March 13, 2025 | News | Spotlight

A Difficult Childhood Increases the Risk of Dying Early

[SPOTLIGHT]

Study quantifies childhood adversity as a risk factor for inequalities in mortality

In their recent paper, Josephine Jackisch and Alyson van Raalte from the Max Planck Institute for Demographic Research (MPIDR) find that a difficult childhood is an important determinant of inequalities in mortality. The size of the contribution is equivalent to established behavioral risk factors such as smoking or little exercise.

Childhood adversity might be an even more important determinant of mortality inequalities than any single health behavior. © istockphoto.com/Imgorthand

The MPIDR researchers estimate that childhood adversity contributes around 40 to 50 percent of the socioeconomic-gradient in mortality. Results were similar for men and women; for education or income. “This is an enormous contribution. Childhood adversity might be an even more important determinant of mortality inequalities than any single health behavior, and as important as all health behaviors combined”, says Josephine Jackisch.

Co-author Alyson van Raalte adds: “While these results affirm previously held assumptions, we believe that our paper finally moves a needle in a long-lasting debate about the determinants of disparities in mortality.” It is long known that children who experience major adversities are less likely to reach higher educational levels or to earn higher incomes as adults. These children are also more likely to experience poor health. But what hasn’t been clear up until now is whether these adverse experiences are common enough to be explaining the life expectancy gaps between the rich and poor, or the high and low educated.

A lack of longitudinal data has prevented researchers from answering this question. Even worse, papers that look to determinants of socioeconomic inequalities in mortality generally ignore childhood factors by conditioning upon survival to adulthood, after socioeconomic positions are attained. As a result, adult behavioral factors consistently emerge as the paramount drivers of mortality gradients. Buried in the limitations sections of papers is an acknowledgement that mortality associations with socioeconomic factors might be mediated or confounded by childhood circumstances. The objective of this study, published in the journal Social Science & Medicine, is to quantify how much of the socioeconomic gradient in adult life expectancy is associated with childhood adversity.

Data from a Swedish cohort study used in a counterfactual scenario

The study results come from the longest-running population-based cohort study in the world with information on involvement with child welfare services, the Stockholm 1953 birth cohort with more than 14,000 participants, with follow-up from birth to age 67. Childhood adversity is measured prospectively from Swedish registers and proxied as contact with child welfare services; around 20 percent of the cohort were in contact. The researchers created a counterfactual scenario where individuals with adverse childhoods experienced the same death rates as those without an adverse childhood, matched on adult socioeconomic position. For example, the difference in life-expectancy for the ages 30–68 years between a man in the lowest income quintile and in the highest income quintile is 3 years. Many of the men in the low-income group will have had difficult childhoods which is part of the reason they end up with low education and low income. The difference in life expectancy would only be about 1.5 years in a world were men with difficult childhoods had the same mortality as their peers in the lowest income group.

„Children cannot choose the family in which they are born and grow-up, which makes these inequalities in mortality clearly unfair and a matter of equity. We believe that our study can help to firmly place childhood adversity on the health equity policy agenda. Policy interventions to reduce inequalities that are aimed at adults might be largely ineffective “, says Josephine Jackisch.

Definition Childhood Adversity:

Childhood adversity are circumstances in the family or direct social environment of a child that might threaten health and wellbeing of a child at the ages of 0 to 18 years. These conditions might be particularly stressful or traumatic if they are so severe that they come to the attention of child welfare services and especially in substantiated cases where the child is removed from their homes. Examples of adverse circumstances that might disrupt parent’s ability to care for their child include: parental death, mental health problems, substance abuse, but also sometimes child maltreatment including violence, abuse, or neglect.

Original Publication

Jackisch, J., van Raalte, A.: The contribution of childhood adversity to adult socioeconomic gradients in mortality: A Swedish birth cohort analysis. Social Science & Medicine (2025). DOI: 10.1016/j.socscimed.2024.117627.