Early life conditions of overall and cause-specific mortality among inner-city African Americans

Objectives. We examined how early life conditions influence midlife overall and cause-specific mortality in a community cohort of disadvantaged African Americans. Methods. Using a prospective design, we assessed first-grade children and their teachers and families when children were 6 years old, with follow-up at ages 16, 32, and 42 years. We obtained information on death from family members, neighbors, and the National Death Index (NDI). We conducted a survival analysis and competing risk analysis to examine early life predictors of mortality. Results. Of 1242 participants, 87 (7%) had died by 2004. In multivariate Cox proportional hazards regression, males who lived in foster care and females with lower math grades in first grade were more likely to die by age 42 years. In multivariate competing risks analysis, hospitalization by the time of first grade was related to mortality from acute and chronic illness. Male gender, being in foster care, and aggressive behavior in first grade were related to mortality from drug use, violence, or suicide. Conclusions. Early classroom, environmental, and family-level interventions are potentially beneficial in reducing later overall and cause-specific mortality.