Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden.
Int J Epidemiol. 2020 Jun 1;49(3):896-907. doi: 10.1093/ije/dyaa041.
Life course epidemiology suggests that early life circumstances affect adult mortality, but most of the evidence is based on cohorts born in the beginning of the 20th century. It remains unclear whether and how the influences of early life circumstances on mortality have changed in later birth cohorts.
Analyses rely on 10% register-based samples of households drawn from the 1950 and the 1975 Finnish censuses, with consistent follow-up of socioeconomic and housing-related characteristics and early mid-life mortality (at ages 30-55 years). We estimate survival models for the associations between childhood circumstances and all-cause, internal and external mortality for cohorts born in 1936-50 and 1961-75 adjusting for attained social characteristics. We estimate sibling intraclass correlations as summary measures of all early life and familial influences.
Adverse childhood social circumstances were typically associated with about 10-30% excess cause-specific mortality. These associations were almost fully attenuated by adjustment for achieved later life social characteristics. Early life influences have grown over time for mortality from external causes, particularly as related to home ownership and family type. Differentials have remained stable for internal causes. The intraclass correlations further confirmed the increasing association of early life circumstances on external-cause mortality.
Our analyses show that the associations between childhood characteristics and mid-life mortality are substantial and almost fully mediated by achieved adult social characteristics. The increase in the contribution of childhood circumstances to mid-life mortality is driven by ever stronger associations with external causes of death.
生命历程流行病学表明，早期生活环境会影响成年人的死亡率，但大多数证据都基于 20 世纪初出生的队列。目前尚不清楚早期生活环境对死亡率的影响在后来的出生队列中是否以及如何发生变化。
分析依赖于从 1950 年和 1975 年芬兰人口普查中抽取的 10%基于登记的家庭样本，对社会经济和住房相关特征以及早中年期死亡率（30-55 岁）进行一致的随访。我们根据出生于 1936-50 年和 1961-75 年的队列的获得社会特征，为童年环境与全因、内部和外部死亡率之间的关联估计生存模型。我们估计兄弟姐妹的类内相关系数作为所有早期生活和家族影响的综合衡量标准。
不良的童年社会环境通常与特定原因的死亡率增加 10-30%有关。通过调整获得的后生命社会特征，这些关联几乎完全减弱。随着时间的推移，早期生活的影响对外部原因导致的死亡率不断增加，特别是与住房拥有和家庭类型有关。内部原因的差异保持稳定。类内相关系数进一步证实了早期生活环境对外部原因死亡率的关联不断增强。
我们的分析表明，童年特征与中年死亡率之间的关联是显著的，并且几乎完全由成年后获得的社会特征介导。童年环境对中年死亡率的贡献增加是由于与外部死亡原因的关联越来越强。
