Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study

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Abstract
Objective: To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood. Design: Nationally representative birth cohort study with prospective information on socioeconomic conditions. Setting: England, Scotland, and Wales. Study members: 2132 women and 2322 men born in March 1946 and followed until age 55 years. Main outcome measures: Deaths between 26 and 54 years of age notified by the NHS central register. Results: Study members whose father's occupation was manual at age 4, or who lived in the worst housing, or who received the poorest care in childhood had double the death rate during adulthood of those living in the best socioeconomic conditions. All indicators of socioeconomic disadvantage at age 26 years, particularly lack of home ownership, were associated with a higher death rate. Manual origins and poor care in childhood remained associated with mortality even after adjusting for social class in adulthood or home ownership. The hazard ratio was 2.6 (95% confidence interval 1.5 to 4.4) for those living in manual households as children and as adults compared with those living in non-manual households at both life stages. The hazard ratio for those from manual origins who did not own their own home at age 26 years was 4.9 (2.3 to 10.5) compared with those from non-manual origins who were home owners. Conclusions: Socioeconomic conditions in childhood as well as early adulthood have strongly influenced the survival of British people born in the immediate post war era. What is already known on this topic Associations between socioeconomic conditions in childhood and mortality in adulthood suggest that risks to survival begin in early life Studies have been generally retrospective, been unrepresentative, used only one marker of childhood conditions, controlled inadequately for adult conditions, or not included women What this study adds The death rate for women and men between 26 and 54 years living in poor socioeconomic conditions in childhood was double that of those living in the best conditions Those for whom socioeconomic disadvantage continued into early adulthood were between three and five times more likely to die than those in the most advantageous conditions

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