- Open Access
Implications of Lifecourse Epidemiology for Research on Determinants of Adult Disease
Public Health Reviews volume 32, pages489–511 (2010)
Many diseases commonly associated with aging are now thought to have social and physiologic antecedents in early life. Understanding how the timing of exposure to early life risk factors influences later-life health may illuminate mechanisms driving adult health inequalities and identify possible points for effective interventions. Recognizing chronic diseases as developing across the lifecourse also has implications for the conduct of research on adult risk factors for disease. We review alternative conceptual models that describe how the timing of risk factor exposure relates to the development of disease. We propose some expansions of lifecourse models to improve their relevance for research on adult chronic disease, using the relationship between education and adult cognitive decline and dementia as an example. We discuss the important implications each of the lifecourse conceptual models has on study design, analysis, and interpretation of research on aging and chronic diseases. We summarize several research considerations implied by the lifecourse framework, including: advantages of analyzing change in function rather than onset of impairment; the pervasive challenge of survivor bias; the importance of controlling for possible confounding by early life conditions; and the likely heterogeneity in responses of adults to treatment.
Barker DJ, Martyn C. The maternal and fetal origins of cardiovascular disease. J Epidemiol Community Health. 1992;46:8–11.
Kuh D, Ben-Shlomo Y, (editors). A lifecourse approach to chronic disease epidemiology: Tracing the origins of ill-health from early to adult life. Oxford (UK): Oxford University Press; 1997.
Power C, Hertzman C. Social and biological pathways linking early life and adult disease. Br Med Bull. 1997;53:21—22.
Galobardes B, Smith GD, Lynch JW. Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. Ann Epidemiol. 2006;16:91–104.
Galobardes B, Lynch JW, Smith GD. Childhood socioeconomic circumstances and cause-specific mortality in adulthood: Systematic review and interpretation. Epidemiol Rev. 2004;26:7–21.
Pollitt RA, Rose KM, Kaufman JS. Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review. BMC Public Health. 2005;5:7.
Berkman LF. Social epidemiology: Social determinants of health in the United States: Are we losing ground? Ann Rev Public Health. 2009;30:27–41.
Wilson RS, Hebert LE, Scherr PA, et al. Educational attainment and cognitive decline in old age. Neurology. 2009;72:460.
Alley D, Suthers K, Crimmins E. Education and cognitive decline in older Americans: Results from the AHEAD sample. Res Aging. 2007;29:73–94.
Karlamangla AS, Miller-Martinez D, Aneshensel CS, Seeman TE, Wight RG, Chodosh J. Trajectories of cognitive function in late life in the United States: Demographic and socioeconomic predictors. Am J Epidemiol. 2009;170:331–42.
Stern C, Munn Z. Cognitive leisure activities and their role in preventing dementia: a systematic review. Int J Evid Based Healthc. 2010;8:2–17.
Whalley LJ, Dick FD, McNeill G. A life-course approach to the aetiology of late-onset dementias. Lancet Neurol. 2006;5:87–96.
Glymour MM, Manly JJ. Lifecourse social conditions and racial and ethnic patterns of cognitive aging. Neuropsychol Rev. 2008;18:223–54.
Singh-Manoux A, Richards M, Marmot M. Socioeconomic position across the lifecourse: How does it relate to cognitive function in mid-life? Ann Epidemiol. 2005;15:572–8.
Turrell G, Lynch JW, Kaplan GA, Everson SA, Helkala EL, Kauhanen J, Salonen JT. Socioeconomic position across the lifecourse and cognitive function in late middle age. J Gerontology B Psychol Sci Soc Sci. 2002;57:S43–51.
Wadsworth M. Health inequalities in the life course perspective. Soc Sci Med. 1997;44:859–69.
Pearl J. Causality. Cambridge (UK): Cambridge University Press; 2000.
Kraemer H, Kazdin A, Offord D, Kessler RC, Jensen PS, Kupfer DJ. Coming to terms with the terms of risk. Arch Gen Psychiatry. 1997;54:337.
