| Literature DB >> 29028834 |
Anusha M Vable1,2, Paola Gilsanz3,4,5, Thu T Nguyen4, Ichiro Kawachi3, M Maria Glymour3,4.
Abstract
Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992-2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was <16 years (at least 34 years prior). We assessed internal consistency reliability (Cronbach's alpha) for the scales (cSC and cFC), and construct validity, and predictive validity for all measures. Validity was assessed with hypothesized correlates of cSES (educational attainment, measured adult height, self-reported childhood health, childhood learning problems, childhood drug and alcohol problems). We then compared the performance of our validated measures with other indices used in HRS in predicting self-rated health and number of depressive symptoms, measured in 2010. Internal consistency reliability was acceptable (cSC = 0.63, cFC = 0.61). Most measures were associated with hypothesized correlates (for example, the association between educational attainment and cSC was 0.01, p < 0.0001), with the exception that measured height was not associated with cFC (p = 0.19) and childhood drug and alcohol problems (p = 0.41), and childhood learning problems (p = 0.12) were not associated with cHC. Our measures explained slightly more variability in self-rated health (adjusted R2 = 0.07 vs. <0.06) and number of depressive symptoms (adjusted R2 > 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes.Entities:
Mesh:
Year: 2017 PMID: 29028834 PMCID: PMC5640422 DOI: 10.1371/journal.pone.0185898
Source DB: PubMed Journal: PLoS One ISSN: 1932-6203 Impact factor: 3.240
Fig 1Options for modelling the relationship between SES and Health.
There are conceptual and disciplinary differences in the functional form assumed to describe the relationship between SES and health. Some researchers posit that social capital, human capital, and financial capital have common effects (i.e. are mutually exchangeable), meaning an SES index is appropriate (Fig 1a). Other researchers posit that each form of capital has a distinct effect on health, and therefore each variable should be included in regression models separately (Fig 1b). Depending on theoretical orientation and the research question, one specification may be more appropriate than another. We validate measures of childhood social capital, childhood financial capital, and childhood human capital, which can be used independently or combined into a single cSES index; we note, however, that combining the measures into an index is likely a violation of the consistency assumption for causal inference [18,19].
Fig 2Factor structure for the social capital scale.
We found that, as hypothesized, a two-factor solution best fit our data for the childhood social capital scale. Although we had limited data for some questions (i.e. number of parent figures was only available for 2.4% of the sample), through full-information confirmatory factor analysis, we were able to impute scale scores for 89.4% of our sample.
Fig 3Factor structure for the financial capital scale.
We found that a two-factor solution best fit our data for the childhood financial capital scale (we had hypothesized a one-factor solution, see S1 Fig for details). Although we had limited data for some questions (i.e. data on if the respondent’s family declared bankruptcy before at 16 was only available for 2.3% of the sample), through full-information confirmatory factor analysis, we were able to impute scale scores for 89.5% of our sample.
Fig 4Structure of human capital index.
For the childhood human capital index, data on parental education were recorded from 0–17 years for 64% of mothers and 60% of fathers, data were recorded dichotomized at 8 years for 23% of mothers and 23% of fathers, and data were missing for 13% of mothers and 17% of fathers. Through using expectation maximization (more details in S3 Table), we were able to impute continuous education information for 100% of the sample. We used expectation maximization rather than full information confirmatory factor analysis (which was used for the social and financial capital scales) because we conceptualized human capital as an index.
Fig 5Flowchart of individuals included in the achievable sample size and complete case analyses.
Internal consistency reliability of the childhood social capital, and financial capital scales.
| Scale | N | Standardized Cronbach’s alpha |
|---|---|---|
| Childhood social capital | 226 | 0.63 |
| Maternal investment | 6871 | 0.89 |
| Family structure | 595 | 0.52 |
| Childhood financial capital | 657 | 0.63 |
| Average financial resources | 664 | 0.56 |
| Financial instability | 718 | 0.74 |
Reliability is assessed among individuals who have data on all scale items; many of the questions included in the social and financial capital scales were included in experimental modules, resulting in relatively small Ns for the relatability calculation. It is not appropriate to calculate the reliability of an index, so cHC is not included in this table.
