Childhood Socioeconomic Position and Objectively Measured Physical Capability Levels in Adulthood: A Systematic Review and Meta-Analysis

Abstract

BackgroundGrip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood.Methods and FindingsRelevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations.ConclusionsPolicies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.

From Developmental Origins of Adult Disease to Life Course Research on Adult Disease and Aging: Insights from Birth Cohort Studies

“…As mentioned above, the cohorts demonstrate social inequalities from earlyto later-life stages, across a range of health indicators (5,20,41,42,75,77,108). They also provide some evidence for a link between health status and social mobility: Poor health is associated with downward mobility, and better health is associated with upward mobility (28,75 (75,77,103).…”

Lifecourse Adversity and Physical Performance Across Countries Among Men and Women Aged 65-74

“…Although SES in early life has been previously associated with adverse health and functional outcomes in later life, including poor physical performance [4][5][6]8,9], few studies have examined the associations between social adversity and physical performance in old age.…”

“…Previous research has shown that economic disadvantage in childhood is associated with a range of adverse outcomes in adulthood, often independent of adulthood socioeconomic status [8,10,[24][25][26], suggesting that apparent current effects of economic adversity on health outcomes [5] may be a proxy for an accumulation of adverse exposures over a lifetime [6]. In addition to the effects of childhood economic adversity, we found a significant and graded association between childhood social adversity and poor physical performance, strongest in the most advantaged of our study sites, i.e.…”

“…Childhood adversity was measured via the following questions on events occurring during the first fifteen years of life: death of parents, abuse of alcohol or drugs by either parent, parental divorce, witnessing physical violence in the family, having been physically abused, low economic status, having been hungry, parent unemployment [5,7]. Exploratory factor analyses of these indicators with oblimin rotation yielded three underlying factors.…”

“…While considerable research describes the relationship between individual circumstances over time, and physical function in older populations [4][5][6][7][8] few of these studies include middle and lowincome countries where very different childhood and adulthood conditions may shape aging [5]. Most lifecourse studies examine ongoing effects of socioeconomic adversity [3][4][5][6][8][9][10][11][12][13].…”