McEwen BS. Stress, adaptation, and disease: Allostasis and allostatic load. In: McCann SM, Lipton JM, (editors). Annals of the New York Academy of Sciences, Vol 840: Neuroimmunomodulation: Molecular aspects, integrative systems, and clinical advances. New York (NY): New York Academy of Sciences; 1998. p.33–44.
Seeman T, Epel E, Grueewald T, Karlamangla A, McEwen BS. Socio-economic differentials in peripheral biology: Cumulative allostatic load. Ann N Y Acad Sci. 2010;1186:223–39.
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec:80–94.
Cowell AJ. The relationship between education and health behavior: some empirical evidence. Health Econ. 2006;15:125–46.
Gilman SE, Martin LT, Abrams DB, Kawachi I, Kubzansky L, Loucks EB, et al. Educational attainment and cigarette smoking: a causal association? Int J Epidemiol. 2008;37:615–24.
Barker DJ. The fetal and infant origins of adult disease. BMJ. 1990;301:1111.
Barker DJP, Lackland DT. Prenatal influences on stroke mortality in England and Wales. Stroke. 2003;34:1598–602.
Fox S, Levitt P, Nelson III C. How the Timing and Quality of Early Experiences Influence the Development of Brain Architecture. Child Dev. 2010;81:28–40.
Gale CR, O’Callaghan FJ, Godfrey KM, Law CM, Martyn CN. Critical periods of brain growth and cognitive function in children. Brain. 2004;127:321–9.
Meaney MJ, Bhatnagar S, Larocque S, McCormick CM, Shanks N, Sharma S, et al. Early environment and the development of individual differences in the hypothalamic-pituitary-adrenal stress response. In: Pfeffer CR, (editor). Severe stress and mental disturbance in children. Washington (DC): American Psychiatric Press, Inc: 1996. p.85–127.
Meaney MJ, Aitken DH, Bodnoff SR, Iny LJ, Sapolsky RM. The effects of postnatal handling on the development of the glucocorticoid receptor systems and stress recovery in the rat. Prog Neuropsychopharmacol Biol Psychiatry. 1985;9:731–4.
Wang C. Beyond frequencies and coefficients — toward meaningful descriptions for life course epidemiology. Am J Epidemiol. 2006;164:122–5.
Pampel FC. The Persistence of Educational Disparities in Smoking. Soc Problems. 2009;56:526–42.
Doupe A, Kuhl P. Birdsong and human speech: Common themes and mechanisms. Ann Rev Neurosci. 1999;22:567–631.
Roshania R, Narayan K, Oza-Frank R. Age at arrival and risk of obesity among US immigrants. Obesity. 2008;16:2669–75.
Wilkinson A, Spitz M, Strom S, Prokhorov AV, Barcenas CH, Cao Y, et al. Effects of nativity, age at migration, and acculturation on smoking among adult Houston residents of Mexican descent. Am J Public Health. 2005;95:1–43.
Mayer KU. New directions in life course research. Ann Rev Sociol. 2009;35: 413–33.
Robert CW, William HD. Role of the prenatal environment in the development of obesity. J Pediatr. 1998;132:768–76.
Stettler N, Kumanyika SK, Katz SH, Zemel BS, Stallings VA. Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans. Am J Clin Nutr. 2003;77:1374–8.
Hallqvist J, Lynch J, Bartley M, Lang T, Blane D. Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Soc Sci Med. 2004;58:1555–62.
Glymour MM. Commentary: Selected samples and nebulous measures: Some methodological difficulties in life-course epidemiology. Int J Epidemiol. 2007;36:566–8.
Rosvall M, Chaix B, Lynch J, Lindström M, Merlo J. Similar support for three different life course socioeconomic models on predicting premature cardiovascular mortality and all-cause mortality. BMC Public Health. 2006;6:2–3.
