Integrating Cumulative Advantage Theory and the Intergenerational Transmission of Inequality to Understand Health Risk Trajectories

The Link Between Childhood Adversity and Adult Health Risk TrajectoriesAndrea WillsonKim Shuey

The University of Western Ontario1Understanding Health from a Life Course PerspectiveHealth is positively associated with socioeconomic status (SES).We know less about how health disparities are the outcome of long-term, accumulative processes.Individual patterning of trajectories according to social statuses.2Cumulative Dis/Advantage TheoryProcess through which a favorable relative position generates further gains across the life courseInitial disadvantage accumulates over time, generating further disadvantageResults in growth of the advantage of one individual or group relative to another over time

(Eg., Dannefer 1987; 2003; Merton 1968; ORand 1996)

3Cumulative Dis/Advantage & HealthHealth inequalities follow a process of cumulative dis/advantage Early life advantage/disadvantage generates diverging trajectories and widening health disparities over time

(e.g., Willson et al. 2007; Shuey & Willson 2008; MacLean 2010)

4Cumulative InequalityLife course trajectories are influenced by early and accumulated inequalities but can be modified by available resources, perceived trajectories, and human agency.

(Ferraro and Shippee 2009)

5Cumulative InequalitySocial systems generate inequalityImportance of childhood conditionsInfluenced by genes and environment

Trajectories may be modified by resources and human agency

(Ferraro and Shippee 2009)

6The Long-term Effects of Childhood Economic DisadvantagePoor children have:Higher infant mortality ratesMore asthmaMore physical and mental health problemsLower self-esteemLower gradesLower high school grad ratesHigher unemploymentLower wagesHigher rates of poverty

7Cumulative Inequality & the Role of ChildhoodResearch has focused on role of childhood circumstances and cumulative processes in adulthood

(Eg. Hayward & Gorman 2004; Hamil-Luker & ORand 2007)8Measuring Childhood Economic DisadvantagePerhaps more important than overall level of deprivation:Persistence/durationTiming (early or late in childhood)Trajectory (improving or deteriorating)

(Wagmiller et al. 2006)9Research QuestionsWhat is the effect of childhood disadvantage on health risk trajectories in middle age?To what extent do adult resources and health behaviours alter the pathway between childhood disadvantage and health?10Data SourcePanel Study of Income Dynamics (PSID)1968-presentRepresentative sample of U.S. householdsFollowed split-offs from original sample households

11SampleAdult children of original PSID households

Baby Boom cohorts (born 1950-1964 in this analysis)2007: Ages 43-56

N=4,24112AnalysisLatent Class AnalysisCollins & Lanza 2010; Vermunt & Magidson 2005SAS Proc LCA (The Methodology Center, Penn State U)

Person-centered approach.Sorts individuals into mutually exclusive groups based on responses to a set of indicators.Detects associations among variables due to an unmeasured, latent source of variation.

13AnalysisLatent Class AnalysisSteps:Estimate LCA for childhood disadvantageEstimate baseline LCA of health risk trajectoriesUse childhood disadvantage classes and other covariates to estimate multinomial logistic regression LCA of health risk trajectories14VariablesDV: Latent Class AnalysisHealth risk trajectories (Hamil-Luker & ORand 2005 )5 Physician-diagnosed health conditions, 1999-2007Chronic condition=1 if any diagnosis in a survey waveRespondents ages 43-56Age and gender controlled 15Health Risk Trajectories

16VariablesIVs: Latent Class Analysis: Childhood DisadvantageIndicatorsLow income (averaged income