Journal of Epidemiology and Community Health

Background: The two-child benefit cap, implemented in April 2017, restricted Universal Credit and Child Tax Credit to the first two children in households with three or more children. We evaluate the impact of the two-child benefit cap on parental mental, general, and financial health, as well as investigate how this may differ in particular sociodemographic and economic subgroups based on sex, ethnicity and income. Methods: Data was obtained from parents (youngest child aged 5 or under) in the UK Household Longitudinal Survey from 2009 to 2023. Outcomes included parental mental health (psychological distress and life satisfaction), general health (health-related quality of life (HRQoL), self-rated health and health satisfaction), and financial health (current financial situation and financial outlook). We used complementary policy evaluation methods with different strengths and assumptions to triangulate evidence and strengthen inference: interrupted time series (ITS), difference-in-differences (DiD) and controlled time series analysis (CITS). Subgroup analyses were stratified by sex, ethnicity, and income. Findings: Across methods, findings consistently indicate that the policy worsened life satisfaction, self-rated health, health satisfaction, and financial health for parents of 3+ children. Findings were less consistent across methods for psychological distress and HRQoL. For instance, for psychological distress ITS and CITS indicate adverse impacts of the policy; however, one DiD model did not support this conclusion due to greater average worsening in the control group between the pre- and post-periods. Subgroup analyses indicate greater mental health and general health impacts in lower income, male and ethnic minority parents; while financial health was negatively impacted in all subgroups examined. Conclusions: Using repeated cross-sectional panel data and triangulating across causal inference methods, we conclude that the two-child benefit cap in the UK had a measurable adverse impact on most health outcomes examined, with worse outcomes for male, lower income and ethnic minority parents.

ObjectiveTo estimate the risk of Long COVID by socioeconomic deprivation and to further examine the socioeconomic inequalities in Long COVID by sex and occupational groups. DesignWe analysed data from the COVID-19 Infection Survey conducted by the Office for National Statistics between 26/04/2020 and 31/01/2022. This is the largest and nationally representative survey of COVID-19 in the UK and provides uniquely rich, contemporaneous, and longitudinal data on occupation, health status, COVID-19 exposure, and Long COVID symptoms. SettingCommunity-based longitudinal survey of COVID-19 in the UK. ParticipantsWe included 201,799 participants in our analysis who were aged between 16 and 64 years and had a confirmed SARS-CoV-2 infection. Main outcome measuresWe used multivariable logistic regression models to estimate the risk of Long COVID at least 4 weeks after acute SARS-CoV-2 infection by deciles of index of multiple deprivation (IMD) and adjusted for a range of demographic and spatiotemporal factors. We further examined the modifying effects of socioeconomic deprivation by sex and occupational groups. ResultsA total of 19,315 (9.6%) participants reported having Long COVID symptoms. Compared to the least deprived IMD decile, participants in the most deprived decile had a higher adjusted risk of Long COVID (11.4% vs 8.2%; adjusted OR: 1.45; 95% confidence interval [CI]: 1.33, 1.57). There were particularly significantly higher inequalities (most vs least deprived decile) of Long COVID in healthcare and patient facing roles (aOR: 1.76; 1.27, 2.44), and in the education sector (aOR: 1.62; 1.26, 2.08). The inequality of Long COVID was higher in females (aOR: 1.54; 1.38, 1.71) than males (OR: 1.32; 1.15, 1.51). ConclusionsParticipants living in the most socioeconomically deprived areas had a higher risk of Long COVID. The inequality gap was wider in females and certain public facing occupations (e.g., healthcare and education). These findings will help inform public health policies and interventions in adopting a social justice and health inequality lens.

