Villadsen Aase, Asaria Miqdad, Skarda Ieva, Ploubidis George B, Williams Mark Mon, Brunner Eric John, Cookson Richard
Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.
Department of Health Policy, London School of Economics, London, UK; REAL Centre, The Health Foundation, London, UK.
Lancet Public Health. 2023 Apr;8(4):e286-e293. doi: 10.1016/S2468-2667(23)00029-4.
Disadvantage in early childhood (ages 0-5 years) is associated with worse health and educational outcomes in adolescence. Evidence on the clustering of these adverse outcomes by household income is scarce in the generation of adolescents born since the turn of the millennium. We aimed to describe the association between household income in early childhood and physical health, psychological distress, smoking behaviour, obesity, and educational outcomes at age 17 years, including the patterning and clustering of these five outcomes by income quintiles.
In this population-based, retrospective cohort study, we used data from the Millennium Cohort Study in which individuals born in the UK between Sept 1, 2000, and Jan 1, 2002, were followed up. We collected data on five adverse health and social outcomes in adolescents aged 17 years known to limit life chances: psychological distress, self-assessed ill health, smoking, obesity, and poor educational achievement. We compared how single and multiple outcomes were distributed across early childhood quintile groups of income, as an indicator of disadvantage, and modelled the potential effect of three income-shifting scenarios in early childhood for reducing adverse outcomes in adolescence.
We included 15 245 adolescents aged 17 years, 7788 (51·1%) of whom were male and 7457 (48·9%) of whom were female. Adolescents in the lowest income quintile group in childhood were 12·7 (95% CI 6·4-25·1) times more likely than those in the highest quintile group to have four or five adverse adolescent outcomes, with poor educational achievement (risk ratio [RR] 4·6, 95% CI 4·2-5·0) and smoking (3·6, 3·0-4·2), showing the largest single risk ratios. Shifting up to the second lowest, middle, and highest income groups would reduce multiple adolescent adversities by 4·9% (95% CI -23·8 to 33·6), 32·3% (-2·7 to 67·3), and 83·9% (47·2 to 120·7), respectively. Adjusting for parental education and single parent status moderately attenuated these estimates.
Early childhood disadvantage is more strongly correlated with multiple adolescent adversities than any of the five single adverse outcomes. However, shifting children from the lowest income quintile group to the next lowest group is ineffective. Tackling multiple adolescent adversities requires managing early childhood disadvantage across the social gradient, with income redistribution as a central element of coordinated cross-sectoral action.
UK Prevention Research Partnership.
幼儿期（0至5岁）处于不利地位与青少年时期更差的健康和教育结果相关。在千禧年之交后出生的这代青少年中，关于这些不良后果按家庭收入聚类的证据很少。我们旨在描述幼儿期家庭收入与17岁时的身体健康、心理困扰、吸烟行为、肥胖及教育结果之间的关联，包括这五种结果按收入五分位数的模式和聚类情况。
在这项基于人群的回顾性队列研究中，我们使用了千禧队列研究的数据，该研究对2000年9月1日至2002年1月1日在英国出生的个体进行了随访。我们收集了17岁青少年已知会限制生活机会的五种不良健康和社会结果的数据：心理困扰、自我评估的健康不佳、吸烟、肥胖和教育成绩差。我们比较了单一和多种结果在幼儿期收入五分位数组中的分布情况，以此作为不利地位的指标，并模拟了幼儿期三种收入转移情景对减少青少年不良后果的潜在影响。
我们纳入了15245名17岁的青少年，其中7788名（51.1%）为男性，7457名（48.9%）为女性。童年时期处于最低收入五分位数组的青少年出现四种或五种青少年不良后果的可能性是最高五分位数组青少年的12.7倍（95%置信区间6.4至25.1），其中教育成绩差（风险比[RR]4.6，95%置信区间4.2至5.0）和吸烟（3.6，3.0至4.2）的单一风险比最大。提升至第二低、中等和最高收入组分别可使多种青少年不良情况减少4.9%（95%置信区间-23.8至33.6）、32.3%（-2.7至67.3）和83.9%（47.2至120.7）。对父母教育程度和单亲身份进行调整后，这些估计值略有减弱。
幼儿期的不利地位与多种青少年不良情况的关联比五种单一不良结果中的任何一种都更强。然而，将儿童从最低收入五分位数组转移到次低组是无效的。应对多种青少年不良情况需要在社会梯度上解决幼儿期的不利地位问题，将收入再分配作为跨部门协调行动的核心要素。
英国预防研究伙伴关系。
