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Open Access Highly Accessed Research article

The role of childhood social position in adult type 2 diabetes: evidence from the English Longitudinal Study of Ageing

Jitka Pikhartova1*, David Blane2 and Gopalakrishnan Netuveli3

Author Affiliations

1 School of Health Sciences and Social Care, Brunel University, Uxbridge UB8 3PH, Middlesex, UK

2 Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK

3 Institute of Health and Human Development, University of East London, London E15 4LZ, UK

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BMC Public Health 2014, 14:505  doi:10.1186/1471-2458-14-505

Published: 26 May 2014

Abstract

Background

Socioeconomic circumstances in childhood and early adulthood may influence the later onset of chronic disease, although such research is limited for type 2 diabetes and its risk factors at the different stages of life. The main aim of the present study is to examine the role of childhood social position and later inflammatory markers and health behaviours in developing type 2 diabetes at older ages using a pathway analytic approach.

Methods

Data on childhood and adult life circumstances of 2,994 men and 4,021 women from English Longitudinal Study of Ageing (ELSA) were used to evaluate their association with diabetes at age 50 years and more. The cases of diabetes were based on having increased blood levels of glycated haemoglobin and/or self-reported medication for diabetes and/or being diagnosed with type 2 diabetes. Father’s job when ELSA participants were aged 14 years was used as the measure of childhood social position. Current social characteristics, health behaviours and inflammatory biomarkers were used as potential mediators in the statistical analysis to assess direct and indirect effects of childhood circumstances on diabetes in later life.

Results

12.6 per cent of participants were classified as having diabetes. A disadvantaged social position in childhood, as measured by father’s manual occupation, was associated at conventional levels of statistical significance with an increased risk of type 2 diabetes in adulthood, both directly and indirectly through inflammation, adulthood social position and a risk score constructed from adult health behaviours including tobacco smoking and limited physical activity. The direct effect of childhood social position was reduced by mediation analysis (standardised coefficient decreased from 0.089 to 0.043) but remained statistically significant (p = 0.035). All three indirect pathways made a statistically significantly contribution to the overall effect of childhood social position on adulthood type 2 diabetes.

Conclusions

Childhood social position influences adult diabetes directly and indirectly through inflammatory markers, adulthood social position and adult health behaviours.

Keywords:
ELSA; Diabetes; Longitudinal; Glycated haemoglobin; Inflammation