Socioeconomic status across the life course and all-cause and cause-specific mortality in Finland
Introduction
Socioeconomic (SES) inequalities in mortality have been extensively documented (Cutler et al., 2008, Elo, 2009) but factors that underlie these differentials continue to be debated. Until recently, most studies of SES inequalities in adult mortality focused on the role of adult characteristics. However, as evidence of the associations between childhood conditions and adult health has accumulated, increased attention is now being paid to the contribution of entire life course to adult health inequalities (e.g., Elo and Preston, 1992, Haas, 2008, Hayward and Gorman, 2004, Næss et al., 2012, Palloni et al., 2009). This evidence suggests that childhood nutritional status, health, SES, place of residence and other household characteristics contribute to adult disparities in health and mortality (Case et al., 2005, Galobardes et al., 2004, Galobardes et al., 2008, Laaksonen et al., 2005, Osler et al., 2005). Among the mechanisms through which childhood environment is hypothesized to influence adult health include indirect mechanisms operating through attained adult characteristics (e.g., SES and lifestyle factors) and direct effects of childhood health (Preston, Hill, & Drevenstedt, 1998).
In this paper, we examine (1) the associations between childhood family characteristics and all-cause and cause-specific mortality in Finland, (2) whether these associations are indirect operating through attained adult SES, and (3) whether the associations between adult SES and mortality are robust to controls for observed and unobserved childhood characteristics. The data come from a unique register based data that consist of a 10% sample of households drawn from the 1950 Finnish Census of Population with follow-up of household members in subsequent censuses and death records beginning in the end of 1970 through December 31, 2007. This paper contributes to related literatures concerning the role of childhood conditions and adult SES and all-cause and cause-specific mortality in several ways. First, all information on childhood and adult characteristics are drawn from census records and thus are not subject to recall or misreporting bias or loss to follow-up after the beginning of the follow-up at age 35. Second, we are able to follow the oldest members of the study cohorts from early childhood to age 72. Third, we have sufficient sample size to study both all-cause and cause-specific mortality. Finally, we are able to analyze the impact of unobserved family characteristics on adult SES differences in mortality by comparing siblings.
Section snippets
Background
The documentation of SES inequalities in mortality dates back to the 19th century and they continue to be the subject of active investigation today (Bengtsson and van Poppel, 2011, Elo, 2009). That these inequalities have persisted and widened in many countries during the 20th century in changing disease, economic, and social environments has led some investigators to call them “fundamental causes” of disease (Link & Phelan, 1995). Higher educational attainment and income as well as higher
Data and methods
Our data consist of 10% sample of households from the 1950 Finnish Census of Population that has been linked to subsequent census records beginning in 1970 through 1995 and to death records through December 31, 2007 using unique personal identifiers by Statistics Finland (Statistics Finland, 1997). We utilized information on the individuals' family of origin from the 1950 census and his/her adult characteristics from the 1970, 1975, 1980 or 1985 censuses, as close to age 35 as possible, when
Results
Table 1 provides sample characteristics and Table 2 shows distribution of causes. The hazard ratios for all-cause mortality are shown in Table 3 and for causes of death in Table 4. The results from the fixed effect models are presented in Table 5.
As seen in Table 1, just over half of the sample was male, close to half was born after September 19, 1944, and most (91%) lived with both parents in 1950. Relatively few grew up in families (15%) where a parent was employed in professional or
Discussion
We used high quality register based data to examine associations between childhood and adult socio-demographic characteristics and all-cause and cause-specific mortality in Finland in the latter half of the twentieth century. These data include prospective follow-up of children from early childhood up to age 72. Information on childhood conditions came from the 1950 Finnish Census, whereas linkage to census and death records from the end of 1970 through the end of 2007 provided information on
Acknowledgements
This research was supported by a pilot project grant from the Population Aging Research Center (PARC), University of Pennsylvania, with funding from the National Institute on Aging (P30 AG-012836). Pekka Martikainen was supported by Academy of Finland. Mikko Myrskylä was at the Max Planck Institute for Demographic Research in Rostock, Germany when this paper was written. We thank Ye Wang for invaluable programming assistance.
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