Tu YK, West R, Ellison GTH, Gilthorpe MS. Why evidence for the fetal origins of adult disease might be a statistical artifact: The “reversal paradox” for the relation between birth weight and blood pressure in later life. Am J Epidemiol. 2005;161:27–32.
Tu Y, Woolston A, Baxter P, Gilthorpe MS. Assessing the impact of body size in childhood and adolescence on blood pressure: an application of partial least squares regression. Epidemiology. 2010;21:440.
Winship C, Harding D. A mechanism-based approach to the identification of age-period-cohort models. Soc Meth Res. 2008;36:362.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34:939.
Hachinski V. Shifts in thinking about dementia. JAMA. 2008;300:2172–3.
Jorm A. A method for measuring dementia as a continuum in community surveys. In: Huppert FA, Brayne C, O’Connor DW, (editors). Dementia and normal aging. Cambridge (UK): Cambridge University Press; 1994. p.244–53.
McGuire LC, Ford ES, Ajani UA. Cognitive Functioning as a Predictor of Functional Disability in Later Life. Am J Geriatric Psych. 2006;14:36–42.
St John PD, Montgomery PR, Kristjansson B, McDowell I. Cognitive scores, even within the normal range, predict death and institutionalization. Age Ageing. 2002;31:373–8.
Altman DG. Categorizing continuous variables. John Wiley & Sons, Ltd; 2005.
Van der Weele TJ, Robins JM. Directed acyclic graphs, sufficient causes, and the properties of conditioning on a common effect. Am J Epidemiol. 2007;166:1–96.
Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology. 1999;10:37–48.
Hernán MA, Hernandez-Diaz S, Robins JM. A structural approach to selection bias. Epidemiology. 2004;15:615–25.
Glymour MM, Greenland S. Causal Diagrams. In: Rothman KJ, Greenland S, Lash TL, (editors). Modern epidemiology. Philadelphia (PA): Lippincott Williams & Wilkins; 2008. p.183–210.
Van de Mheen H, Stronks K, Looman C, Mackenbach JP. Does childhood socioeconomic status influence adult health through behavioural factors? Int J Epidemiol. 1998;27:431.
Lynch J, Kaplan G, Salonen J. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997;44:809–19.
Melchior M, Moffitt T, Milne B, Poulton R, Caspi A. Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study. Am J Epidemiol. 2007;166:966–74.
Goodman E, McEwen B, Huang B, Dolan LM, Adler NE. Social inequalities in biomarkers of cardiovascular risk in adolescence. Psychosom Med. 2005;67:9.
Loucks E, Pilote L, Lynch J, et al. Life course socioeconomic position is associated with inflammatory markers: The Framingham Offspring Study. Social Science & Medicine 2010.
Dufouil C, Alperovitch A, Tzourio C. Influence of education on the relationship between white matter lesions and cognition. Neurology. 2003;60:831–6.
Guralnik JM, Kritchevsky SB. Translating Research to Promote Healthy Aging: The Complementary Role of Longitudinal Studies and Clinical Trials. J Am Geriatr Soc. 2010;58:S337–42.
Ashenfelter O, Rouse C. Schooling, intelligence and income in America: Cracks in the bell curve. NBER Working Paper 1999;69–2.
Glymour MM, Kawachi I, Jencks CS, Berkman LF. Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments. J Epidemiol Community Health. 2008;62:532–7.
Crone DA, Whitehurst GJ. Age and schooling effects on emergent literacy and early reading skills. J Educational Psychol. 1999;91:604–14.
Gorey KM. Early childhood education: A meta-analytic affirmation of the short- and long-term benefits of educational opportunity. School Psychol Q. 2001;16:9–30.
Darling-Hammond L. Cracks in the Bell Curve: How Education Matters. J Negro Education. 1995;64:340–53.
Finkel D, Reynolds CA, McArdle JJ, Pedersen NL. Cohort differences in trajectories of cognitive aging. J Gerontol B Psychol Sci Soc Sci. 2007;62:P286–94.
