields with new theories linking early childhood health conditions and events that occur at later stages in the life course of individuals, particularly physical and mental health as well as disability and mortality. The empirical evidence I gather shows that early childhood health matters for the achievement of or social accession to, adult social class positions. Even if the magnitude of associations is not overwhelming, it is not weaker than that found between adult social accession and other, more conventional and better-studied individual characteristics, such as educational attainment. It is very likely that the evidence presented in this article grossly underplays the importance of early childhood health for adult socioeconomic achievement.     

The Effects of Childhood,Adult, and Community Socioeconomic Conditions on Health and Mortality among Older Adults in China

Using a large, nationally representative longitudinal sample of Chinese aged 65 and older, this study examines the effects of childhood, adult, and community socioeconomic conditions on mortality and several major health outcomes. The role of social mobility is also tested. We find that childhood socioeconomic conditions exert long-term effects on functional limitations, cognitive impairment, self-rated health, and mortality independent of adult and community socioeconomic conditions. Achieved conditions matter for most outcomes as well, considering that adult and community socioeconomic conditions have additional impacts on health among Chinese elders. The majority of the effects of childhood conditions are not mediated by adult and community conditions. The results also show that social mobility and health in later life are linked in complex ways and that psychosocial factors have marginal explanatory power for the effects of socioeconomic conditions. Overall, this study provides new longitudinal evidence from China to support the notion that health and mortality at older ages are influenced by long-term and dynamic processes structured by the social stratification system. We discuss our findings in the context of the life course and ecological perspective, emphasizing that human development is influenced by a nexus of social experiences that impact individuals throughout life.     

Skeletal biology and the history of Native Americans and African Americans

The authors incorporate data from skeletal remains in an attempt to construct health profiles for the Amerindian population before Columbus's arrival and for the antebellum black slave populations of North America and the Caribbean. They examine the impact of poor nutrition among slaves, as evidenced in bone and tooth samples, on infant and childhood mortality, fertility, and adult mortality. They go on to suggest that the change from a hunter-gatherer life-style to a more sedentary agricultural one resulted in poorer health for the Amerindian population. However, agriculture made soft foods more available, allowing women to wean their children earlier, thus increasing overall fertility.     

Fertility and mortality estimation from the Panama Retrospective Demographic Survey, 1976

Summary Data from the Retrospective Demographic Survey of Panama offer a unique opportunity to test a wide range of methods for estimating indirectly basic demographic parameters from inaccurate and incomplete data. Our primary emphasis is to evaluate methods for estimating adult mortality from information on widowhood and orphanhood, though estimates of childhood mortality obtained from information on sibling and child survivorship are assessed as well. The results for most of the estimating procedures are consistent; this finding is encouraging because it lends support to the hypothesis that the techniques can provide good estimates of mortality. Methods which produce results which are inconsistent provide valuable lessons. In particular, methods for providing unconditional estimates of values ofl (x) for adults by combining directly information on childhood mortality and adult mortality are shown to produce estimates which predominantly reflect the level of childhood mortality employed. Furthermore, within-method consistency of estimates appears to be a very poor indicator of reliable performance of the estimating technique or quality of data, since most methods yielded estimates which were internally consistent, though estimates made by different methods could differ considerably. In summary, the analysis indicates a birth rate of around 35 per thousand, a death rate of around 7.5 per thousand, a total fertility ratio of about 4.8, and expectations of life at birth of approximately 59 and 64 years for men and women respectively.     

Reconstructing childhood health histories

This article provides evidence about the quality of retrospective childhood health histories given to respondents in the Health and Retirement Survey (HRS) and the Panel Study of Income Dynamics (PSID). Even though information on early life health events is critical, there is legitimate skepticism about the ability of older respondents to remember specific health problems that they had during childhood. The evidence presented in this article suggests that this view is too negative. Respondents appear to remember salient childhood events about themselves, such as the illnesses they had during childhood, quite well. Moreover, these physical and psychological childhood health events are important correlates of adult health during middle age.     

Effects of early-life conditions on adult mortality: a review

"This paper considers the effects of health conditions in childhood on an individual's mortality risks as an adult. It examines epidemiologic evidence on some of the major mechanisms expected to create a linkage between childhood and adult mortality and reviews demographic and epidemiologic studies for evidence of the hypothesized linkages....Many empirical studies support the notion that childhood conditions play a major role in adult mortality, but only in the case of respiratory tuberculosis has the demographic importance of a specific mechanism been established by cohort studies. One's date and place of birth also appear to be persistently associated with risks of adult death in a wide variety of circumstances. An individual's height, perhaps the single best indicator of nutritional and disease environment in childhood, has recently been linked to adult mortality, especially from cardiovascular diseases. Further research is needed, however, before causal mechanisms can be identified."     

