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OCHS 2000

Childhood Health StatusAnd IntergenerationalSocioeconomic Mobility

Cam Mustard, ScDChristina Kalcevich, MA

Institute for Work & Health

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Childhood Health Status and Intergenerational Socioeconomic Mobility

The unequal distribution of health status among adults relative to socioeconomic position is understood to arise from two processes:

• the effects of socioeconomic disadvantage on health status (social causation), and

• the effects of health status (both current health and potentially health early in the lifecourse) on socioeconomic status (health selection)

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Childhood Health Status and Intergenerational Socioeconomic Mobility

The effect of health status deficits in childhood and adolescence on socioeconomic attainment in early adulthood is not well described in Canada

Prior to completion of 2000 OCHS Follow-up, no Canadian studies of representative samples of children followed to early adulthood with childhood measures of health and function

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Childhood Health Status and Intergenerational Socioeconomic Mobility

Results recently reported from the 1958 British birth cohort found health selection effects were present in a British national sample of young adults followed from birth

Health in childhood and adolescence had modest effects on social class gradients in self-rated health at age 23 and at age 33 (inter-generational mobility).

At labour market entry, adolescents with poor health were more likely to be downwardly mobile and less likely to be upwardly mobile relative to their healthier peers (intra-generational mobility)

Manor O, Matthews S, Power C. Health selection: the role of inter- and intra-generational mobility on social inequalities in health. Social Science and Medicine 2003;57:2217-2227.

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Methods: OCHS 2000

Enrolled 3,294 children aged 4-16 in 1983. Sample was resurveyed in 1987

Sample was traced and re-surveyed in 2000, when respondents were aged 21-33

Results in this paper report on 2,352 adult OCHS respondents

Health domains measured in 1983 and 1987 included chronic health conditions, functional limitations, conduct disorder, hyperactivity, emotional problems and externalizing problem behavior.

Parental socioeconomic status during respondent childhood and adolescence was measured by highest educational attainment of either parent, and separately, highest occupation attainment of either parent

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Methods: OCHS 2000

Respondent socioeconomic position in early adulthood was measured similarly to parents

Dependent variable in these analyses was a three-level change score, indicating respondent socioeconomic position relative to highest parental socioeconomic position (young adult lower than parent, young adult equivalent to parent, young adult higher than parent)

Health status in young adulthood was measured by a single item five-level measure of perceived health status

Polytomous logistic regression was used to estimate the effect of child and adolescent health status on socioeconomic attainment in young adulthood

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ResultsRespondent Health Status in Childhood (83/87)

Males Females Total

Chronic Conditions 29.7% 26.7% 28.2%

Functional Limitations 12.7% 10.6% 11.6%

Conduct Disorder 9.7% 4.5% 7.0%

Hyperactivity 11.2% 4.4% 7.7%

Emotional Problems 5.5% 9.5% 7.6%

Problem Behaviors 11.7% 4.1% 7.8%

Respondent Health Status in Adulthood (2000)

Perceived Health Status (% Good, Fair, Poor)

23.2% 22.9% 23.0%

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ResultsSocioeconomic Status

(Occupation)

Childhood Early Adulthood

Unskilled Worker 3.7% 13.1%

Semi-skilled Worker 11.7% 22.3%

Skilled Worker 26.4% 16.4%

Supervisor 10.1% 8.5%

Semi-Professional, Middle Management

19.3% 27.3%

Professional and Higher-Level Management

28.9% 12.2%

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ResultsSocioeconomic Status

(Education)

Childhood Early Adulthood

No high school diploma 31.0% 6.9%

High school diploma 25.3% 10.7%

Some college 4.1% 10.0%

College completion 10.8% 31.1%

Some University 4.3% 12.0%

University completion 23.7% 29.3%

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ResultsOccupational Position Relative to Parents

Higher than Parents 30.4%

Same as Parents 15.0%

Lower than Parents 54.6%

Educational Attainment Relative to Parents

Higher than Parents 57.0%

Same as Parents 26.1%

Lower than Parents 16.9%

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Childhood Health/Behavioral Risk Factors for Downward Socioeconomic Mobility in Early Adulthood

Occupation Males Females Total

OR 95% CI OR 95% CI OR 95% CI

Downward 1.07 0.66-1.74 0.83 0.37-1.87 0.99 0.66-1.49

Stable 1.00 1.00 1.00

Upward 0.52 0.30-0.91 0.60 0.26-1.43 0.53 0.31-0.94

Education Males Females Total

OR 95% CI OR 95% CI OR 95% CI

Downward 1.85 1.22-2.81 1.07 0.44-2.59 1.79 1.24-2.60

Stable 1.00 1.00 1.00

Upward 0.53 0.35-0.82 0.46 0.23-0.92 0.48 0.33-0.68

Health/Behavioral risk factor: Hyperactivity

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Socioeconomic health status inequalities in early adulthoodPercent with good, fair or poor health status

Educational attainment at ages 23-33 Males 1 (lowest) 2 3 4 5 6 (highest) N 97 147 132 345 128 296 % 44.3 25.9 26.5 25.5 21.9 11.1 Females N 66 104 102 387 154 394 % 40.9 30.8 30.4 23.0 26.0 14.7 Occupational attainment at ages 23-33 Males 1 (lowest) 2 3 4 5 6 (highest) N 118 174 200 82 216 91 % 30.5 29.9 20.5 22. 16.7 14.3 Females N 123 235 100 74 285 137 % 28.5 29.4 19.0 21.6 16.1 16.8

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Socioeconomic health status inequalities in early adulthoodOdds Ratios for poor health (good, fair or poor health status)

Unadjusted Adjusted Occupation OR 95% CI OR 95% CI Unskilled Worker 3.27 2.18 - 4.90 3.04 2.02 – 4.57 Semi-skilled worker 3.03 2.08 - 4.41 2.81 1.92 – 4.11 Skilled worker 1.70 1.13 - 2.55 1.60 1.06 – 2.41 Supervisor 1.78 1.12 - 2.83 1.64 1.03 – 2.63 Semi-professional 1.43 0.98 - 2.10 1.44 0.98 – 2.12 Professional, Mgmt 1.00 1.00 Education No high school diploma 6.24 4.53 – 8.60 5.85 4.15 – 8.25 High school diploma 2.94 2.19 – 3.94 2.73 1.99 – 3.75 Some college 2.97 2.19 – 4.03 2.80 2.03 – 3.85 College completion 2.36 1.86 – 3.00 2.32 1.81 – 2.99 Some university 2.64 1.97 – 3.53 2.56 1.90 – 3.44 University completion 1.00 1.00

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Childhood Health Status and Intergenerational Socioeconomic MobilityConclusions (1)

In the OCHS sample, behavioral disorder in childhood/ adolescence had enduring effects on role attainment in young adulthood

The 10% of OCHS respondents with hyperactive behavioral profile in childhood were more likely to achieve lower educational attainment than parent and were less likely to achieve higher occupational attainment than parents

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Childhood Health Status and Intergenerational Socioeconomic MobilityConclusions (2)

In the OCHS sample, health status in early adulthood showed an important socioeconomic gradient.

This gradient was not explained by childhood/adolescent health status.

These findings generally replicated results from the 1958 NCDS, confirming that socioeconomic mobility of young adults is influenced only marginally by childhood and adolescent health status