The emergence of health inequalities in early adulthood: evidence on timing and mechanisms from a West of Scotland cohort

Sweeting, H. , Green, M. , Benzeval, M. and West, P. (2015) The emergence of health inequalities in early adulthood: evidence on timing and mechanisms from a West of Scotland cohort. BMC Public Health, 16(1), 41. (doi:10.1186/s12889-015-2674-5) (PMID:26792614) (PMCID:PMC4721047)

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Abstract

Background: Evidence is inconsistent as to whether or not there are health inequalities in adolescence according to socio-economic position (SEP) and whether or when they emerge in early adulthood. Despite the large health inequalities literature, few studies have simultaneously compared the relative importance of ‘health selection’ versus ‘social causation’ at this life-stage. This study followed a cohort through the youth-adult transition to: (1) determine whether, and if so, when, health inequalities became evident according to both class of origin and current SEP; (2) compare the importance of health selection and social causation mechanisms; and (3) investigate whether these phenomena vary by gender. Methods: Data are from a West-of-Scotland cohort, surveyed five times between age 15 (in 1987, N=1,515, response=85%) and 36. Self-reported physical and mental health were obtained at each survey. SEP was based on parental occupational class at 15, a combination of own education or occupational status at 18 and own occupational class (with an additional non-employment category) at older ages. In respect of when inequalities emerged, we used the relative index of inequality to examine associations between both parental and own current SEP and health at each age. In respect of mechanisms, path models, including SEP and health at each age, investigated both inter and intra-generational paths from SEP to health (‘causation’) and from health to SEP (‘selection’). Analyses were conducted separately for physical and mental health, and stratified by gender. Results: Associations between both physical and mental health and parental SEP were non-significant at every age. Inequalities according to own SEP emerged for physical health at 24 and for mental health at 30. There was no evidence of selection based on physical health, but some evidence of associations between mental health in early adulthood and later SEP (intra-generational selection). Paths indicated intra-generational (males) and inter-generational (females) social causation of physical health inequalities, and intra-generational (males and females) and inter-generational (females) social causation of mental health inequalities. Conclusions: The results suggest complex and reciprocal relationships between SEP and health and highlight adolescence and early adulthood as a sensitive period for this process, impacting on future life-chances and health.

Item Type:Articles
Additional Information:We are grateful to all of the survey participants and staff. The West of Scotland: Twenty-07 Study is funded by the UK Medical Research Council. HS and MG are funded by the UK Medical Research Council (MC_UU_12017-12 and MC_UU_12017-13). MB is funded by the University of Essex and the UK Economic and Social Research Council.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Green, Dr Michael and Sweeting, Dr Helen
Authors: Sweeting, H., Green, M., Benzeval, M., and West, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:BMC Public Health
Publisher:BioMed Central
ISSN:1471-2458
ISSN (Online):1471-2458
Copyright Holders:Copyright © 2016 Sweeting et al.
First Published:First published in BMC Public Health 16(1):41
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727641SPHSU Core Renewal: Setting and Health Improvement Research ProgrammeKathryn HuntMedical Research Council (MRC)MC_UU_12017/12IHW - MRC/CSO SPHU
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU