Journal of Preventive Medicine and Public Health March 2010, Vol. 43, No. 2, 138-150 doi: 10.3961/jpmph.2010.43.2.138 Analysis for the Impact of Adulthood and Childhood Socioeconomic Positions and Intergenerational Social Mobility on Adulthood Health Jae-Hee Seo 1, Ho Kim 2, Young-Jeon Shin 1 1 Department of Preventive Medicine, Hanyang University College of Medicine; 2 School of Public Health, Seoul National University Objectives: There are at least three conceptual models for the effects of the childhood social environment on adult health: the critical period model, the social mobility model, and the cumulative risk model. However, few studies have investigated all three different models within the same setting. This study aims to examine the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility over the life course on the health in adulthood based both on the critical period model and the social mobility model. Methods: This study was conducted on 9583 adults aged between 25 and 64 years old and they were the respondents to the Korea Welfare Panel Study (2006). A multivariate logistic regression analysis was carried out, using the critical period model and the social mobility model out of the life course approaches, to look into the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility on the health status in adulthood. Results: Household income and occupation out of the adulthood socioeconomic position indicators had an independent influence on the adulthood health status. The childhood socioeconomic position indicators, except for the place of childhood residence, affected the adulthood health status even after adjustment for the adulthood socioeconomic position. The effect of intergenerational social mobility was also statistically significant even after adjusting for the adulthood socioeconomic position, but it became insignificant when the childhood socioeconomic position was additionally adjusted for. Conclusions: Adulthood health is indeed affected by both the childhood and adulthood socioeconomic positions as well as intergenerational social mobility. This result shows that a life course approach needs to be adopted when dealing with health issues. Key words: Chronic disease, Health status, Social mobility, Socioeconomic factor J Prev Med Public Health 2010;43(2):138-150
Figure 1. Type of intergenerational social mobility. Note: Intergenerational social mobility was defined as upward, downward or stable comparing the childhood SEP with the subject s own occupation. Stable non-manual: non-manual population who had nonmanual father, Upward mobile: non-manual population who had manual father, Downward mobile: manual population who had non-manual father, Stable manual: manual population who had manual father. Figure 2. Conceptual framework for this study.
