Does childhood health affect chronic morbidity in later life?

doi:10.1016/S0277-9536(00)00230-6

Social Science & Medicine

Volume 52, Issue 8, April 2001, Pages 1269-1284

https://doi.org/10.1016/S0277-9536(00)00230-6 Get rights and content

Abstract

Our analysis examines whether childhood health has long-term and enduring consequences for chronic morbidity. As a part of this analysis, we address two methodological issues of concern in the literature. Is adult height a surrogate for childhood health experiences in modeling chronic disease in later life? And, are the effects of adult socioeconomic status on chronic disease overestimated when childhood health is not accounted for? The analysis is based on a topical module to the third wave of the Health and Retirement Study, a representative survey of Americans aged 55–65 in 1996. Our results support the hypothesis that poor childhood health increases morbidity in later life. This association was found for cancer, lung disease, cardiovascular conditions, and arthritis/rheumatism. The associations were highly persistent in the face of statistical controls for both adult and childhood socioeconomic status. No support was found for using adult height as a proxy for the effects of childhood health experiences. Further, the effects of adult socioeconomic status were not overestimated when childhood health was excluded from the explanatory models. Our results point to the importance of an integrated health care policy based on the premise of maximizing health over the entire life cycle.

Introduction

Mounting evidence suggests that childhood life circumstances have an enduring effect on late life chronic morbidity. Although the roles of specific etiologic agents are topics of debate, research suggests that these effects may accrue from a range of factors including nutrition, exposure to infectious disease and environmental toxins, the in utero environment, and features of social and economic deprivation. Some scholars have hypothesized that chronic diseases are programmed during gestation or early childhood (e.g., the Barker hypothesis), while other scholars emphasize the role of accumulation of effects from exposure to adverse conditions over the life course (Forsdahl, 1977; Kuh & Davey Smith, 1997). Increasingly it is clear that a life course approach is important to understand how chronic morbidity comes about in later life. Such an approach encompasses the idea that chronic disease may be the long-term outcome of a range of childhood conditions and experiences, beginning as early as in utero combined with the cumulative “insults” experienced during adulthood (Kuh & Ben-Shlomo, 1997).

Our investigation adds to this growing body of literature by examining the association between self-reported childhood health experiences and the presence of a number of major chronic health problems among a nationally representative sample of Americans aged 55 to 65. Several issues guide our analysis. First, we assess whether self-reported childhood health experiences are associated with chronic health problems in later life, while controlling for socioeconomic deprivation in both childhood and adulthood. That is, we determine whether childhood health per se has long-term and direct consequences for chronic health conditions experienced decades after childhood. Second, we examine whether adult height is a surrogate for childhood health experiences and deprivation in modeling chronic disease in later life. Adult height is often viewed as an indicator of childhood health and deprivation in analyses lacking direct measures of childhood life circumstances. Lastly, we assess whether the effects of adult socioeconomic status on chronic disease are overestimated when childhood conditions are not taken into account.

The analysis is based on a new population health survey representative of Americans born from 1931 to 1941, the Health and Retirement Survey (HRS). HRS respondents were interviewed in 1992, 1994, 1996, and 1998. We use the third wave of the HRS (1996) in this analysis because at this interview a randomly chosen subset of respondents (N=654) recollected their health as children and reported their parental education and father's occupation, along with family living arrangements, and their family's financial well-being. At the same interview they reported details of their current adult health state. Measurement of both childhood health conditions and adult health is based on self-report data. Our analysis, therefore, focuses on associations between childhood conditions and health conditions at age 55–65 using self-reported information from a nationally representative survey. Previewing our results, despite the relatively small sample size of the HRS module, our statistical analysis reveals a strong association between childhood health and the occurrence of a variety of chronic health problems among middle-aged Americans.

Section snippets

Background

Social science and social epidemiological studies of chronic health problems have focused principally on the association between adult life circumstances, especially socioeconomic status, and disease prevalence or mortality at older ages. The general presumption is that socioeconomic status, as an enduring feature of adult life, gives rise to chronic health conditions, which by themselves develop slowly over the life cycle (Adler et al., 1994; Marmot, Kogevinas, & Elston, 1987).

In fact,

The present study

Clearly, a number of factors — social and behavioral, genetic or familial, nutritive or environmental — play a role in later life morbidity and mortality. Because these factors may be felt at different points in the life cycle — prior to birth, throughout infancy, childhood, and adolescence, and during early-, mid-, and late-adulthood — they are complementary rather than competing explanations (Wadsworth & Kuh, 1997).

Our data include information on childhood life circumstances, specifically the

Data overview

Our analysis is based on a topical module on childhood experiences from the third wave of the HRS. The first wave of the survey was fielded in 1992 for a nationally representative sample of persons born between 1931 and 1941 and their spouses or partners. Initial screening identified 15,497 individuals eligible for interview; interviews were obtained with 82% of these persons at the first wave. Respondents were re-interviewed in 1994, 1996, and 1998; overall response rates for 1994 and 1996

Results

Table 3 shows the prevalence of diseases in middle age by the presence or absence of any incapacitating childhood illness or condition. Persons who experienced a major childhood illness were more likely to report having cancer, chronic lung conditions, arthritis, and cardiovascular conditions. Some of the differences between those with and without childhood illness are quite large. Twice as many persons with childhood health problems had cancer or chronic lung disease by late middle age.

Conclusions

Our analysis of the self-reports of major limiting childhood health conditions supports the hypothesis that poor health in childhood is associated with a higher rate of chronic morbidity in later life. Respondents who experienced childhood health problems were more likely to experience a variety of chronic illnesses and conditions such as cancer, lung illnesses, cardiovascular conditions, and arthritis/rheumatism. On the other hand, we found no statistical association between childhood health

Acknowledgements

Partial support for this research was provided by grants from the National Institute of Aging (R01 AG11758, R01 AG11235, and T32 AG00208) and the National Institute of Child Health and Human Development (5 P30 HD28263). We would like to thank Professor Blaxter and the three anonymous Social Science and Medicine referees for their very helpful comments on an earlier version of this paper.

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Does childhood health affect chronic morbidity in later life?

Abstract

Introduction

Section snippets

Background

The present study

Data overview

Results

Conclusions

Acknowledgements

The Lancet

Social Science and Medicine

Public Health

Social Science and Medicine

Social Science and Medicine

Social Science and Medicine

The Lancet

Social Science and Medicine

Social Science and Medicine

Socioeconomic status and health

American Psychologist

The Tromso heart studyCoronary risk factors and their association with living conditions during childhood

Journal of Epidemiology and Community Health

Mothers, babies and health in later life

Fetal and placental size and risk of hypertension in adult life

British Medical Journal

Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease

British Medical Journal

Height and mortality in the counties of England and Wales

Annals of Human Biology

Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen

The Lancet

Infant diarrhoea and subsequent mortality from heart disease and cancer

Journal of Epidemiology and Community Health

Self-report and medical record report agreement of selected medical conditions and the elderly

American Journal of Public Health

Stature prediction equations for elderly non-Hispanic white, non-Hispanic black, and Mexican American persons developed from NHANES III data

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Cancer Causes & Control