Life course socioeconomic position and general and oral health in later life: Assessing the role of social causation and health selection pathways

Alejandra Letelier; Stephen Jivraj; Anja Heilmann; Richard G Watt; Georgios Tsakos

doi:10.1016/j.ssmph.2022.101026

Life course socioeconomic position and general and oral health in later life: Assessing the role of social causation and health selection pathways

SSM Popul Health. 2022 Feb 7:17:101026. doi: 10.1016/j.ssmph.2022.101026. eCollection 2022 Mar.

Authors

Alejandra Letelier^{1

2}, Stephen Jivraj², Anja Heilmann², Richard G Watt², Georgios Tsakos²

Affiliations

¹ Instituto de Odontoestomatología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile, Postal Address: Rudloff 1640, Valdivia, 5111710, Chile.
² Department of Epidemiology and Public Health, University College London, UCL, London, UK. Postal Address:, Gower Street Campus, 1 - 19 Torrington Place, WC1E 6BT, UK.

Abstract

Objective: To examine the pathways between life course socioeconomic position (SEP) and general and oral health, assessing the role of two competing theories, social causation and health selection, on a representative sample of individuals aged 50 years and over in England.

Methods: Secondary analysis from the English Longitudinal Study of Ageing Wave 3 data (n = 8659). Structural equation models estimated the social causation pathways from childhood SEP to adult self-rated general health and total tooth loss, and the health selection pathways from childhood health to adult SEP.

Results: There were direct and indirect (primarily via education, but also adult SEP, and behavior) pathways from childhood SEP to both health outcomes in older adulthood. There was a direct pathway from childhood health to adult SEP, but no indirect pathway via education. The social causation path total effect estimate was three times larger for self-rated general health and four times larger for total tooth loss than the health selection path respective estimates.

Conclusions: The relationship between SEP and health is bidirectional, but with a clearly stronger role for the social causation pathway.

Keywords: Health selection; Life course; Oral health; Self-rated health; Social causation; Structural equation models.