Courtney Margaret Gough, Roberts Josephine, Quintero Yadira, Godde K
Department of Sociology/Anthropology University of La Verne La Verne California USA.
JBMR Plus. 2023 Mar 26;7(5):e10735. doi: 10.1002/jbm4.10735. eCollection 2023 May.
Demographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study ( = 5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.69, 0.92), but childhood SES was not (OR = 1.03, 95% CI = 0.94, 1.13). Identifying as Black/African American (OR = 0.56, 95% CI = 0.40, 0.80) was associated with lower odds, and identifying as female (OR = 7.22, 95% CI = 5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. © 2023 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
人口统计学、早年社会经济状况及父母投资因素可能会影响晚年健康以及慢性和进行性疾病的发展，包括骨质疏松症，这是一种在女性中常见的高成本疾病。“童年的深远影响”相关文献将早年的负面经历与较低的社会经济成就及较差的成年健康状况联系起来。我们以少量将儿童社会经济地位（SES）与骨骼健康联系起来的文献为基础，提供证据证明儿童SES较低和母亲投资与骨质疏松症诊断风险较高之间是否存在关联。我们进一步研究自我认同为非白人种族/族裔群体的人是否存在诊断不足的情况。对来自具有全国代表性的基于人群的队列健康与退休研究（样本量=5490 - 11819）中50 - 90岁参与者的数据进行分析，以评估这些关系。使用机器学习算法，我们估计了七个经调查加权的逻辑回归模型。母亲投资增加与骨质疏松症诊断几率降低相关（优势比[OR]=0.80，95%置信区间[CI]=0.69，0.92），但儿童SES并非如此（OR = 1.03，95% CI = 0.94，1.13）。自我认同为黑人/非裔美国人（OR = 0.56，95% CI = 0.40，0.80）与较低的诊断几率相关，而自我认同为女性（OR = 7.22，95% CI = 5.54，9.40）则与较高的诊断几率相关。在考虑进行骨密度扫描后，不同交叉种族/族裔和性别身份的诊断存在差异，并且一个预测骨密度扫描接受情况的模型表明各群体之间的筛查不平等。母亲投资增加与骨质疏松症诊断几率降低相关，这可能反映了与人力资本的生命历程积累及儿童营养的联系。有一些证据表明与骨密度扫描机会相关的诊断不足情况。然而，结果表明童年的深远影响在晚年骨质疏松症诊断中的作用有限。研究结果表明：（1）临床医生在评估骨质疏松症风险时应考虑生命历程背景；（2）针对临床医生的多样性、公平性和包容性培训可以改善健康公平性。© 2023作者。由Wiley Periodicals LLC代表美国骨与矿物质研究学会出版。