Linear regression models evaluating relationships between childhood SES domains and theoretical correlates.
| Childhood social capital | Childhood financial capital | Childhood human capital | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Predictors | N | β | p-value | N | β | p-value | N | β | p-value | |
| Childhood financial capital | 27,690 | 0.07 | <.0001 | |||||||
| Childhood human capital | 27,865 | 0.01 | 0.0241 | 27,890 | 0.21 | <.0001 | ||||
| Construct validity | Childhood drug / alcohol problems | 13,370 | -0.16 | 0.009 | 13,353 | -0.34 | <.0001 | 13,370 | 0.13 | 0.235 |
| Childhood learning problems | 16,626 | -0.11 | <.0001 | 16,606 | -0.21 | <.0001 | 16,626 | -0.05 | 0.292 | |
| Childhood self-rated health | 26,663 | -0.03 | <.0001 | 26,682 | -0.10 | <.0001 | 26,714 | -0.17 | <.0001 | |
| Predictive validity | Educational attainment | 27,804 | 0.01 | <.0001 | 27,829 | 0.04 | <.0001 | 30,677 | 0.16 | <.0001 |
| Measured height | 12,844 | 0.01 | <.0001 | 12,837 | 0.002 | 0.19 | 12,844 | 0.04 | <.0001 | |
All betas are linear regression coefficients; the row variables predicted the column variables. Childhood social, financial, and human capital, educational attainment, and measured height are coded so higher numbers reflect better properties; childhood drug / alcohol problems, learning problems, and self-rated health is coded so lower numbers reflect better properties. Childhood drug / alcohol problems, learning problems, and self-rated health were used to assess construct validity, while educational attainment and measured height were used to assess predictive validity.
Our finding that childhood financial capital is not associated with adult height is contrary to the literature on cSES and adult height. We conducted supplemental analyses to understand these discrepant findings and concluded that the observed differences are likely due to differences in the way cSES is operationalized across studies. Our results suggest that the relationship between cSES and adult height is primarily through parental education, however similar analyses should be conducted in different samples to confirm or refute these findings.
Complete case comparison of validated measures with other comprehensive measures (N = 7,783) predicting self-rated health and number of depressive symptoms.
| Self-rated health | Number of depressive symptoms | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Beta | (95%CI) | p | Adj. R2 | Beta | (95%CI) | p | Adj. R2 | ||
| Model 1 | cSES index | -0.18 | (-0.20,-0.15) | <.0001 | 0.070 | -0.25 | (-0.29,-0.21) | <.0001 | 0.049 |
| Model 2 | cSC | -0.05 | (-0.07,-0.03) | <.0001 | 0.070 | -0.12 | (-0.16,-0.09) | <.0001 | 0.050 |
| cFC | -0.06 | (-0.09,-0.04) | <.0001 | -0.11 | (-0.15,-0.07) | <.0001 | |||
| cHC | -0.15 | (-0.17,-0.12) | <.0001 | -0.15 | (-0.20,-0.10) | <.0001 | |||
| Model 3 | Maternal investment | -0.15 | (-0.23,-0.07) | 0.0002 | 0.071 | -0.32 | (-0.46,-0.18) | <.0001 | 0.050 |
| Family structure | 0.11 | (-0.16,0.37) | 0.430 | 0.07 | (-0.40,0.54) | 0.782 | |||
| Average financial resources | -0.14 | (-0.43,0.14) | 0.325 | 0.38 | (-0.12,0.89) | 0.137 | |||
| Financial instability | 0.06 | (-0.10,0.21) | 0.471 | 0.43 | (0.15,0.70) | 0.002 | |||
| Mother’s education | -0.10 | (-0.13,-0.07) | <.0001 | -0.10 | (-0.16,-0.04) | 0.0004 | |||
| Father’s education | -0.06 | (-0.09,-0.03) | 0.0003 | -0.07 | (-0.13,-0.02) | 0.018 | |||
| Luo Index | -0.14 | (-0.16,-0.12) | <.0001 | 0.060 | -0.15 | (-0.19,-0.10) | <.0001 | 0.040 | |
| Glymour Index | -0.45 | (-0.52,-0.37) | <.0001 | 0.060 | -0.46 | (-0.59,-0.32) | <.0001 | 0.039 | |
| Hargrove measures | Mother’s education ≥ 12 | -0.17 | (-0.22,-0.11) | <.0001 | 0.064 | -0.15 | (-0.25,-0.06) | 0.002 | 0.041 |
| Father’s education ≥ 12 | -0.09 | (-0.14,-0.03) | 0.002 | -0.12 | (-0.22,-0.02) | 0.020 | |||
| Self-rated poor SES | 0.09 | (0.03,0.14) | 0.002 | 0.12 | (0.02,0.22) | 0.014 | |||
| Moved for financial reasons | 0.11 | (0.05,0.17) | 0.001 | 0.23 | (0.11,0.34) | <0.0001 | |||
| Father occupation | -0.10 | (-0.17,-0.04) | 0.002 | 0.02 | (-0.10,0.13) | 0.80 | |||
Self-related health and CESD score are coded so lower numbers reflect better health.
All of the validated measures, are coded so that higher number reflect more capital; financial instability, is coded so higher numbers reflect more financial instability.
