Childhood circumstances shape multimorbidity and functional limitation in the old age in England: a life course pathway model

The study presents a pathway model of the risk of multimorbidity and functional limitation from childhood to old age. Childhood circumstances, measured as parents’ social class, adverse experiences and child’s health, influenced multimorbidity and functional limitation at old age indirectly via material, psychosocial and behavioural pathways. These pathways acted as magnifiers of early inequalities: they enhanced the unequal impacts of the pre-existing differences between individuals in socio-economic position, psychological connections and health. The pathway effects measured at age 50-64 years were larger than the total effects of childhood social class, adverse experiences and child’s health. Thus pre-retirement appears to be an important period for the health of ageing adults in England. However, in people suffering from complex multimorbidity the total effect of the adverse experiences of abuse and family dysfunction in childhood surpassed the effect of adult psychosocial circumstances. This suggests an early-life sensitive period for this outcome. The strength of the paper is that childhood circumstances were approached from a broader angle than the usual focus on either the material conditions or extreme experiences of children. The framework is based on a complex mediation analysis with both parallel and serial mediators where the SEM framework with latent factors is an excellent tool to handle multiple regression relationships and measurement error.