Table 1. Number and percentage of subjects self-reported health status and current chronic disease according to type of social mobility and socioeconomic position: adult aged 25-64 of Korean Welfare Panel Study, 2006 Social mobility and socioeconomic position indicators N Men (n=5039*) Self-reported health status Current chronic disease Healthy Average Unhealthy No Yes Social mobility Type of social mobility stable Upward mobile Downward mobile Manual stable Adulthood socioeconomic position Household income High Low Own occupation Manual Others Current residence Childhood socioeconomic position Own education level College or more High school Less than high school Father s education level High school or higher Elementary or middle No education Father s occupation Manual Others Residence at childhood 446 1072 311 2309 4289 750 1562 2667 810 2410 2629 2292 1949 798 2162 1865 1012 925 4014 101 1655 3385 401 (90.0) 908 (84.7) 258 (83.0) 1750 (75.8) 3466 (80.8) 429 (57.2) 1349 (86.3) 2041 (76.5) 506 (62.5) 1838 (76.3) 2057 (78.2) 1962 (85.6) 1503 (77.1) 431 (54.0) 1831 (84.7) 1437 (77.0) 627 (62.0) 802 (86.7) 3015 (75.1) 79 (78.5) 1364 (82.4) 2531 (74.8) 36 (8.1)0 114 (10.6) 33 (10.5) 310 (13.4) 501 (11.7) 92 (12.2) 154 (9.9)0 349 (13.1) 89 (11.0) 293 (12.1) 300 (11.4) 223 (9.7)0 246 (12.6) 124 (15.5) 193 (8.9)0 236 (12.7) 164 (16.2) 78 (8.5)0 503 (12.5) 12 (11.8) 163 (9.9)0 430 (12.7) 9 (1.9)0 50 (4.7)0 20 (6.6)0 249 (10.8) 322 (7.5)0 229 (30.6) 59 (3.8)0 277 (10.4) 214 (26.5) 279 (11.6) 272 (10.3) 107 (4.7)0 201 (10.3) 243 (30.5) 138 (6.4)0 192 (10.3) 221 (21.8) 45 (4.8)0 496 (12.4) 10 (9.8)0 127 (7.7)0 424 (12.5) 412 (92.5) 967 (90.2) 268 (86.3) 1938 (83.9) 3720 (86.7) 512 (68.2) 1418 (90.8) 2245 (84.2) 569 (70.3) 1998 (82.9) 2234 (85.0) 2084 (90.9) 1634 (83.8) 514 (64.4) 1970 (91.1) 1538 (82.5) 724 (71.5) 820 (88.7) 3327 (82.9) 85 (84.5) 1449 (87.6) 2783 (82.2) 34 (7.5)0 106 (9.8)0 43 (13.7) 371 (16.1) 569 (13.3) 238 (31.8) 144 (9.2)0 422 (15.8) 241 (29.7) 412 (17.1) 395 (15.0) 207 (9.1)0 315 (16.2) 284 (35.6) 192 (8.9)0 327 (17.5) 288 (28.5) 104 (11.3) 687 (17.1) 16 (15.5) 205 (12.4) 602 (17.8)
Table 1. [Continued] Number and percentage of subjects self-reported health status and current chronic disease according to type of social mobility and socioeconomic position: adult aged 25-64 of Korean Welfare Panel Study, 2006 Social mobility and socioeconomic position indicators N Women (n=5321*) Self-reported health status Current chronic disease Healthy Average Unhealthy No Yes Social mobility Type of social mobility stable Upward mobile Downward mobile Manual stable Adulthood socioeconomic position Household income High Low Own occupation Manual Others Current residence Childhood socioeconomic position Own education level College or more High school Less than high school Father s education level High school or higher Elementary or middle No education Father s occupation Manual Others Residence at childhood * Weighted total number. 294 644 206 1336 4377 943 962 1574 2785 2623 2698 1731 2156 1435 2474 1891 955 1076 4137 108 1710 3611 264 (89.7) 577 (89.6) 151 (73.2) 876 (65.6) 3348 (76.5) 446 (47.3) 864 (89.8) 1051 (66.7) 1879 (67.5) 1851 (70.6) 1943 (72.0) 1531 (88.5) 1651 (76.6) 611 (42.6) 2024 (81.8) 1301 (68.8) 469 (49.1) 849 (78.9) 2866 (69.3) 79 (72.8) 1338 (78.2) 2456 (68.0) 21 (7.2)0 45 (6.9)0 31 (15.2) 221 (16.5) 547 (12.5) 167 (17.7) 67 (7.0)0 258 (16.4) 390 (14.0) 362 (13.8) 353 (13.1) 139 (8.1)0 290 (13.5) 285 (19.8) 260 (10.5) 299 (15.8) 155 (16.3) 125 (11.7) 570 (13.8) 19 (17.6) 185 (10.8) 529 (14.7) 9 (3.1)0 22 (3.5)0 24 (11.6) 239 (17.9) 482 (11.0) 330 (35.0) 31 (3.3)0 266 (16.9) 