BackgroundYoung people who are not in education, employment or training (NEET) are at an increased risk of long-term social and economic disadvantage. While previous research has linked various risk factors and individual characteristics to NEET status, evidence on the cumulative impact of early-life exposure to childhood adversity in the UK remains limited. MethodsWe analysed longitudinal data on 8,368 participants from the UK Millennium Cohort Study. Using group-based multi-trajectory modelling approach, we identified six distinct exposure trajectories of poverty and family adversity (including poor parental mental health, domestic violence and abuse and alcohol use) from aged 9 months to 14 years. NEET status was assessed at age 17. Adjusted odds ratios (aORs) and 95% CIs were estimated using logistic regression models. Population attributable fractions (PAFs) were calculated to estimate the proportion of NEET cases attributable to childhood poverty and family adversity. ResultsOverall, 3.5% of participants were NEET at age 17 years. NEET status was more prevalent among young people from socially disadvantaged backgrounds than their peers. Exposure to persistent family childhood adversities was associated with greater likelihood of being NEET. Young people exposed to both persistent poverty and poor parental mental health throughout childhood (0-14 years) had five times greater odds of being NEET (adjusted odds ratio [aOR] 5.0; 95% CI 3.4-7.5) compared to those in low poverty and adversity. An estimated 52.9% (95% CI: 41.1-61.7) of NEET cases were attributable to persistent exposure to poverty and family adversity. ConclusionFamily childhood adversities, particularly household poverty and poor parental mental health are strongly associated with an increased risk of being NEET on transition to adulthood. Interventions that address early-life socio-economic disadvantage and family functioning may be critical for preventing NEET and mitigating its long-term social and economic consequences. What is already known on this topicO_LIYoung people who are not in education, employment or training (NEET) are at risk of poor health, social exclusion and long-term economic disadvantage. C_LIO_LIChildhood poverty and family adversity have been associated with NEET status, but their cumulative and life-course impact in the UK remains unclear. C_LI What this study addsO_LIUsing longitudinal data from a nationally representative UK cohort, this study shows that persistent exposure to poverty and family childhood adversity including poor parental mental health increase the likelihood of being NEET at age 17. C_LIO_LIIndividuals exposed to multiple family childhood adversity (i.e., poverty and poor parental mental health) were five times more likely to be NEET. C_LIO_LIAn estimated 52.9% NEET cases were attributable to persistent poverty and family childhood adversity. C_LI How this study might affect research, policy, or practiceO_LIInterventions that address family childhood adversity, particularly household poverty and poor parental mental health could substantially reduce NEET prevalence and mitigate long-term inequalities. C_LI

BackgroundIntergenerational welfare contact (IWC) is a policy issue because of the personal and social costs of intergenerational disadvantage. We estimated the hospital burden of IWC for children aged 11-20 years. MethodsThis linked data study of children born in South Australia, 1991-1995 (n=94,358), and their parent/s (n=143,814) used de-identified data from the Better Evidence Better Outcomes Linked Data platform. Using Australian Government Centrelink data, welfare contact (WC) was defined as parent/s receiving a means-tested welfare payment (low-income, unemployment, disability or caring) when children were aged 11-15, or children receiving payment at ages 16-20. IWC was WC occurring in both parent and child generations. Children were classified as: No WC, parent only WC, child only WC, or IWC. Hospitalisation rates and cumulative incidence were estimated by age and WC group. FindingsIWC affected 34.9% of children, who had the highest hospitalisation rate (133.5 per 1,000 person-years) compared to no WC (46.1 per 1,000 person-years), parent only WC (75.0 per 1,000 person-years), and child only WC (87.6 per 1,000 person-years). Of all IWC children, 43.0% experienced at least one hospitalisation between 11-20, frequently related to injury, mental health, and pregnancy. InterpretationChildren experiencing IWC represent a third of the population aged 11-20. Compared to children with parent-only WC, IWC children had 78% higher hospitalisation rates from age 11 to 20, accounting for over half of all hospitalisations in this age group. Frequent IWC hospitalisation causes were injuries, mental health, and pregnancy. FundingMedical Research Future Fund, National Health and Medical Research Council, Westpac Scholars Trust.

BackgroundEarly childhood poverty is associated with poorer health and educational outcomes in adolescence. However, there is limited evidence about the clustering of these adverse outcomes by income group. MethodsWe analysed five outcomes at age 17 known to limit life chances - psychological distress, self-assessed ill health, smoking, obesity, and poor educational achievement - using data from the longitudinal UK Millennium Cohort Study (N=15,245). We compared how single and multiple outcomes were distributed across quintiles of household income in early childhood (0-5 years) and modelled the maximum potential benefit of tackling the income gradient in these outcomes. FindingsChildren from the poorest households were 12.7(95% CI 6.4-25.1) times more likely than those from the richest to experience four or five adverse adolescent outcomes, with poor educational achievement and smoking showing the largest single risk ratios-4.6(95% CI: 4.2-5.0) and 3.6(95% CI 3.0-4.2), respectively. We modelled hypothetical absolute and relative poverty elimination scenarios, as well as an income inequality elimination scenario, and found these would yield maximum reductions in multiple adolescent adversity of 5%, 30%, and 80% respectively. InterpretationEarly childhood poverty is more strongly correlated with multiple adolescent adversity than any single adverse outcome. Reducing absolute poverty alone is not sufficient to eliminate the life-long burden of multiple adversity, which disproportionately impacts children across the bottom three-fifths of the income distribution. An ambitious levelling up agenda needs co-ordinated multi-agency action to tackle the complex interacting factors generating the steep social gradient in multiple adolescent adversity.

