Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis.
Birnie K., Cooper R., Martin RM., Kuh D., Sayer AA., Alvarado BE., Bayer A., Christensen K., Cho S-I., Cooper C., Corley J., Craig L., Deary IJ., Demakakos P., Ebrahim S., Gallacher J., Gow AJ., Gunnell D., Haas S., Hemmingsson T., Inskip H., Jang S-N., Noronha K., Osler M., Palloni A., Rasmussen F., Santos-Eggimann B., Spagnoli J., Starr J., Steptoe A., Syddall H., Tynelius P., Weir D., Whalley LJ., Zunzunegui MV., Ben-Shlomo Y., Hardy R., HALCyon study team None.
BACKGROUND: Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood. METHODS AND FINDINGS: Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations. CONCLUSIONS: Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.