Guimarães Joanna Miguez Nery, Werneck Guilherme Loureiro, Faerstein Eduardo, Lopes Claudia S, Chor Dora
Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
BMJ Open. 2014 Nov 21;4(11):e005321. doi: 10.1136/bmjopen-2014-005321.
Although there is evidence that socioeconomic conditions in adulthood are associated with worse self-rated health, the putative effect of early adverse life circumstances on adult self-rated health is not consistent. Besides, little is known on this subject in the context of middle-income countries. We aimed to investigate the association between indicators of socioeconomic position in early life and self-rated health in adulthood, taking into account the influence of current socioeconomic position.
Cross-sectional.
3339 civil servants (44.5% male) working at a public university in Rio de Janeiro, Brazil, participants of the Pró-Saúde cohort study.
Through a lifecourse approach, we evaluated if seven indicators of participants' socioeconomic position earlier in life were associated with worse self-rated health in adulthood. Ordinal logistic regression analysis with a proportional odds model was used.
After adjusting for socioeconomic position in adulthood (education and income), the indicators of early socioeconomic position associated with poor self-rated health were as follows: not eating at home due to lack of money at the age of 12 (OR=1.29 95% CI 1.06 to 1.57) and having lived in a small city or rural area at the age of 12 (OR=1.51 95% CI 1.21 to 1.89).
Self-rated health was associated with two indicators of remarkable experiences of poverty in early life, even when socioeconomic conditions improved throughout life. Our findings have shown a long-term impact of extreme socioeconomic hardship during childhood and/or adolescence on the development of social inequalities in health. In terms of implications for public health, our work emphasises that health policies, usually focused on adult lifestyle interventions, should be complemented by initiatives aimed at reducing socioeconomic inequalities during the earliest stages of development, such as childhood and adolescence.
尽管有证据表明成年期的社会经济状况与较差的自评健康状况相关，但早期不良生活环境对成年期自评健康的假定影响并不一致。此外，在中等收入国家的背景下，关于这一主题的了解甚少。我们旨在研究早期生活中社会经济地位指标与成年期自评健康之间的关联，并考虑当前社会经济地位的影响。
横断面研究。
巴西里约热内卢一所公立大学的3339名公务员（男性占44.5%），他们是健康促进队列研究的参与者。
通过生命历程方法，我们评估了参与者早期生活中七个社会经济地位指标是否与成年期较差的自评健康状况相关。使用比例优势模型进行有序逻辑回归分析。
在对成年期社会经济地位（教育和收入）进行调整后，与自评健康状况不佳相关的早期社会经济地位指标如下：12岁时因缺钱不在家吃饭（OR=1.29，95%CI 1.06至1.57）以及12岁时生活在小城市或农村地区（OR=1.51, 95%CI 1.21至1.89）。
即使一生的社会经济状况有所改善，但自评健康仍与早期生活中贫困显著经历的两个指标相关。我们的研究结果表明，童年和/或青少年时期极端社会经济困难对健康方面社会不平等的发展具有长期影响。在对公共卫生的影响方面,我们的工作强调，通常侧重于成人生活方式干预的卫生政策，应辅之以旨在减少儿童和青少年等发展最早阶段社会经济不平等的举措。
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