Karlamangla AS, Miller-Martinez D, Aneshensel CS, Seeman TE, Wight RG, Chodosh J. Trajectories of Cognitive Function in Late Life in the United States: Demographic and Socioeconomic Predictors. Am J Epidemiol. 2009;170:331–42.
Schaie K. What can we learn from longitudinal studies of adult development? Res Human Develop. 2005;2:133–58.
Faul J. The effect of lifecourse socioeconomic position and health of trajectories of cognitive function in older adults. Ann Arbor (MI): University of Michigan; 2010.
Salthouse TA. When does age-related cognitive decline begin? Neurobiology Aging. 2009;30:507–14.
Nikolova R, Demers L, Béland F. Trajectories of cognitive decline and functional status in the frail older adults. Arch Gerontol Geriatr. 2009;48:28–34.
Yaffe K, Lindquist K, Vittinghoff E, et al. The effect of maintaining cognition on risk of disability and death. J Am Geriatr Soc. 2010;58:889–94.
Rogers MAM, Plassman BL, Kabeto M, Barnes D, Simonsick EM, Newman A, et al. Parental Education and Late-life Dementia in the United States. J Ger Psych Neurol 2009;22(1):71.
Brayne C, Calloway P. The association of education and socioeconomic status with the Mini Mental State Examination and the clinical diagnosis of dementia in elderly people. Age & Ageing 1990;19(2):91–6.
Launer LJ, Dinkgreve MA, Jonker C, Hooijer C, Lindeboom J. Are age and education independent correlates of the Mini-Mental State Exam performance of community-dwelling elderly? J Gerontol. 1993;48:271–7.
Prencipe M, Casini AR, Ferretti C, Lattanzio MT, Fiorelli M, Culasso F. Prevalence of dementia in an elderly rural population: Effects of age, sex, and education. J Neurol Neurosurg Psychiatry. 1996;60:628–33.
Katzman R. Education and the prevalence of dementia and Alzheimer’s disease. Neurology. 1993;43:13–20.
Fratiglioni L, Grut M, Forsell Y, Viitanen M, Grafström M, Holmén K, et al. Prevalence of Alzheimer’s disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology. 1991;41:1886–92.
De Ronchi D, Fratiglioni L, Rucci P, Paternicò A, Graziani S, Dalmonte E. The effect of education on dementia occurrence in an Italian population with middle to high socioeconomic status. Neurology. 1998;50:1231–8.
Mortel KF, Meyer JS, Herod B, Thornby J. Education and occupation as risk factors for dementias of the Alzheimer and ischemic vascular types. Dementia. 1995;6:55–62.
Gatz M, Svedberg P, Pedersen NL, Mortimer JA, Berg S, Johansson B. Education and the risk of Alzheimer’s disease: findings from the study of dementia in Swedish twins. J Gerontol B Psychol Sci Soc Sci. 2001;56:292–300.
Raiha I, Kaprio J, Koskenvuo M, Rajala T, Sourander L. Environmental differences in twin pairs discordant for Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 1998;65:785–7.
Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer’s disease. JAMA. 1994;271:1004–10.
Evans DA, Hebert LE, Beckett LA, Scherr PA, Albert MS, Chown MJ, et al. Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Arch Neurol. 1997;54:1399–405.
Anstey K, Christensen H. Education, activity, health, blood pressure and apolipoprotein E as predictors of cognitive change in old age: A review. Gerontology. 2000;46:163–77.
Glymour MM, Weuve J, Berkman LF, Kawachi I, Robins JM. When is baseline adjustment useful in analyses of change? An example with education and cognitive change. Am J Epidemiol. 2005;162:267–78.
Christensen H, Hofer SM, MacKinnon AJ, Korten AE, Jorm AF, Henderson AS. Age is no kinder to the better educated: absence of an association investigated using latent growth techniques in a community sample. Psychol Med. 2001;31:15–28.
