Juárez Sol P, Goodman Anna, Koupil Ilona
Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden Division of Environmental and Occupational Medicine, Lund University, Lund, Sweden.
Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden London School of Hygiene and Tropical Medicine (LSHTM), University of London, London, UK.
J Epidemiol Community Health. 2016 Jun;70(6):569-75. doi: 10.1136/jech-2015-206547. Epub 2016 Jan 5.
Ample evidence has shown that early-life social conditions are associated with mortality later in life. However, little attention has been given to the strength of these effects across specific age intervals from birth to old age. In this paper, we study the effect of the family's socioeconomic position and mother's marital status at birth on all-cause mortality at different age intervals in a Swedish cohort of 11 868 individuals followed across their lifespan.
Using the Uppsala Birth Cohort Multigenerational Study, we fitted Cox regression models to estimate age-varying HRs of all-cause mortality according to mother's marital status and family's socioeconomic position.
Mother's marital status and family's socioeconomic position at birth were associated with higher mortality rates throughout life (HR 1.18 (95% CI 1.12 to 1.26) for unmarried mothers; 1.19 (95% CI 1.12 to 1.25) for low socioeconomic position). While the effect of family's socioeconomic position showed little variation across different age groups, the effect of marital status was stronger for infant mortality (HR 1.47 (95% CI 1.23 to 1.76); p=0.04 for heterogeneity). The results remained robust when early life and adult mediator variables were included.
Family's socioeconomic position and mother's marital status involve different dimensions of social stratification with independent effects on mortality throughout life. Our findings support the importance of improving early-life conditions in order to enhance healthy ageing.
大量证据表明，生命早期的社会状况与晚年死亡率相关。然而，从出生到老年的特定年龄区间内这些影响的强度却很少受到关注。在本文中，我们研究了瑞典一个包含11868名个体的队列中，出生时家庭的社会经济地位和母亲的婚姻状况对不同年龄区间全因死亡率的影响，这些个体在其一生中都受到跟踪研究。
利用乌普萨拉出生队列多代研究，我们拟合了Cox回归模型，以估计根据母亲婚姻状况和家庭社会经济地位的全因死亡率的年龄变化风险比。
出生时母亲的婚姻状况和家庭的社会经济地位与一生的较高死亡率相关（未婚母亲的风险比为1.18（95%置信区间1.12至1.26）；社会经济地位低的为1.19（95%置信区间1.12至1.25））。虽然家庭社会经济地位的影响在不同年龄组间变化不大，但婚姻状况对婴儿死亡率的影响更强（风险比为1.47（95%置信区间1.23至1.76）；异质性检验p = 0.04）。当纳入生命早期和成年期的中介变量时，结果依然稳健。
家庭的社会经济地位和母亲的婚姻状况涉及社会分层的不同维度，对一生的死亡率有独立影响。我们的研究结果支持改善生命早期状况以促进健康老龄化的重要性。
