Life course socioeconomic trajectories and chronic disease risk in later life among 30,055 older adults across 27 European countries (the SHARE study)

BACKGROUND: Although socioeconomic position (SEP) is consistently associated with health outcomes, little is known about life course SEP in relation to chronic disease risk over long-term follow-up and in multiple countries. This study aimed to identify life course socioeconomic trajectories and examine their relation with chronic disease risk in later life in a cohort study of an older European population of 27 countries.

METHODS: We used data from the European Longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE). SEP was measured in childhood (household overcrowding in childhood), adulthood (educational attainment) and older adulthood (income). Occurrence of eight chronic diseases was self-reported over a 16-year follow-up period. We identified life course socioeconomic trajectories with latent class growth analysis (LCGA) and assessed their association with chronic disease risk using covariate-adjusted Poisson regression.

RESULTS: Among 30,055 participants, we identified a five-trajectory solution. The risk of chronic disease in older adulthood was lower for those in the stable high trajectory (0.87; 95% CI: 0.82-0.93) and steep upward stable (0.90; 95% CI: 0.86-0.94) trajectories compared to those in the most disadvantaged trajectory (stable low). In gender-stratified analysis, models showed similar findings as those for the main analysis.

CONCLUSIONS: Our study revealed five distinct life course SEP trajectories in a sample of European individuals aged 50 years or older. Two trajectories were associated with chronic disease risk later in life, with more advantageous trajectories associated with reduced chronic disease risk.