Childhood adversity is a key driver of socioeconomic mortality inequalities
Childhood adversity is a major contributor to socioeconomic disparities in adult mortality. This is the result of a new study from the Department of Public Health Sciences at Stockholm University. The study that was published recently in Social Science & Medicine highlights how early-life hardships significantly shape life expectancy outcomes.
The study found that individuals who experienced childhood adversity, for instance being investigated by child welfare services, were more likely to end up in lower socioeconomic groups as adults and die earlier. Something that, in turn, is shown to contribute substantially to inequalities in mortality.
Childhood adversity accounted for nearly half of the disparities in mortality linked to adult education and income. When childhood adversity was factored out, the mortality gradient across socioeconomic groups was reduced by 40% for men and 54% for women. Income-based mortality inequalities also saw a substantial decrease – 49% for men and 47% for women – when childhood adversity was taken out of the equation.
“While these results affirm previously held assumptions, we believe that our paper finally moves a needle in a long-lasting debate about determinants of disparities in mortality. A lack of longitudinal data has prevented us from prospectively estimating how large the contribution of childhood adversity is to disparities in mortality,” says Josephine Jackisch, guest researcher at the Department of Public Health Sciences at Stockholm University.
A life course approach to reducing health disparities
Mortality inequalities have traditionally been examined through the lens of adult socioeconomic status, often overlooking early-life circumstances. However, this study underscores that a significant share of lifespan inequality has its roots in childhood. The findings align with a WHO report identifying child maltreatment as a leading cause of health disparities worldwide.
Childhood adversity might be an even more important determinant of mortality inequalities than any single health behaviour, and as important as health behaviours combined.
These results come from a 1953 birth cohort from Stockholm, which might be the longest-running population-based cohort study in the world with information on involvement with child welfare services consisting of 14,210 individuals with follow-up from birth to age 67.
The researchers compared inequalities in adult mortality to a counterfactual scenario. A scenario where individuals with a history of childhood adversity, indicated by involvement with child welfare services, experienced the mortality rates of those achieving the same adult socioeconomic position, but with no history of childhood adversity.
The resulting attenuation of the education and income gradient that the researchers found highlights that childhood adversity is a determinant of lifespan inequality. As such it could be of equal impact as established behavioral risk factors, such as smoking or alcohol use.
“If childhood adversity is as important as we have estimated it to be, then this is an enormous contribution. Childhood adversity might be an even more important determinant of mortality inequalities than any single health behaviour, and as important as health behaviours combined," says Jackisch.
Implications for health disparaties policies
The study’s findings open up for new policies aimed at mitigating health disparities. Addressing childhood adversity through early interventions, improved child welfare systems, and targeted support for at-risk youth could significantly reduce socioeconomic inequalities in mortality.
“Social inequalities in mortality are likely to persist unless states invest in social determinants preventing the occurrence and mitigating negative outcomes after childhood adversity,” says Jackisch.
With evidence supporting the role of early-life experiences in shaping adult health outcomes, policymakers and public health officials may need to rethink existing strategies for tackling socioeconomic health disparities. Investing in childhood interventions may hold the key to a healthier and more equitable society.
Håkan Soold
Facts on the study
The study The contribution of childhood adversity to adult socioeconomic gradients in mortality: A Swedish birth cohort analysis was recently published in the scientific journal Social Science & Medicine.
In addition to Josephine Jackisch, Alyson van Raalte, researcher at the Max Planck Institute for Demographic Research, Rostock, Germany, participated in the study.
Last updated: February 13, 2025
Source: Department of Public Health Sciences