Background Childhood socioeconomic position (SEP) is a key determinant of later life health. Understanding the extent to which adult SEP mediates this association into early old age is important for explaining how health inequalities are propagated across generations and how they might be addressed in later life. To our knowledge, no prospective study has examined whether childhood SEP remains associated with health at the threshold of older age and the extent to which any such association is mediated by adult SEP. Methods We used data from the 1958 British Birth Cohort, a prospective study that has followed participants since birth, drawing on earlier data collected at birth and ages 33 and 55 years and newly collected data from the age 62 sweep. Using interventional causal mediation analyses, we assessed whether adult occupational class, education, housing tenure, and income mediate associations between childhood social class (manual vs non manual) and health at age 62 (self rated health, C reactive protein [CRP], cholesterol ratio, Glycated hemoglobin [HbA1c], and N terminal pro B type natriuretic peptide [NT proBNP]). Findings Associations between childhood SEP and self rated health, CRP, cholesterol ratio, and HbA1c persisted after accounting for adult SEP. Mediation was outcome specific and differed by sex. Among men, occupational class mediated 39% of the association with self rated health (indirect effect RR 0.90, 95% CI 0.86,0.95) and education mediated 27% (0.93, 0.90,0.96). Among women, education mediated 10% (0.95, 0.91,0.98) and housing tenure mediated 6% (0.97, 0.94,0.99). Indirect effects for CRP were smaller, and mediation was minimal for cholesterol ratio, HbA1c, and NT proBNP Interpretation Population level improvements in adult SEP could reduce, but are unlikely to eliminate, later life health inequalities associated with childhood SEP. Reducing these inequalities will require policies that address disadvantage in early life and improve adult financial and employment conditions. Funding UK Economic and Social Research Council

IntroductionLow educational attainment is associated with increased risk of COVID-19 mortality, but it remains unclear whether the link between education and COVID-19 mortality is causal or due to confounding factors, such as childhood socio-economic status or cognitive skills. To address this question, we evaluated whether older adults risk of COVID-19 mortality was associated with historical state-level compulsory schooling laws (CSLs) applicable when they were school-aged. We also evaluated whether that impact was unique to COVID-19 mortality or also applied to all-cause mortality, both before and during the pandemic. MethodsWe defined mortality outcomes using US death certificate data from Mar 2019-Dec 2021 for people born in the US before 1964 in three time periods: the year prior to the pandemic (Mar 2019-Feb 2020), pandemic year 1 (Mar 2020-Feb 2021), and pandemic year 2 (Mar-Dec 2021). We determined the population at risk using 2019 American Community Survey PUMS data with population weights, representing 78.7 million individuals born in the US before 1964. We linked individuals to the number of mandatory years of education defined by CSLs specific to their state of birth and years when school age. We estimated intention-to-treat effects of CSLs on mortality using logistic regressions controlling for state-of-birth fixed effects, birth year (linear and quadratic), sex, race, ethnicity, and state-level factors including percent urban, Black, and foreign-born (at age 6) and manufacturing jobs per capita and average manufacturing wages (at age 14). ResultsWe identified a dose-response relationship between CSLs and mortality. In the first year of the pandemic, people mandated to receive 8 vs 9 (reference) years of education had higher odds of COVID-19 mortality (Odds Ratio [OR]: 1.15; 95% Confidence Interval [CI]: 1.10, 1.19), while those mandated to receive 10 vs 9 (reference) years of education had lower odds of COVID-19 mortality (OR: 0.96; 95% CI: 0.94, 0.98). The association of CSLs with COVID-19 mortality was similar in pandemic years 1 and 2; for all-cause mortality in pandemic years 1 and 2; and for all-cause mortality in the year prior to the pandemic. Results were robust to alternative model specifications. ConclusionsThese findings support a causal benefit of education for reduced mortality during the COVID-19 pandemic. State investments in childrens education may have reduced pandemic-era mortality decades later. Our research has implications beyond the pandemic context, as our results suggest the observed relationship mirrors a pre-existing relationship between CSLs and all-cause mortality.

BackgroundSocioeconomic differences in body mass index (BMI) have widened alongside the obesity epidemic. However, the utility of socioeconomic position (SEP) indicators at the individual level remains uncertain, as does the potential temporal variation in their predictive value. Examining this is important in light of the increasing incorporation of SEP indicators into predictive algorithms and the possibility that SEP has become a more important predictor of BMI over time. We thus investigated SEP differences in BMI over three decades of the obesity epidemic in England and compared population-wide (SEP group differences in mean BMI) and individual-level (out-of-sample prediction of individuals BMI) approaches. MethodsWe used repeated cross-sectional data from the Health Survey for England, 1991-2019. BMI (kg/m2) was measured objectively, and SEP was measured via educational attainment and neighborhood index of deprivation (IMD). We ran random forest models for each survey year and measure of SEP adjusting for age and sex. ResultsThe mean and variance of BMI increased within each SEP group over the study period. Mean differences in BMI by SEP group also increased across time: differences between lowest and highest education groups were 1.0 kg/m2 (0.4, 1.6) in 1991 and 1.5 kg/m2 (0.9, 1.8) in 2019. At the individual level, the predictive capacity of SEP was low, though increased in later years: including education in models improved predictive accuracy (mean absolute error) by 0.14% (-0.9, 1.08) in 1991 and 1.06% (0.17, 1.84) in 2019. Similar patterns were obtained when analyzing obesity, specifically. ConclusionSEP has become increasingly important at the population (group difference) and individual (prediction) levels. However, predictive ability remains low, suggesting limited utility of including SEP in prediction algorithms. Assuming links are causal, abolishing SEP differences in BMI could have a large effect on population health but would neither reverse the obesity epidemic nor explain the vast majority of individual differences in BMI.

