Letelier, Alejandra; (2018) Intergenerational social mobility and general health, oral health and physical function in older adulthood: a study of the association and pathways. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Recent research in life course epidemiology has established the relevance of a life course approach when examining the relationship between socioeconomic position, measured as occupational class, and adult health outcomes. // Aims: The present study examined the association between changes in socioeconomic position from childhood to later adulthood, known as intergenerational social mobility and five indicators of adult general health, oral health and physical function. Additionally, the potential pathways to the aforementioned associations were investigated to explore the relative contribution of the social mobility theories: social causation and health selection. // Methods: This study is based on the secondary analysis of data from the English Longitudinal Study of Ageing. Data from wave 3 (2006/07) and wave 4 (2008/09) were used to create nine social trajectories based on parental and adult occupational socioeconomic position. First, regression models were used to estimate the association between social trajectories and the following five outcomes: self-rated general health, self-rated oral health, oral health related quality of life, total tooth loss and grip strength; while controlling for demographic factors, education and health-related behaviours. Then, structural equation modeling was used to assess to what degree these data support the social causation theory and the health selection theory. // Results: There was a linear association between intergenerational social mobility and adult general health and oral health among men and women. Also, a linear association was found with physical function but only among women. There was strong evidence that compared to those who remained stable in high SEP over time, the mobile groups presented higher odds ratios of reporting poor self-rated general and total tooth loss among men and women and lower grip strength among women. Additionally, the general health, total tooth loss levels and grip strength of the mobile individuals tend to be between the levels of the stable individuals from the SEP they left and the stable individuals from the SEP they joined. However, there was little evidence that the mobile groups had a different risk of reporting poor self-rated oral health and poor oral health related quality of life. Additionally, the structural equation modelling analyses provided strong evidence for both social causation and health selection pathways suggesting that both co-exist, although the social causation effect was much larger. There was statistical evidence of a direct and indirect effect (via adult SEP, education and behaviour) of childhood SEP on self-rated general health, total tooth loss and on grip strength on older adulthood, and evidence of an indirect effect of childhood SEP on self-rated oral health and oral health related quality of life. Also, there was evidence of a direct effect of childhood health on adult SEP, but no indirect effect via education was found. However, the social causation effect was over two times larger than the health selection effect. // Conclusion: The exposure to adverse/protective socioeconomic position over the life course had an additive effect on the health and physical function of older adults. In addition, these findings also suggested that the relationship between socioeconomic position and health is bidirectional, although, the social causation effect is considerably larger than the health selection effect. Finally, these results support that promoting intergenerational social mobility reduces health inequalities in old age.

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