Lifetime socioeconomic position and mortality: prospective observational study

Area of Science:

• Public Health
• Epidemiology
• Social Determinants of Health

Background:

• Socioeconomic position (SEP) is a known determinant of health outcomes.
• Understanding the lifelong impact of SEP on cardiovascular disease (CVD) risk and mortality is crucial for public health interventions.

Purpose of the Study:

• To evaluate how lifetime socioeconomic position influences CVD risk factors, morbidity, and all-cause mortality.
• To determine the cumulative effect of social class across different life stages on health outcomes.

Main Methods:

• Prospective observational study with 21 years of follow-up involving 5766 men.
• Social class (manual/non-manual) assessed at three life stages: paternal occupation, first job, and screening job.
• A cumulative social class indicator was developed to represent lifelong SEP.

Main Results:

• Positive trends observed for blood pressure, BMI, smoking, angina, and bronchitis with increasing manual social class over a lifetime.
• Higher cumulative manual social class was associated with significantly increased all-cause mortality (RR 1.71 for manual at all stages) and CVD mortality.
• Adjustment for risk factors attenuated associations for non-CVD, non-cancer mortality but minimally for all-cause and CVD mortality.

Conclusions:

• Socioeconomic factors exert a lifelong influence on health and premature mortality risk.
• The impact of SEP varies by cause of death, with different life stages having differential importance.
• Assessing socioeconomic circumstances at only one life stage provides an incomplete picture of their contribution to health and mortality.