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Cited by 753Health disparities and outcomesBirth, Development, and HealthObesity, Physical Activity, Diet

Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation

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Galobardes, B.·2004·Epidemiologic Reviews
DOI 10.1093/epirev/mxh008
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Abstract

There is convincing evidence that exposures acting across the life course influence adult health outcomes (1–3). Lifecourse epidemiology examines a range of potential processes through which exposures acting at different stages of life can, singly or in combination, influence disease risk (table 1) (4). In the critical period model, an exposure acting at a specific time has long-lasting effects on the structure or function of the body. The fetal origins hypothesis, in its original formulation, took this approach (5). Other examples of processes where outcomes appear to depend upon the time window during which an exposure acts are limb development (in relation to maternal thalidomide use); infection with hepatitis B and risk of adulthood liver cancer (with very early postnatal infection being most implicated); and environmental lead exposure, which results in serious neurodevelopmental deficits only if occurring in infancy and childhood (3). However, the influence of exposures acting during critical periods of susceptibility may be modified by later life exposures. This is the case for the associations of birth weight with coronary heart disease, high blood pressure, and insulin resistance, where associations are stronger (or only evident) among those who become obese during adolescence or adulthood (6–8). In contrast, the accumulation of risk model suggests that effects accumulate over the life course, although it also allows for developmental periods during which susceptibility may be greater (4). Health damage may increase with the duration and/or number of detrimental exposures. This has been shown in relation to exposure to poor socioeconomic conditions, where additive effects of experiencing low socioeconomic position across different stages of the life course influence the risk of several diseases (9, 10). Accumulation of risk can also be due to clustering of exposures. For example, children from a lower socioeconomic background are more likely to be of low birth weight, to have poorer diets, to be more exposed to passive smoking and some infectious agents, and to have fewer educational opportunities (4). Exposures may also form chains of risk and thus tend to occur together. For example, low educational attainment will increase the probability that a person works in an occupation with a high risk of toxic exposures and lower income (3). Coronary heart disease is a good example of a disease that develops throughout the life course. Although coronary heart disease manifests itself in adulthood, atherosclerosis, an important underlying process leading to the disease, begins at a much earlier age. Fatty streaks in the artery walls are found in children (11, 12), and arterial lesions are evident in young men suffering violent deaths (13–15). Moreover, the presence of risk factors during childhood or adolescence is associated with an increased risk of developing coronary heart disease (16). For example, serum cholesterol in early adult life was strongly associated with coronary heart disease in the Johns Hopkins Precursors Study (17). The magnitude of this association was greater than that reported with respect to adulthood cholesterol measures. Recent studies have suggested that unfavorable preadulthood measures of cholesterol, blood pressure, and adiposity are associated with increased intimal-medial thickness, a presymptomatic indicator of coronary heart disease (18, 19). Socioeconomic circumstances at different stages of the life course can influence specific adulthood health outcomes through the different pathways outlined in table 1. While associations of adulthood socioeconomic position with a wide range of specific health outcomes have been described extensively (20–25), relatively little investigation of how early life social circumstances influence adult health has been conducted (26). This paper therefore presents a systematic review of epidemiologic evidence on the association between preadulthood socioeconomic position and cause-specific mortality. We performed a systematic review of individual-level studies examining childhood socioeconomic circumstances and adult overall and cause-specific mortality. For the electronic search, childhood socioeconomic circumstances were defined in general and via specific indicators such as father/mother/parental education or occupation, housing conditions, overcrowding, number of siblings, maternal marital status, illegitimacy, and residence in an orphanage or similar facility. Full details on the search strategy are available from the authors. The electronic search was supplemented by the authors’ files. We excluded those publications that reported exclusively on infant/childhood mortality or adolescent suicide. However, studies that presented all-age mortality were included. In these populations, most deaths are likely to have occurred in adulthood, except for those due to external causes. We also excluded studies that grouped nonfatal and fatal events to

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  • Lower SES during both childhood and adulthood predicts increased mortality.

    “Results from the nationally representative Health and Retirement Study (HRS) show that lower SES during both childhood and adulthood predict worse self-rated health, greater chronic conditions in later life (Luo and Waite, 2005), and increased mortality (Galobardes et al., 2004; Nandi et al., 2014).”

    From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Galobardes et al., 2004

    The “Overall mortality” section reports higher mortality among people with poorer childhood socioeconomic circumstances, even after accounting for adult socioeconomic position. The Conclusion also describes accumulated effects of poorer childhood and adult circumstances on risks of specific fatal diseases. However, this paper is a review of multiple cohorts, not a report of Health and Retirement Study results, so it does not support that part of the citing sentence. (LLM, conf=0.84)

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Research works printed but not linked: 3

  1. Berenson GS, Srinivasan SR, Freedman DS, et al. Atheroscle- rosis and its evolution in childhood. Am J Med Sci 1987;294: 429-40.
  2. McCarron P, Davey Smith G. Physiological measurements in children and young people, and risk of coronary heart disease in adults. In: Giles A, ed. A lifecourse approach to coronary heart disease prevention: scientific and policy review. London, United Kingdom: The Stationery Office, 2003:49-78.
  3. Harding S, Rosato M, Brown J, et al. Social patterning of health and mortality: children, aged 6-15 years, followed-up for 25 years in the ONS Longitudinal Survey. Health Stat Q 1999;3:30-4.

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Authors
Galobardes, B.
Affiliations
University of Bristol (GB)
Corresponding author
Galobardes, B.
Venue
Epidemiologic Reviews
Publisher
Oxford University Press (OUP)
Published
2004-07-01
Volume
26
Issue
1
Pages
7-21
ISSN
  • 0193-936X (ISSN-L)
  • 1478-6729
DOI
10.1093/epirev/mxh008
OpenAlex
W2109872440
Cited by
753
References
127
Citations by year
2026: 12 · 2025: 11 · 2024: 9 · 2023: 14 · 2022: 30 · 2021: 26 · 2020: 31 · 2019: 51 · 2018: 35 · 2017: 51 · 2016: 49 · 2015: 48 · 2014: 36 · 2013: 37 · 2012: 36
FWCI
7.42
Type
journal article
Language
en
Open access
Locations
  • Epidemiologic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
cause-specific mortality, life course epidemiology, fetal origins hypothesis, coronary artery disease, low birth weight, obesity, educational attainment, socioeconomic position, cardiovascular risk factors, atherosclerosis, alcohol consumption, cancer, chronic kidney disease, liver cancer, chronic obstructive pulmonary disease
MeSH terms
Accidents, Adult, Cardiovascular Diseases, Cause of Death, Child, Coronary Disease, Humans, Lung Neoplasms, Neoplasms, Rheumatic Heart Disease, Risk Factors, Social Class, Socioeconomic Factors, Survival Rate, Substance-Related Disorders, Stroke

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