BackgroundHousing insecurity is an escalating problem in the UK but there is limited evidence about its health impacts. Using nationally representative panel data and causally focussed methods, we examined the effect of insecure housing on mental health, sleep and blood pressure, during a period of government austerity. MethodsWe used longitudinal survey data (2009-2019) from the UK Household Longitudinal Study. Outcomes were probable common mental disorder, sleep disturbance due to worry, and new diagnoses of hypertension. The primary exposure was housing payment problems in the past year. Using doubly robust marginal structural models with inverse probability of treatment weights, we estimated absolute and relative health effects of housing payment problems, and population attributable fractions. In stratified analyses we assessed potentially heterogeneous impacts across the population, and potential modifying effects of government austerity measures. A negative control analysis was conducted to detect bias due to unmeasured confounding. ResultsHousing payment problems were associated with a 2.5 percentage point increased risk of experiencing a common mental disorder (95% CI 1.1%, 3.8%) and 2.0% increased risk of sleep disturbance (95% CI 0.7%, 3.3%). Estimates were larger for renters, younger people, less educated, households with children, and people living in areas most affected by austerity-related cuts to housing support services. We did not find consistent evidence for an association with hypertension (RD=0.6%; 95% CI -0.1%, 1.2%). The negative control analysis was not indicative of unmeasured confounding. ConclusionsHousing payment problems were associated with worse mental health and sleep disturbance in a large UK sample. Households at risk of falling into rent or mortgage arrears need more support, especially in areas where housing support services have been diminished. Substantial investment is urgently needed to improve supply of social and affordable housing.

BackgroundThere are concerns that mortality remains elevated after peaks COVID-19. This study examined whether mortality rates in England and Scotland in 2022 were excessive compared to rates predicted by austerity-era (2012-2019) and pre-austerity (2001-2010) trends. MethodsA linear time trend analysis was conducted using mortality data from 2001-2022. The outcomes were observed and expected age- and sex-standardised mortality rates (ASMRs; standardised to the 2013 European Standard Population). Expected ASMRs in 2022 were calculated independently based on austerity-era and pre-austerity trends. Excess deaths were estimated by comparing observed and expected ASMRs. ResultsIn 2022, ASMRs were higher than predicted by austerity-era trends but substantially higher than pre-austerity trends. Relative excesses in England for females were 4.4% (4.0-4.8) and 38.2% (95% CI: 37.7-38.7), respectively; for males, excesses were 7.2% (6.8-7.6) and 57.0% (56.4-57.6). Relative excesses in Scotland for females were 3.4% (2.2-4.5) and 26.6% (25.2-28.0); for males, excesses were 2.6% (1.5-3.8) and 45.2% (43.6-46.9). COVID-19 accounted for 5.3-6.5% of deaths in 2022 and explained much of the excess relative to austerity-era trends. ASMRs in the most deprived areas were 1.68-1.94 times higher than in the least deprived. ConclusionMortality was higher than predicted by both austerity-era and pre-austerity trends. Deaths attributable to COVID-19 explain a substantial proportion of the excess based on austerity-era trends. However, the 879,430 excess deaths relative to pre-austerity trends, even after excluding direct COVID-19 deaths, highlights the devastating impacts of austerity on public health. KEY MESSAGESO_ST_ABSWhat is already known on this topic?C_ST_ABSMortality in England and Scotland remained elevated following the peaks of 2020 and 2021 caused by COVID-19, indicating a further worsening of the unprecedented stalling of mortality rates observed from around 2012. What this study addsWhile COVID-19 explained much of the 2022 excess mortality relative to projections based on austerity-era trends, far greater excesses emerged when compared to projections based on the consistent decline in mortality observed prior to austerity. How this study might affect research, practice or policyThese findings highlight the profound, long-term harm of austerity, particularly in deprived areas, with an estimated 879,430 excess deaths between 2013 and 2022. The study strengthens calls for urgent policy action to reverse austeritys effects and reduce health inequalities.

