Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA, 02215 USA.
BMC Public Health. 2011 May 14;11:313. doi: 10.1186/1471-2458-11-313.
Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.
Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.
Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.
This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.
许多老年人患有多种慢性疾病（即多种疾病）；而这些慢性疾病中有许多具有共同的风险因素，如成年期的低社会经济地位（SES）和整个生命周期的低 SES。为了更好地捕捉童年时期的社会经济状况，生命历程流行病学的最新研究拓宽了 SES 的概念，将特定困难经历也包括在内。在这项研究中，我们调查了童年时期经济困难、一生收入与多种疾病之间的关系。
对 2004 年健康与退休研究（HRS）中 7305 名年龄在 50 岁及以上的参与者进行横断面分析，这些参与者还允许将他们的 HRS 记录与他们在美国的社会保障记录相联系。使用零膨胀泊松回归模型同时对无疾病和预期慢性疾病数量的可能性进行建模。
童年经济困难和一生收入与无疾病状态无关。然而，童年经济困难与 8%更高的慢性疾病数量相关；并且，将一生收入（定义为中青年时期的平均年收入）增加与报告的慢性疾病数量减少 5%相关。我们还发现童年经济困难和一生收入对多种疾病的相互作用显著。
本研究表明，童年经济困难和一生收入与多种疾病有关，但与无疾病状态无关。一生收入改变了童年经济困难与多种疾病之间的关系，表明这种关系在年轻和中年时期的收入差异方面具有不同的影响。需要进一步研究来阐明与老年人无疾病和多种疾病存在相关的生命历程社会经济途径。
