The Impact of Childhood Socioeconomic Disadvantage on Physical and Mental Health in Middle Age: Importance of Heterogeneous Pathway Trajectories

Background and Purpose: While numerous studies have confirmed the impact of early socioeconomic conditions on later year health outcomes, very few life course studies explored potential pathways. Following a social pathway life course model, this prospective study seeks to examine whether pathways of material, social, and health-related behavioral adversities across the life course link socioeconomic disadvantage in adolescence to physical and mental health in mid-adulthood.  

Methods: Drawing from the social pathway model, this study expands the life course literature by utilizing data collected over 35 years from the National Longitudinal Survey of Youth, 1979 Cohort (NLSY79). Date came from the respondents aged 14 to 18 in 1979 (born between 1957 and 1961) and followed until in their late-middle adulthood (aged 51-59 years of age in 2016) (N=5185 respondents). Considering the empirical proposition that several pathway trajectories may exist, this study used Latent Class Growth Modeling to examine heterogeneous trajectories of multiple pathways (material, social, and health-related behavioral adversities) across the life course (from young adulthood to mid-adulthood). Through structural equation analyses with a phantom model, we estimated depressive symptoms and functional limitations in middle age as a result of pathway effects starting with childhood socio-economic status.

Results: Six heterogeneous patterns of joint trajectories were identified: (1) Consistently (relatively) low level of material, social, and behavioral adversities; (2) Steep increase in material adversities and Moderate increase in social and behavioral adversities; (3) Moderate increase in all adversities; (4) Steep increase in social and material adversities and consistently high level of behavioral adversity; (5) Consistently (relatively) high levels of all adversities; (6) Consistently high level of behavioral adversity and moderate increase in material and social adversities. The consistently high levels of all adversities class was characterized by a concentration of disadvantages over the life course as it was significantly associated with early life socioeconomic conditions and with adverse physical and mental health outcomes. The steep increase in material adversities class also appeared to be related to both physical and mental health in middle age.

Conclusions and Implications: The effect of childhood SES disadvantage on health in middle age appeared to be indirect through multiple pathways across the life course. This study highlights the importance of identifying significant heterogeneity in the joint trajectories of material, social, and health-related behavioral adversities and their association with childhood socioeconomic conditions and physical and mental health in middle age. This study suggests that growing up in an unfavorable socioeconomic environment might be a source for a chain of adverse material, social, and behavioral situations, which in turn affects adult health. This result supports the need for the development of public health interventions that may help reduce co-existing adversities throughout the life course for people from impoverished backgrounds to provide a more comprehensive approach integrating medical care with psychosocial interventions and non-medical interventions which may be particularly beneficial for those with consistently high levels of adversities.