515 (18.5) 410 (15.6) 402 (14.9) 60 (3.5)0 214 (9.9)0 538 (37.5) 191 (7.7)0 291 (15.4) 331 (34.6) 101 (9.4)0 701 (16.9) 10 (9.6)0 187 (10.9) 626 (17.3) 277 (94.0) 620 (96.3) 166 (80.9) 1026 (76.8) 3694 (84.4) 574 (60.9) 921 (95.7) 1220 (77.5) 2127 (76.4) 2098 (80.0) 2170 (80.4) 1644 (95.0) 1873 (86.9) 752 (52.4) 2218 (89.7) 1494 (79.0) 556 (58.2) 912 (84.8) 3265 (78.9) 91 (84.6) 1468 (85.9) 2801 (77.6) Weighted total number: men=4,318 women=2,480 (if own occupation or father s occupation was others then they were excluded). 18 (6.0)0 24 (3.7)0 39 (19.1) 310 (23.2) 683 (15.6) 369 (39.1) 41 (4.3)0 354 (22.5) 657 (23.6) 524 (20.0) 528 (19.6) 87 (5.0)0 283 (13.1) 683 (47.6) 256 (10.3) 397 (21.0) 399 (41.8) 164 (15.2) 872 (21.1) 17 (15.4) 242 (14.1) 811 (22.4)
Table 2. Changes in odds ratio (95% confidence intervals) of self-reported health for adulthood socioeconomic position (SEP) indicators with adjustment for childhood SEP indicators: adults aged 25-64 of Korea Welfare Panel Study, 2006 Adulthood SEP Household income High Low Own occupation Manual Others Current residence 2.20 (1.83-2.64) 1.39 (1.16-1.66) 2.29 (1.82-2.88) 0.93 (0.80-1.07) * Father s occupation, father s education level. Father s SEP and own education level were adjusted. Men Age, father s SEP*adjusted 2.16 (1.79-2.60) 1.28 (1.07-1.54) 2.22 (1.76-2.80) 0.90 (0.78-1.04) Fully adjusted 2.03 (1.68-2.45) 1.10 (0.90-1.35) 2.00 (1.57-2.54) 0.89 (0.77-1.02) 2.61 (2.22-3.08) 1.47 (1.14-1.90) 1.76 (1.38-2.23) 0.98 (0.85-1.12) Women Age, father s SEP*adjusted 2.57 (2.18-3.03) 1.34 (1.03-1.73) 1.66 (1.31-2.12) 0.96 (0.84-1.10) Fully adjusted 2.40 (2.03-2.84) 1.02 (0.78-1.34) 1.40 (1.09-1.80) 0.94 (0.82-1.08) Table 3. Changes in odds ratio (95% confidence intervals) of current chronic disease for adulthood socioeconomic position (SEP) indicators with adjustment for childhood SEP indicators: adults aged 25-64 of Korea Welfare Panel Study, 2006 Adulthood SEP Household income High Low Own occupation Manual Others Current residence 2.02 (1.64-2.50) 1.16 (0.93-1.44) 2.11 (1.61-2.76) 0.90 (0.76-1.07) * Father s occupation, father s education level. Father s SEP and own education level were adjusted. Men Age, father s SEP*adjusted 2.00 (1.62-2.47) 01.1 (0.88-1.37) 2.03 (1.55-2.67) 0.88 (0.75-1.05) Fully adjusted 1.95 (1.57-2.41) 0.96 (0.75-1.22) 1.84 (1.38-2.45) 0.87 (0.74-1.03) 2.25 (1.87-2.71) 1.56 (1.09-2.24) 2.03 (1.43-2.88) 1.08 (0.92-1.27) Women Age, father s SEP*adjusted 2.22 (1.85-2.68) 1.44 ( - 2.08) 1.96 (1.38-2.78) 1.06 (0.91-1.25) Fully adjusted 2.06 (1.71-2.48) 0.99 (0.67-1.45) 1.50 (1.04-2.17) 1.04 (0.88-1.22)
Table 4. Changes in odds ratio (95% confidence intervals) of self-reported health for childhood socioeconomic position (SEP) indicators with adjustment for adulthood SEP indicators: adults aged 25-64 of Korea Welfare Panel Study, 2006 Childhood SEP Own education College or more High school Less than high school Father s education level High school or higher Less than middle school Father s occupation Manual and others Residence at childhood 1.33(1.13-1.58) 2.12(1.71-2.63) 0.95(0.80-1.14) 1.61(1.28-2.03) 1.01(0.85-1.19) * Age, own occupation, household income were adjusted. Men Age and own occupation adjusted 