Abstract
Introduction: Different patterns of socioeconomic mobility (SEM) across the life course may influence the risk of all-cause mortality in adulthood. Lifetime low socioeconomic status and downward social mobility may be associated with a higher risk of mortality.
Hypothesis: SEM is associated with mortality, and persons with enduring intergenerational adversity or downward SEM have a higher risk of mortality compared to persons with enduring intergenerational advantage.
Methods: This study included 13,459 participants, 18-74 years of age, from the Hispanic Community Health Study/Study of Latinos who participated in the baseline visit (2008-2011) and were not missing key covariate information. Socioeconomic position (SEP) was assessed as parental education in childhood (dichotomized at high school), and a 5-facet index of SEP in adulthood across education, income, employment status, longest held occupation type, and homeownership. The adulthood SEP index was dichotomized at the median value of 2 (range: 0-5). Childhood and adulthood SEP were then combined into a single 4-level measure of SEM (enduring advantage, upward mobility, downward mobility, and enduring adversity). Multivariable sampling weight-adjusted Cox proportional hazards regression was performed to estimate the association between SEM and all-cause mortality. Potential confounders included age, gender, Hispanic/Latino ethnic background, US nativity, years spent in the US, and study center, whereas alcohol and tobacco use, depression score, and BMI were considered potential mediators. Presence of mediation was assessed by calculating total and direct effects via modeling, then evaluating percent change from total to direct effects against a 10% guideline.
Results: During the follow-up period of 2008-2019, 515 deaths were recorded. After adjusting for all potential confounders, a significant association was found between adulthood all-cause mortality and SEM overall (F = 7.62, p < 0.0001). Downward mobility had significantly higher hazard of death compared to enduring advantage (aHR: 1.81, 95% CI: 1.17-2.81), although upward mobility and enduring adversity groups were not significant. The direct effect for downward mobility was reduced after adjustment for potential mediators (aHR: 1.49, 95% CI: 0.96, 2.30).
Conclusions: Socioeconomic mobility, specifically downward mobility, is associated with all-cause mortality among a diverse cohort of Hispanic/Latino individuals residing in the United States. This association shows evidence of mediation by clinical and behavioral characteristics.