All models are adjusted for age (linear and quadratic terms), race / ethnicity, gender, and birthplace. The cSES index, cHC, cFC, cSC, Luo index, as well as, mother’s years of education, and father’s years of education in Model 3 were all z-scored so a one-unit change represents a change of 1-standard deviation.
Exclusion of the socially vulnerable in the complete case analysis induced a (non-statistically significant, p = 0.14) spurious relationship between average financial resources and number of depressive symptoms such that more financial resources predicts more depressive symptoms, which contradicts past literature. In the achievable N analysis (Table 4) the socially vulnerable are included, pushing this relationship towards the null (p = 0.55).
The change in variability explained from 0.060 (Luo and Glymour indices) to 0.070 (the cSES index, Model 1) for self-rated health represents a 17.7% increase in variability explained; such an increase in variance explained would concomitantly improve statistical power or reduce necessary sample size to detect an association. To contextualize this change in variability, a one-percentage point increase in explained variability (i.e. 0.060 to 0.070) is more than double the variability explained by age (linear and quadratic terms) and gender combined (R2 = 0.0046). Simulation results (with 10,000 repetitions) reveal that, given two measures that explain 7% of the variability in the outcome, a difference in R2 as big a 0.01 occurs 2.6% of the time when N = 7,783, indicating that this difference is statistically significant.
Comparison of validated measures with other comprehensive measures on self-rated health and number of depressive symptoms, using all available cases.
| Self-rated health | Number of depressive symptoms | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| N | Beta | (95%CI) | p | N | Beta | (95%CI) | p | ||
| Model 1 | Childhood SES Index | 15,345 | -0.19 | (-0.20,-0.17) | <.0001 | 14,181 | -0.32 | (-0.35,-0.29) | <.0001 |
| Model 2 | cSC | 15,322 | -0.06 | (-0.07,-0.04) | <.0001 | 14,166 | -0.16 | (-0.19,-0.13) | <.0001 |
| cFC | -0.06 | (-0.08,-0.05) | <.0001 | -0.14 | (-0.17,-0.10) | <.0001 | |||
| cHC | -0.16 | (-0.18,-0.14) | <.0001 | -0.19 | (-0.23,-0.15) | <.0001 | |||
| Model 3 | Maternal investment | 15,322 | -0.13 | (-0.19,-0.08) | <.0001 | 14,166 | -0.36 | (-0.46,-0.26) | <.0001 |
| Family structure | 0.004 | (-0.14,0.15) | 0.962 | -0.02 | (-0.30,0.25) | 0.870 | |||
| Average financial resources | -0.11 | (-0.32,0.10) | 0.291 | 0.12 | (-0.27,0.52) | 0.545 | |||
| Financial instability | 0.07 | (-0.04,0.18) | 0.248 | 0.34 | (0.13,0.55) | 0.002 | |||
| Mother’s education | -0.08 | (-0.11,-0.06) | <.0001 | -0.12 | (-0.16,-0.07) | <.0001 | |||
| Father’s education | -0.08 | (-0.11,-0.06) | <.0001 | -0.09 | (-0.14,-0.05) | <.0001 | |||
| Luo Index | 15,345 | -0.17 | (-0.19,-0.15) | <.0001 | 14,181 | -0.25 | (-0.28,-0.22) | <.0001 | |
| Glymour Index | 15,345 | -0.30 | (-0.36,-0.24) | <.0001 | 14,181 | -0.26 | (-0.37,-0.15) | <.0001 | |
| Hargrove measures | Mother’s education ≥ 12 | 8,248 | -0.17 | (-0.22,-0.12) | <.0001 | 7,785 | -0.15 | (-0.25,-0.05) | 0.002 |
| Father’s education ≥ 12 | -0.11 | (-0.16,-0.05) | 0.0002 | -0.12 | (-0.22,-0.02) | 0.020 | |||
| Self-rated poor SES | 0.06 | (0.01,0.11) | 0.026 | 0.12 | (0.02,0.22) | 0.014 | |||
| Moved for financial reasons | 0.11 | (0.04,0.17) | 0.001 | 0.23 | (0.11,0.34) | <.0001 | |||
| Father occupation | -0.10 | (-0.16,-0.04) | 0.002 | 0.01 | (-0.10,0.13) | 0.812 | |||
Self-related health and CESD score are coded so lower numbers reflect better health.
All of the validated measures are coded so that higher number reflect more capital; financial instability, is coded so higher numbers reflect more financial instability.
All models are adjusted for age (linear and quadratic terms), race / ethnicity, gender, and birthplace. The cSES index, cHC, cFC, cSC, Luo index, as well as, mother’s years of education, father’s years of education in Model 3 were all z-scored so a one-unit change represents a change of 1-standard deviation.