Gender differences in positive and negative self-assessments of health status in a national epidemiological study of Israeli aged

The literature in subjective health appraisals frequently notes that elderly women, more so than men, generally experience a lower quality of life in all major indicators (physical health status, functional ability, perceived income adequacy, social contacts, psychological distress, and cognitive ability). The current epidemiological study, of 1,352 reporting Israeli subjects between the ages of 75-94, was undertaken in order to obtain reliable estimates of "poor" and "excellent/good" self assessments of health in a national sample of aged; to identify the most significant correlates of "poor" and "excellent/good" assessments; and to ascertain whether the models of "poor" and "good/excellent" subjective health are different for elderly men and women. While it was found that women indeed rate their health as being poorer than men, of greater theoretical interest was the finding that the pattern of variables predicting to "poor" and "good/excellent" health are different for men and women. The findings point to the fact that the simple health self-evaluation question is not a unitary construct, but rather a complex attitudinal measure which yields different structural and conceptual results when controlling for the subjective health outcome ("poor" or "good/excellent") and when analyzing gender-dichotomized models.     

Adult height and childhood disease

Taller populations are typically richer populations, and taller individuals live longer and earn more. In consequence, adult height has recently become a focus in understanding the relationship between health and wealth. We investigate the childhood determinants of population adult height, focusing on the respective roles of income and of disease. Across a range of European countries and the United States, we find a strong inverse relationship between postneonatal (ages 1 month to 1 year) mortality, interpreted as a measure of the disease and nutritional burden in childhood, and the mean height of those children as adults. Consistent with these findings, we develop a model of selection and stunting in which the early-life burden of undernutrition and disease not only is responsible for mortality in childhood but also leaves a residue of long-term health risks for survivors, risks that express themselves in adult height and in late-life disease. The model predicts that at sufficiently high mortality levels, selection can dominate scarring, leaving a taller population of survivors. We find evidence of this effect in the poorest and highest-mortality countries of the world, supplementing recent findings on the effects of the Great Chinese Famine.     

Cumulative Childhood Adversity,Educational Attainment,and Active Life Expectancy Among U.S. Adults

Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998–2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50–100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels.     

The use of the CES-D for measuring symptoms of depression in three rural Russian villages

This paper reports the use of a standardized depression scale (CES-D) in a sample survey of three Russian villages (N=263) in the summer of 1993. The analysis shows a good response rate on all items, except for two. The internal consistency of the scale is good (alpha reliability is 0.79), and the factor loadings are sensible and relatively high. There is a greater percentage of the respondents in rural Russia who showed symptoms of depression compared to the percentage of respondents who showed symptoms of depression in other studies. Greater levels of depression were found among respondents who were elderly, in poor health, who were women, divorced or separated, and had little social support.     

The Effects of Childhood SNAP Use and Neighborhood Conditions on Adult Body Mass Index

The disproportionate number of individuals who are obese or overweight in the low-income U.S. population has raised interest in the influence of neighborhood conditions and public assistance programs on weight and health. Generally, neighborhood effects and program participation effects have been explored in separate studies. We unite these two areas of inquiry, using the 1968-2005 Panel Study of Income Dynamics (PSID) to examine the long-term effects of childhood Supplemental Nutrition Assistance Program (SNAP) participation, neighborhood conditions, and the interaction of these two, on adult body mass index (BMI). Using sibling fixed-effects models to account for selection bias, we find that relative to children in other low-income families, children in SNAP-recipient households have higher average adult BMI values. However, the effects of childhood SNAP usage are sensitive to both residential neighborhood and age at receipt. For those growing up in advantaged neighborhoods, projected adult BMI is higher for children in SNAP-recipient households than for children in low-income, nonrecipient households. In contrast, for those growing up in less-advantaged areas, adult BMI differences between children in SNAP-recipient and those in low-income, nonrecipient households are small. SNAP usage during preschool years (0 to 4) has no impact on adult BMI scores. However, at later childhood ages, the time elapsed receiving SNAP income increases adult BMI values relative to a condition of low-income nonreceipt.     