ObjectivesTo estimate the potential impacts of unmitigated and mitigated cost of living increases on real household income, mortality, and mortality inequalities in Scotland. DesignModelling study. SettingScotland, 2022/23. ParticipantsA representative sample of 5,602 Scottish individuals (within 2,704 households) in the 2015/16 Family Resources Survey. We estimated changes in real household income associated with differential price inflation (based on proportion of household spending on different goods and services, by income group), both with and without mitigating UK Government policies, and scaled these to the Scottish population. We estimated mortality effects using a cross-sectional relationship between household income and mortality data, by deprivation group. InterventionsBaseline was Scotland in 2022/23 with the average wage and price inflation of preceding years. The comparison scenarios were unmitigated cost of living increases, and mitigation by the UK Governments Energy Price Guarantee (EPG) and Cost of Living Support payments. Main outcome measuresPremature mortality rate and life expectancy at birth by Scottish Index of Multiple Deprivation (SIMD) group, and inequalities in both. ResultsUnmitigated price inflation was 14.9% for the highest income group and 22.9% for the lowest. UK Government policies partially mitigated impacts of the rising cost of living on real incomes, although households in the most deprived areas of Scotland would still be {pound}1,400 per year worse off than at baseline. With the mitigating measures in place, premature mortality was estimated to increase by up to 6.4%, and life expectancy to decrease by up to 0.9%. Effects would be greater in more deprived areas, and inequalities would increase as a result. ConclusionsLarge and inequitable impacts on mortality in Scotland are predicted if real-terms income reductions are sustained. Progressive Cost of Living Support payments are not sufficient to offset the mortality impacts of the greater real income reductions in deprived areas. What is already known on this topicO_LIOver the last decade, life expectancy in Scotland has stalled and inequalities have increased. C_LIO_LIIncome reductions have been related to increased mortality risk, hence the economy matters for public health. C_LIO_LIThe impacts of the rising cost of living and mitigating policies on mortality and inequalities require estimation to inform policymaking. C_LI What this study addsO_LIThe mortality impacts of inflation and real-terms income reduction are likely to be large and negative, with marked inequalities in how these are experienced. C_LIO_LICurrent public policy responses are not sufficient to protect health and prevent widening inequalities. C_LIO_LIBolder and more progressive policy responses are required if health is to improve and health inequalities are to narrow. C_LI

BackgroundStructural barriers to testing may introduce selection bias in COVID-19 research. We explore whether changes to testing and lockdown restrictions introduce time-specific selection bias into analyses of socioeconomic position (SEP) and SARS-CoV-2 infection. MethodsUsing UK Biobank (N = 420 231; 55 % female; mean age = 56{middle dot}3 [SD=8{middle dot}01]) we estimated the association between SEP and i) being tested for SARS-CoV-2 infection versus not being tested ii) testing positive for SARS-CoV-2 infection versus testing negative and iii) testing negative for SARS-CoV-2 infection versus not being tested, at four distinct time-periods between March 2020 and March 2021. We explored potential selection bias by examining the same associations with hypothesised positive (ABO blood type) and negative (hair colour) control exposures. Finally, we conducted a hypothesis-free phenome-wide association study to investigate how individual characteristics associated with testing changed over time. FindingsThe association between low SEP and SARS-CoV-2 testing attenuated across time-periods. Compared to individuals with a degree, individuals who left school with GCSEs or less had an OR of 1{middle dot}05 (95% CI: 0{middle dot}95 to 1{middle dot}16) in March-May 2020 and 0{middle dot}98 (95% CI: 0{middle dot}94 to 1{middle dot}02) in January-March 2021. The magnitude of the association between low SEP and testing positive for SARS-CoV-2 infection increased over the same time-period. For the same comparisons, the OR for testing positive increased from 1{middle dot}27 (95% CI: 1{middle dot}08 to 1{middle dot}50), to 1{middle dot}73 (95% CI: 1{middle dot}59 to 1{middle dot}87). We found little evidence of an association between both control exposures and all outcomes considered. Our phenome-wide analysis highlighted a broad range of individual traits were associated with testing, which were distinct across time-periods. InterpretationThe association between SEP (and indeed many individual traits) and SARS-CoV-2 testing changed over time, indicating time-specific selection pressures in COVID-19. However, positive, and negative control analyses suggest that changes in the magnitude of the association between SEP and SARS-CoV-2 infection over time were unlikely to be explained by selection bias and reflect true increases in socioeconomic inequalities. FundingUniversity of Bristol; UK Medical Research Council; British Heart Foundation; European Union Horizon 2020; Wellcome Trust and The Royal Society; National Institute of Health Research; UK Economic and Social Research Council