Van Dijk KRA, Van Gerven PWM, Van Boxtel MPJ, Van der Elst W, Jolles J. No protective effects of education during normal cognitive aging: results from the 6-year follow-up of the Maastricht Aging Study. Psychol Aging. 2008;23:119.
Karlamangla AS, Miller-Martinez D, Aneshensel CS, Seeman TE, Wight RG, Chodosh J. Trajectories of cognitive function in late life in the United States: demographic and socioeconomic predictors. Am J Epidemiol. 2009;170:331–42.
Yu B, Ghosh P. Joint modeling for cognitive trajectory and risk of dementia in the presence of death. Biometrics. 2010;66:294–300.
Flynn JR. The mean IQ of Americans — Massive gains 1932 to 1978. Psychol Bull. 1984;95:29–51.
Kalantar-Zadeh K, Block G, Humphreys M, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int. 2003;63:793–808.
Hernan MA, Alonso A, Logroscino G. Cigarette smoking and dementia: Potential selection bias in the elderly. Epidemiology. 2008;19:448–50.
Haneuse S, Schildcrout J, Crane P, Sonnen J, Breitner J, Larson E. Adjustment for selection bias in observational studies with application to the analysis of autopsy data. Neuroepidemiology. 2009;32:229–39.
Hernan MA, Hernandez-Diaz S, Robins JM. A structural approach to selection bias. Epidemiology. 2004;15:615–25.
Morgan SW, Christopher. Counterfactuals and causal inference: Methods and principles for social research. Cambridge (UK): Cambridge University Press; 2007.
Gabler N, Duan N, Liao D, Elmore JG, Ganiats TG, Kravitz RL. Dealing with heterogeneity of treatment effects: is the literature up to the challenge? Trials. 2009;10:43.
Kravitz RL, Duan N, Braslow J. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. Milbank Q. 2004;82:661–87.
Wang R, Lagakos SW, Ware JH, Hunter DJ, Drazen JM. Statistics in medicine — reporting of subgroup analyses in clinical trials. N Engl J Med. 2007;357:2189–94.
Terry MB, Wei Y, Esserman D. Maternal, birth, and early-life influences on adult body size in women. Am J Epidemiol. 2007;166:5–13.
Forrest CB, Riley AW. Childhood origins of adult health: A basis for life-course health policy. Health Aff. 2004;23:155–64.
Lu MK, M; Hogan, V; Jones, L; Wright, K; Halfon, N. Closing the Black-White gap in birth outcomes: A life-course approach. Ethn Dis. 2010;20(Suppl 2):62–72.
Misra DP, Guyer B, Allston A. Integrated perinatal health framework: A multiple determinants model with a life span approach. Am J Prev Med.2003;25:65–75.
Wise PH. Framework as metaphor: The promise and peril of MCH life-course perspectives. Matern Child Health J 2003;7:151–6.
U.S. Department of Health and Human Services. Rethinking MCH: The life course model as an organizing framework. October 2010. USDHHS Health Resources and Services Adminsitration Maternal and Child Health Bureau.
Lemere C, Masliah E. Can Alzheimer disease be prevented by amyloid- immunotherapy? Nature Rev Neurol. 2010;6:108–19.
Carlson MC, Erickson KI, Kramer AF, Voss MW, Bolea N, Mielke M, et al. Evidence for neurocognitive plasticity in at-risk older adults: The experience corps program. J Gerontol A Biol Sci Med Sci. 2009;64:1275–82.
Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51:S225–39.
Wolinsky FD, Unverzagt FW, Smith DM, Jones R, Stoddard A, Tennstedt SL. The ACTIVE cognitive training trial and health-related quality of life: Protection that lasts for 5 years. J Gerontol A Biol Sci Med Sci. 2006;61:1324–9.
Recommended Citation: Liu S, Jones RN, Glymour MM. Implications of Lifecourse Epidemiology for Research on Determinants of Adult Disease. Public Health Reviews. 2-1-;32:489–511.