Understanding links between adolescent health and educational attainment

The educational and economic consequences of poor health during childhood and adolescence have become increasingly clear, with a resurgence of evidence leading researchers to reconsider the potentially significant contribution of early-life health to population welfare both within and across generations. Meaningful relationships between early-life health and educational attainment raise important questions about how health may influence educational success in young adulthood and beyond, as well as for whom its influence is strongest. Using data from the National Longitudinal Survey of Youth 1997, I examine how adolescents’ health and social status act together to create educational disparities in young adulthood, focusing on two questions in particular. First, does the link between adolescent health and educational attainment vary across socioeconomic and racial/ethnic groups? Second, what academic factors explain the connection between adolescent health and educational attainment? The findings suggest that poorer health in adolescence is strongly negatively related to educational attainment, net of both observed confounders and unobserved, time-invariant characteristics within households. The reduction in attainment is particularly large for non-Hispanic white adolescents, suggesting that the negative educational consequences of poor health are not limited to only the most socially disadvantaged adolescents. Finally, I find that the link between adolescent health and educational attainment is explained by academic factors related to educational participation and, most importantly, academic performance, rather than by reduced educational expectations. These findings add complexity to our understanding of how the educational consequences of poor health apply across the social hierarchy, as well as why poor health may lead adolescents to complete less schooling.In a presidential address to the Population Association of America, Palloni (2006) emphasized the need for research on early-life health as a mechanism in the intergenerational transmission of socioeconomic status. Although poor health is well known as a consequence of childhood and family socioeconomic conditions, it is also clear that illness during childhood and adolescence has lasting educational and socioeconomic effects (Case, Fertig, and Paxson 2005; Conley and Bennett 2000; Smith 2005). What remains less clear is how health early in life influences educational success in young adulthood and beyond. Do those with a health disadvantage graduate from high school at lower rates, for example, because they perform poorly in school or because they and their families develop reduced expectations for the future? In addition, how do race/ethnicity and socioeconomic status complicate these relationships? Our understanding of how health’s influence on educational attainment differs across groups is unclear.This article considers these complexities by asking several questions. It confirms that health during adolescence is strongly negatively associated with educational attainment and then examines this relationship in greater depth than is typical. First, I examine variation in the link between health and educational attainment along socioeconomic and racial/ethnic lines. Are the families of adolescents in poorer health better able to mitigate the negative educational consequences of a condition if they are socially and/or economically advantaged? Or do youths in these families suffer an equal or greater disadvantage? Second, I evaluate the role of academic factors—specifically, educational participation, performance, and expectations—that may explain the connection between adolescents’ health and educational attainment. I examine these questions with data from the National Longitudinal Survey of Youth 1997 (NLSY97), with an overall goal of understanding the ways in which health and social status act together to create educational disparities in the early life course.     

The long arm of childhood: The influence of early-life social conditions on men’s mortality

Increasingly, social scientists are turning to childhood to gain a better understanding of the fundamental social causes of adult mortality. However, evidence of the link between childhood and the mortality of adults is fragmentary, and the intervening mechanisms remain unclear. Drawing on the National Longitudinal Survey of Older Men, our analysis shows that men's mortality is associated with an array of childhood conditions, including socioeconomic status, family living arrangements, mother's work status, rural residence, and parents' nativity. With the exception of parental nativity, socioeconomic-achievement processes in adulthood and lifestyle factors mediated these associations. Education, family income, household wealth, and occupation mediated the influence of socioeconomic status in childhood. Adult lifestyle factors, particularly body mass, mediated the effects of family living arrangements in childhood, mother's work status, and rural residence. Our findings bring into sharp focus the idea that economic and educational policies that are targeted at children's well-being are implicitly health policies with effects that reach far into the adult life course.     

Premature Birth and Asthma Among Young Puerto Rican Children

Puerto Rican children are more likely to have asthma than children in any other racial/ethnic group in the United States, yet little research has examined the factors contributing to childhood asthma among Puerto Ricans. Using data from a representative sample of mainland Puerto Rican children, the present study investigates the relationship between preterm birth and early-childhood asthma (i.e., in the first years of life). The roles of other risk factors (i.e., socioeconomic and demographic characteristics, environmental conditions, and maternal health behavior) in the development of asthma in early childhood also are considered. The analysis reveals a relatively high rate of asthma for preterm children as well as differences between term and preterm children in the risk factors for early-childhood asthma. Measures of socioeconomic status and the cleanliness of the home environment are related to asthma for term, but not preterm, children; in contrast, demographic characteristics and maternal health behavior are important risk factors for asthma among preterm children.     

子女外出对农村留守父母健康的影响

老龄化背景下,成年子女的异地流动增加了中老年人的健康负担,本文使用中国健康与养老追踪调查数据和倾向分值匹配法,实证考察了农村地区成年子女跨省外出对留守父母健康的影响。估计结果显示,有子女外出的家庭,中老年父母的主观健康如自评健康、认知状况和抑郁程度较差;客观健康也受到不利影响,患关节炎、胃病和肺病的可能性更大。基于收入考量的子女外出确实增加了对父母的经济支持力度,但同时也增加了父母从事隔代照料的可能性。隔代照料负担的增加可能是子女外出对父母健康有不利影响的原因。     

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.