Childhood SES gradients in adult functional limitations: Does state-level macro-economic context matter?

Numerous studies document associations between childhood socioeconomic status (SES) and adult health, but less is understood about how macroeconomic context shapes these links. The current study examined whether income and income inequality measured at the state level moderated the association between parent education and functional limitations in a national sample of adults. Time-series economic data, derived from tax records (1917-2014), were merged with Midlife in the United States Study (MIDUS) data (N = 10,685; Mean age = 47.7, SD = 13.6; 51 % female) by state/year to assess economic conditions during four life stages: childhood (0-15), emerging adulthood (20-25), early adulthood (ages 30-35), and midlife (ages 40-45). Results showed that higher state mean income (at all four ages of exposure) was associated with fewer adult functional limitations. Childhood exposure to higher state-level income inequality (but not later periods) predicted more adult functional limitations. Childhood SES-adult health associations weakened with higher state income during childhood (B = 0.023, p = .018) and emerging adulthood (B = 0.036, p = .026), but not in later stages. Income inequality did not moderate SES-health links. Findings suggest that the impact of childhood SES on adult health varies by state economic context, particularly mean income, with effects dependent on exposure timing. Notably, childhood income inequality also independently predicted worse health outcomes, irrespective of state income. Future directions and policy implications are discussed.