BackgroundMissing data may induce bias when analysing longitudinal population surveys. We aimed to tackle this problem in the 1970 British Cohort Study (BCS70) MethodsWe utilised a data-driven approach to address missing data issues in BCS70. Our method consisted of a 3-step process to identify important predictors of non-response from a pool of [~]20,000 variables from 9 sweeps in 18037 individuals. We used parametric regression models to identify a moderate set of variables (predictors of non-response) that can be used as auxiliary variables in principled methods of missing data handling to restore baseline sample representativeness. ResultsIndividuals from disadvantaged socio-economic backgrounds, increased number of older siblings, non-response at previous sweeps and ethnic minority background were consistently associated with non-response in BCS70 at both early (ages 5-16) and later sweeps (ages 26-46). Country of birth, parents not being married and higher fathers age at completion of education were additional consistent predictors of non-response only at early sweeps. Moreover, being male, greater number of household moves, low cognitive ability, and non-participation in the UK 1997 elections were additional consistent predictors of non-response only at later sweeps. Using this information, we were able to restore sample representativeness, as we could replicate the original sample distribution of fathers social class and cognitive ability and reduce the bias due to missing data in the relationship between fathers socioeconomic status and mortality. ConclusionsWe provide a set of variables that researchers can utilise as auxiliary variables to address missing data issues in BCS70 and restore sample representativeness. Key MessagesO_LIWe aimed to address the problem of missing data in the 1970 British Cohort Study (BCS70) caused by non-response at different sweeps C_LIO_LIWe identified a set of predictors of non-response that can successfully restore baseline sample representativeness across sweeps C_LIO_LIThe information from this study can be used from researchers in the future to utilise appropriate auxiliary variables to tackle problems due to missing data in BCS70 C_LI

IntroductionSocioeconomic position has been strongly associated with cardiovascular health. However, little is known about the short-term health impacts of socioeconomic exposures during early adulthood. In this study we describe distinct socioeconomic trajectories of early adulthood (age 16-24y), and assess associations of these trajectories with measures of cardiometabolic health at age 24y. MethodsParticipants of the Avon Longitudinal Study of Parents and Children (ALSPAC), with data across age 16y to 24y (2007-2017) were included (n=7,568). Longitudinal latent class analysis identified socioeconomic trajectories, based on education and employment data across ages 16-24y. Cardiometabolic outcomes at age 24y comprised anthropometric, vascular, metabolic and cardiovascular structure and function measures. We modelled differences in cardiometabolic outcomes at age 24y across the socioeconomic trajectory classes, adjusting for childhood socioeconomic position, adolescent health behaviours and adolescent health. ResultsFour early adulthood socioeconomic trajectories were identified: (1) Higher Education (41% of the population), (2) Extended Education (9%), (3) Part-Time Employment (21%), and (4) Early Employment (29%). Associations between socioeconomic trajectory and cardiometabolic outcomes differed by sex. Among males, the Higher Education and Extended Education classes showed a healthier cardiometabolic profile, and the Part-time Employment class the least healthy. Among females there was less clear distinction between the classes, and the pattern across different outcomes was not consistent. ConclusionThe newly identified Part-time Employment class showed the least healthy cardiometabolic profile, and further research should focus on this group to understand the exposures contributing to poor cardiometabolic health in this sector of the population.

BackgroundUN Sustainable Development Goal 1.2 targets a 50% reduction in childhood poverty by 2030. This study explores the potential impact of such a reduction in Denmark on (1) the distribution of individuals over trajectories of childhood adversity and (2) social vulnerability (mental health, crime and social benefits) in young adulthood. MethodsWe included 607,308 individuals born in Denmark (1987-1996). Childhood poverty was defined as an annual equivalized disposable income below 50% of the national median. Using group-based multi-trajectory modeling, five childhood adversity groups were previously identified based on 12 adversities (including poverty) over three dimensions from ages 0-15. A 50% annual poverty reduction was simulated, and individuals were reassigned to adversity groups. Social vulnerability (ages 16-24) was measured using three binary indicators: mental health problems, crime conviction, and long-term social benefit use. Using G-computation, we estimated how the reassignment to adversity groups affected each outcome. FindingsOf those affected by the simulated poverty reduction, 32% changed adversity group. This resulted in a modest decrease in social vulnerability among these individuals: 11.6 fewer crime convictions (CI95%: 10.9-12.2), 12.6 fewer long-term benefit recipients (CI95%: 12.0-13.2), and 7.0 fewer mental health cases (CI95%: 6.2-7.8) per 1,000 individuals. Population-wide risk differences were smaller (1-2 cases per 1,000 individuals). InterpretationReducing childhood poverty may lower social vulnerability in young adulthood, but it needs to be integrated with broader, multifaceted approaches that support children facing multiple, clustered adversities while growing up and as they transition to adulthood. FundingEuropean Research Council (ERC) (Grant agreement No. 101124807). The Copenhagen Health Complexity center is funded by TrygFonden.