1.26(1.05-1.52) 1.91(1.50-2.42) 0.95(0.79-1.13) 1.66(1.32-2.09) 1.06(0.90-1.25) Fully adjusted* 1.21(-1.47) 1.67(1.31-2.13) 0.94(0.78-1.13) 1.64(1.30-2.07) 1.10(0.93-1.30) 1.62(1.34-1.97) 2.98(2.34-3.80) 1.12(0.94-1.32) 1.05(0.86-1.28) 0.93(0.79-1.09) Women Age and own occupation adjusted 1.56(1.27-1.92) 2.96(2.30-3.82) 1.14(0.96-1.35) 1.04(0.85-1.27) 0.93(0.79-1.09) Fully adjusted* 1.53(1.24-1.88) 2.61(2.02-3.38) 1.13(0.95-1.34) 1.03(0.84-1.26) 0.95(0.81-1.12) Table 5. Changes in odds ratio (95% confidence intervals) of current chronic disease for childhood socioeconomic position (SEP) indicators with adjustment for adulthood SEP indicators: adults aged 25-64 of Korea Welfare Panel Study, 2006 Childhood SEP Own education College or more High school Less than high school Father s education level High school or higher Less than middle school Father s occupation Manual and others Residence at childhood 1.36(1.10-1.67) 1.63(1.27-2.09) 1.22(0.97-0.52) 1.03(0.79-1.35) 0.86(0.70-1.05) * Age, own occupation, household income were adjusted. Men Age and own occupation adjusted 1.33(1.06-1.68) 1.55(1.18-2.04) 01.2(0.96-1.51) 1.07(0.82-1.40) 0.90(0.73-1.10) Fully adjusted* 1.30(1.03-1.63) 1.37(1.03-1.81) 1.20(0.96-1.51) 1.05(0.80-1.38) 0.93(0.76-1.14) 1.85(1.40-2.43) 3.67(2.69-5.00) 1.25(1.01-1.55) 0.75(0.58-0.96) 0.81(0.67-0.99) Women Age and own occupation adjusted 1.80(1.35-2.40) 3.76(2.71-5.22) 1.28(1.03-1.59) 0.74(0.57-0.95) 0.81(0.67-0.99) Fully adjusted* 1.79(1.34-2.39) 3.42(2.46-4.75) 1.28(1.03-1.59) 0.73(0.57-0.94) 0.83(0.68-1.01)
Table 6. Changes in odds ratio (95% confidence intervals) of self-reported health status and current chronic disease for intergenerational social mobility with adjustment for childhood SEP (own education) and adulthood SEP (household income): adults aged 25-64 of Korea Welfare Panel Study, 2006 Intergenerational social mobility* Men Stable non-manual Upward mobile Downward mobile Stable manual Women Stable non-manual Upward mobile Downward mobile Stable manual 2.17(1.04-4.53) 2.68(1.18-6.08) 4.13(2.07-8.25) 1.76(0.79-3.92) 2.63(1.18-5.88) 3.06(1.53-6.10) Self-reported health status Age and own education adjusted 2.07(0.99-4.32) 2.20(0.96-5.06) 2.84(1.37-5.87) 1.32(0.59-2.97) 1.28(0.54-3.02) 1.17(0.54-2.55) Age and household income adjusted 2.21(1.06-4.60) 2.31(1.01-5.27) 3.58(1.79-7.17) 1.62(0.73-3.60) 2.08(0.93-4.68) 2.36(1.18-4.74) 1.11(0.73-1.70) 1.35(0.81-2.24) 1.37(0.93-2.03) 1.12(0.57-2.20) 2.26(1.19-4.28) 1.73(1.01-2.96) Current chronic diseases Age and own education adjusted 1.07(0.70-1.64) 1.22(0.73-2.06) 1.19(0.77-1.82) 0.90(0.46-1.78) 1.31(0.65-2.63) 0.80(0.43-1.51) Age and household income adjusted 1.12(0.73-1.71) 1.27(0.76-2.11) 1.29(0.87-1.90) 1.06(0.54-2.08) 1.91(-3.63) 1.43(0.83-2.45) * Intergenerational social mobility was defined as upward, downward or stable comparing the childhood SEP (socioeconomic position) with the subjects own occupation; Stable non-manual: non-manual population who had non-manual father; Upward mobile: non-manual population who had manual father; Downward mobile: manual population who had non-manual father; Stable manual: manual population who had manual father.
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