Social Determinants of Mortality from Childhood to Early Adulthood

The purpose of this study was to examine the social determinants of mortality at a young age. The findings are based on several measures of parental social background, and among older adolescents and young adults also on measures reflecting their own social position and current living arrangements. Extensive individual-level register data was obtained from Statistics Finland. Combining longitudinal population census and employment data from the period 1970–2007 with data on mortality and causes of death, the study data covered 80% of all deaths in 1990_2004/2007. Social differentials in mortality in the age range 1_29 years were assessed in both absolute and relative terms, by calculating mortality rates and estimating Cox proportional hazards models. Mortality in childhood among both boys and girls was clearly associated with family type and parental socioeconomic factors. There were no differences in mortality between children in cohabiting-parent families and children of married parents, but children in single-parent families carried an excess risk. Both parental education and household income showed clear mortality gradients, with higher mortality among children of parents with lower levels of education and who earned less. The relationship between single parenthood and child mortality was, in fact, largely attributable to the associated low parental education and income. Mortality in late adolescence and early adulthood was higher among young men and women living in single- or cohabiting-parent families, as single parents themselves, alone, or with others than among those living in the parental home with married parents. Living independently with a partner was associated with lower mortality, especially among people in their late 20s. Following adjustment for childhood and current factors, the strongest excess mortality in early adulthood occurred among the less-highly educated and the non-employed. Leaving the parental home at a young age also remained an independent risk factor for premature death. The associations between parental social background and mortality were distinct but smaller, 4 and were largely mediated by the current factors and age at leaving the parental home. Among children, social inequalities in mortality were strongest in early childhood, between the ages of one and four years, somewhat smaller between five and nine years, and with the exception of a weak association between mortality and parental education, non-existent at 10–14 years. Moreover, the associations between mortality and the current living arrangements and the main activity differed by age in late adolescence and early adulthood. The convergence of social differentials in mortality in late childhood, and their re-emergence in late adolescence related to changes in the most common causes of death during these life phases. Influenced by various factors, different causes of death are more or less likely to associate with social factors. Social differentials in mortality stemmed mostly from external causes, but deaths from diseases contributed to mortality differentials between the ages of one to four, and in early adulthood. Targeting support to high-risk groups in early childhood and in the transition to adulthood could prove to be effective in reducing health inequalities and preventing social exclusion not only among the young but also later in life.