BackgroundLife expectancy at birth in Mexico has stagnated since the early 2000s. As the COVID-19 pandemic hit, Mexico experienced sizable excess mortality, albeit with large regional variation. We aimed to assess the contribution of violence, COVID-19, and causes of death amenable to healthcare to life expectancy changes between 2015 and 2021 in Mexico. MethodsWe used administrative mortality data by causes of death, and adjusted population exposures from the National Population Council. We applied demographic decomposition methods to assess life expectancy changes at the subnational level, by year and sex. FindingsLife expectancy between 2015 and 2019 declined from 71.8 to 71.1 years for males and stagnated at 77.6 years for females. Violence among young males accounted for 54.3% of life expectancy losses. Between 2019 and 2020, life expectancy decreased by 7.1 and 4.4 years for males and females, respectively. COVID-19 deaths accounted for 55.4% (males) and 57.7% (females). In 2021, male life expectancy stagnated at 64.1 years due to reductions in deaths due to amenable diseases but continued increasing for females by 0.44 years mainly due to reductions in COVID-19 deaths. InterpretationWe document large variations in life expectancy losses across Mexican states, which are associated with preexistent high levels of violence, and socioeconomic disadvantages across geographical areas. Our results serve as a reminder that violence has negative health implications for both sexes and that COVID-19 affected more socially disadvantaged states. FundingSupport from the Netherlands Interdisciplinary Demographic Institute-KNAW, AXA Research Fund, Economic and Social Research Council, and European Unions Horizon 2020 Research and Innovation. Research in context.O_ST_ABSEvidence before this studyC_ST_ABSWe searched for studies in English and Spanish that analyzed life expectancy losses in Mexico before and during the COVID-19 pandemic in PubMed. Most studies that assessed life expectancy during the COVID-19 rely on all-cause mortality and indirect demographic methods. We also identified studies on causes of death, those focused on age-standardized mortality or excess deaths, but as of April 2024, we did not find articles assessing the impact of multiple causes of death on life expectancy. Added value of this studyTo our knowledge, this is the first study to assess the impact of different causes of death on life expectancy before and during the COVID-19 pandemic at the subnational level and by sex in Mexico. We focus on the main causes of death including COVID-19, homicides, and causes amenable to health care (e.g. diabetes). Our findings reveal that before the COVID-19 pandemic (2015-2019) life expectancy decreased for males and remained the same for females. During 2019-2020 life expectancy decreased sharply for both males and females, while in the subsequent years (2020-2021), life expectancy roughly remained the same for males, and continued decreasing for females. Most of the life expectancy losses before the pandemic for males were due to violence and homicides, while since 2020 they were due to COVID-19, but diabetes and causes of death amenable to health care also contributed to reduced life expectancy. Life expectancy losses were unevenly distributed at the subnational level, states from southern and central Mexico experienced the largest life expectancy losses compared to states from north of Mexico. Implications of all the available evidenceThis study contributes to understanding life expectancy changes before and during the COVID-19 pandemic years. By quantifying life expectancy losses we uncover the unequal and devastating impact of the pandemic at the subnational level in Mexico. Moreover, our results highlight the continued failure on reducing homicides and violence in the country.

BackgroundThere is a growing concern about the increasing number of young people who are not in employment, education or training (NEET) globally. This study investigates the impact of concurrent cognitive and socioemotional development trajectories in childhood on NEET status in adolescence in a UK cohort. MethodWe analysed longitudinal data on 8,368 children from the UK Millennium Cohort Study. Exposure trajectories of cognitive and socioemotional development from age 3 to 14 years were characterised using group-based multi-trajectory models. We used Poisson regression to examine associations between developmental trajectories and NEET status at age 17, adjusting for confounders. Population-attributable fractions were estimated to quantify NEET proportions attributable to the developmental problems. ResultsAt age 17, 3.5% of participants were NEET; of which about one-third (38%) were not economically active. Children with persistent cognitive and socioemotional development problems had a fourfold increased risk of being NEET (adjusted risk ratio [ARR] 4.0; 95% CI 2.5-6.3), and those with late socioemotional problems had threefold increased risk (3.3; 95% CI 2.2-4.9), compared to children in the no problem group. Early and resolving socioemotional and cognitive problems were not associated with being NEET. An estimated 28% (95% CI 18% to 36%) of NEET cases were attributable to cognitive and socioemotional behaviour problems in childhood. ConclusionChildhood cognitive and socioemotional development play a critical role in shaping pathways to education and employment in adolescence. Thus, policies and strategies aiming to reduce NEET should target early social and emotional skills, alongside efforts to support academic achievement. Strengths and limitations of this study{blacksquare} The study uses longitudinal data from a contemporary and representative cohort of UK children. {blacksquare}The study combines measures of cognitive ability and socioemotional behaviour during childhood, and evaluates the joint effects on youth NEET status {blacksquare}A major limitation was inability to capture transitions in the NEET status as it was measured at a single time point {blacksquare}As with most longitudinal cohort studies, missing data is inevitable and hence a challenge for analysis.

