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The biological embedding of social differences in ageing trajectories
  1. Paolo Vineis1,
  2. Michelle Kelly-Irving2,3,
  3. Stephen Rappaport4,
  4. Silvia Stringhini5
  1. 1MRC-PHE Centre for Environment and Health, Imperial College, London, UK
  2. 2INSERM, UMR1027, F-3100, Toulouse, France
  3. 3Université Toulouse III Paul-Sabatier, UMR1027, F-3100, Toulouse, France
  4. 4School of Public Health, University of California, Berkeley, California, USA
  5. 5Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
  1. Correspondence to Dr Silvia Stringhini, Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, Lausanne 1010, Switzerland; silvia.stringhini{at}chuv.ch

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The occurrence of adult disease is related to lifetime experiences and, at least in part, to early life events. It is now well established that socioeconomic circumstances across the lifetime are major determinants of adult health and disease, and the current economic crisis is amplifying susceptibility to disease and unhealthy ageing in disadvantaged subgroups of the population. In adulthood, the gap between social groups is extensive in terms of mortality, functional performances and cognitive capacity. Since the occurrence of adult disease is related to lifetime experiences, including early life exposures, late-life preventive efforts may be of limited efficacy, particularly in disadvantaged subgroups. We now have the analytical tools to understand mechanisms that underlie life-long susceptibility to unhealthy ageing, and new knowledge can lead to better and more effective mechanisms to prevent diseases and reduce health inequalities. In this perspective, we first discuss the impact of recent changes in the understanding of chronic disease aetiology on our interpretation of the influence of life-course socioeconomic status (SES) on health and ageing. We then propose a model for integrating the exposome concept (the myriad of exposures derived from exogenous and endogenous sources) into the analysis of life-course socioeconomic differentials in ageing.

Changes in disease understanding

In the last decades, the conceptual framework for disease aetiology has changed significantly for non-communicable diseases, which are responsible for two-thirds of global mortality. One of the most important developments concerns the notion of disease inter-relatedness, which is now well established for cardiometabolic diseases such as obesity, diabetes and circulatory diseases, but which also potentially applies to Alzheimer's disease/dementia1 ,2 and cancer.3 Endocrine physiology, immune and inflammatory processes as well as important risk factors such as hyperglycaemia and health-related behaviours are shared by most chronic diseases. As a consequence, non-communicable diseases may be conceptualised as a continuum of …

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