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01-12-2021 | Research article

Parental income gradients in adult health: a national cohort study

Authors: Miriam Evensen, Søren Toksvig Klitkou, Mette C. Tollånes, Simon Øverland, Torkild Hovde Lyngstad, Stein Emil Vollset, Jonas Minet Kinge

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions. This study examined the association between parental income in childhood and several measures of morbidity in adulthood.

Methods

We used administrative data on seven complete Norwegian birth cohorts born in 1967–1973 (N = 429,886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 and 43, were taken from registry data on consultations at primary health care services based on diagnostic codes from the International Classification of Primary Care (ICPC-2) and hospitalizations and outpatient specialist consultations registered in the National Patient Registry (ICD-10).

Results

Low parental income during childhood was associated with a higher risk of being diagnosed with several chronic and pain-related disorders, as well as hospitalization, but not overall primary health care use. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7–9 percentage point difference). There were also differences for chronic disorders such as hypertension (8%, CI 7.9–8.5 versus 4%, CI 4.1–4.7) and diabetes (3.2%, CI 3.0–3.4 versus 1.4%, CI 1.2–1.6). There was no difference in consultations related to respiratory disorders (20.9%, CI 20.4–21.5 versus 19.7%, CI 19.2–20.3). Childhood characteristics (parental education, low birth weight, and parental marital status) and own adult characteristics (education and income) explained a large share of the association.

Conclusions

Children growing up at the bottom of the parental income distribution, compared to children in the top of the income distribution, had a two- to threefold increase in somatic and psychological disorders measured in adulthood. This shows that health inequalities by socioeconomic family background persist in a Scandinavian welfare-state context with universal access to health care.

Available only for authorised users

Notice that we measure the income of both biological parents regardless of whether the parents are married or cohabiting or whether the child lives with both biological parents as it is likely that both biological parents’ income matter for children’s well-being.

Some of the individual registrations in KUHR does not necessarily reflect an in-person contact (they may be advice given by letter/phone/prescriptions/electronic contact, etc.) However, to measure disorders in this paper, we rely on diagnostic codes from face-to-face consultations based on tariff rates.

Codes related to fear of specific disorders are symptom codes. These codes refer to particular concern a patient may have related to symptoms of, e.g., breast cancer. The GP should refer the patient to a specialist, which will give a correct diagnosis.

To examine the sensitivity of our operationalization of the parental income measure, we further adjusted parental income for household size and composition, using equivalence scales. These adjustments had minimal impact on the results (see supplementary Figure S2).

The disorders are grouped by prevalence, where the most prevalent are presented on the top row with a common scale of 0.4. The less prevalent are grouped in the lower panel with a common scale of 0.1.

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Title: Parental income gradients in adult health: a national cohort study
Authors: Miriam Evensen
Søren Toksvig Klitkou
Mette C. Tollånes
Simon Øverland
Torkild Hovde Lyngstad
Stein Emil Vollset
Jonas Minet Kinge
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02022-4

At a glance: The STEP trials

Springer Medicine

Parental income gradients in adult health: a national cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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