ImportanceIndividuals who have been sexually abused are at a greater risk for poor health, but associations with economic outcomes in mid-life have been overlooked. ObjectivesWe investigated associations between child sexual abuse ([≤]18 years) and economic outcomes at 33-37 years, while considering type of report (official/retrospective) and characteristics of abuse (type, severity, and chronicity). DesignThis cohort study used data collected for the Quebec Longitudinal Study of Kindergarten Children. SettingThe Quebec Longitudinal Study of Kindergarten Children is a population-based sample. ParticipantsParticipants were 3,020 boys and girls attending kindergarten in the Canadian Province of Quebec in 1986/88 and followed up until 2017. Main outcome/MeasuresChild sexual abuse (0-18 years old) was assessed using both retrospective self-report questionnaires and objective reports (notification to Child Protection Services). Information on employment earnings was obtained from government tax return records. Tobit regressions were used to test associations of sexual abuse with earnings adjusting for sex and family socioeconomic background. ResultsOf the 3,020 participants 1,320 [43.7%] self-reported no sexual abuse, 1,340 [44.3%] had no official report but were missing on the retrospective questionnaire, 340 [11.3%] reported retrospective sexual abuse, and 20 [0.7%] had official report. In the fully adjusted model, individuals who retrospectively reported being sexually abused earned US$4,031 (CI=-7,134 to -931) less per year at age 33-37 years, while those with official reports earned US$16,042 (CI=-27,465 to -4,618) less, compared to participants who were not abused. Among individuals with retrospectively reported abuse, those who experienced intra-familial abuse earned US$4,696 (CI=-9,316 to -75) less than individuals who experienced extra-familial abuse, while participants who experienced penetration earned US$6,188 (CI=-12,248 to -129) less than those who experienced non-contact abuse. Conclusion and RelevanceChild sexual abuse puts individuals at risk for lasting reductions in employment earnings in adulthood. Early identification and support for sexual abuse victims could help reduce the economic gap and improve long-term outcomes. Key PointsO_ST_ABSQuestionC_ST_ABSIs child sexual abuse associated with lower mid-life employment earnings? FindingsIn a large population-based cohort (n=3,020), children exposed to sexual abuse had lower annual employment earnings from age 33-37 years than children nonexposed, after adjustment for childhood socioeconomic circumstances. These differences were more pronounced for individuals with official Child Protection Service reports compared to those with retrospective reports, and for individuals who experienced more severe forms of sexual abuse (i.e., penetration, intra-familial). MeaningChildren exposed to sexual abuse are at risk of poor socioeconomic outcomes in mid-adulthood; interventions and support to improve long-term economic participation should be considered.

BackgroundNeighbourhood environments may influence cardiovascular disease (CVD) risk, e.g. by influencing diet and physical activity (PA) behaviours. We explored whether associations between characteristics of neighbourhood environments and CVD are modified by area deprivation and household income. If effects of neighbourhood risk exposures vary by socioeconomic position, efforts to improve population health by improving neighbourhood built environments could widen health inequalities. MethodsIn the UK Biobank cohort we used linked records of hospital admissions to assess the relative hazard of being admitted to hospital with a primary diagnosis of CVD according to three characteristics of the neighbourhood built environment: availability of formal PA facilities, proximity of a takeaway/fast-food store, and neighbourhood greenspace. We then examined potential effect modification of the main associations by household income and area deprivation. We used Cox proportional hazards models, adjusted for likely confounding, and calculated relative excess risks due to interaction (RERI) to assess effect modification on the additive scale. We also examined the combined modifying role of income and deprivation. ResultsThere were 13,809 incident CVD admissions in the sample (mean follow-up=6.8 years). Overall associations between neighbourhood exposures and CVD-related hospital admissions were weak to null. However, there was evidence of effect modification by both area deprivation and household income. Greater availability of PA facilities near home was associated with lower risk of CVD-related admission in more deprived areas, but only among people in higher-income households. Area deprivation and household income both modified the association with fast-food proximity. More greenspace was not associated with lower risk of CVD-related admission for any group. Some results differed between women and men. Findings were largely robust to alternative model specifications. ConclusionsImproving deprived neighbourhoods by increasing the number of PA facilities, while also ensuring access to these is free or affordable, may improve population health. Examining effect modification by multiple socioeconomic indicators in parallel can yield deeper insight into how different aspects of the peoples socioeconomic conditions influence their relationship with the built environment and its effects on their health. Improved understanding may help to avoid generating or perpetuating health inequalities when neighbourhood-based built environment interventions are designed.

This study investigated the wellbeing of UK police officers transitioning out of service, examining retirees, early leavers, and those within 12 months of retirement (N = 370). Using the Job Demands-Resources model, the research identifies a wellbeing paradox: leavers demonstrate high resilience and subjective wellbeing alongside significantly elevated psychological distress compared to general population norms. Findings reveal that recently retired ([≤]5 years) and soon-to-retire groups are particularly vulnerable, reporting lower quality of life and higher distress than long-term retirees. Perceived organisational support and resilience emerged as critical buffers against the psychological burden of a policing career. However, participants identified significant unmet needs for career, financial, and mental health guidance during the transition. The study highlights that the anticipatory retirement period is an acute window of vulnerability, suggesting that proactive, targeted organisational interventions are essential to mitigate the lasting psychological burden of policing and ensure successful civilian transitions.