Impact of educational attainment on the association between social class at birth and multimorbidity in middle age in the Aberdeen Children of the 1950s cohort study

Abstract

Objective
Multimorbidity (the co-existence of two or more health conditions) is increasingly prevalent. No long-term cohort study has examined the impact of contemporaneously measured birth social class and educational attainment upon adult self-reported multimorbidity. We investigated the impact of educational attainment on the relationship between social class at birth and adult self-reported multimorbidity in the Aberdeen Children of the 1950s (ACONF) cohort.

Methods
A prospective cohort study using the ACONF cohort. ACONF included 12,150 individuals born in Aberdeen, Scotland 1950-1956. In 2001, 7,184 (64%) responded to a questionnaire providing information including self-reported morbidity and educational attainment. The exposure was father’s social class at birth from birth records and the outcome was self-reported multimorbidity. Logistic regression assessed the association between social class and multimorbidity with adjustment for gender, then by educational attainment and finally by childhood cognition and secondary school type. Odds ratios (ORs) and 95% confidence intervals were presented.

Results
Of 7,184 individuals (mean age 48, 52% female), 5.4% reported multimorbidity. Birth social class was associated with adult multimorbidity. For example the OR of multimorbidity adjusted by gender was 0.62 (95% CI 0.39-1.00) in the highest social class group (I/II) in relation to the reference group (III (manual)) and was 1.85 (95% CI 1.19-2.88) in the lowest social class group. This was partially attenuated in all social class categories by educational attainment, for example the OR was 0.74 (95% CI 0.45-1.21) in group I/II following adjustment.

Conclusion
Lower social class at birth was associated with developing multimorbidity in middle age. This was partially mediated by educational attainment and future research should consider identifying the other explanatory variables. The results are relevant to researchers and to those aiming to reduce the impact of multimorbidity.