Life course socioeconomic position, intergenerational social mobility, and mortality among Brazilian public servants in the ELSA-Brasil cohort

This study examined whether a low socioeconomic position over the course of one's life, the accumulation of low socioeconomic position, and intergenerational social mobility are associated with all-cause mortality over a 15-year follow-up period, and whether these associations varied according to race/skin color. A prospective study was conducted with 13,652 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. The outcome was time to death from any cause. The explanatory variables were socioeconomic position in childhood (mother's schooling), adolescence (head of household's socio-occupational class), adulthood (participant's schooling and socio-occupational class), cumulative socioeconomic position, and intergenerational social mobility. Cox proportional hazards models were adjusted for sociodemographic characteristics. The mortality rate was 4.9/1,000 person-years and was higher among men, older adults, Blacks, and those with a low socioeconomic position. After adjustments, low socioeconomic position in childhood, adolescence, and adulthood remained associated with higher mortality. The greatest accumulation of low socioeconomic position across life (HR = 2.02; 95%CI: 1.64-2.48, 4th vs. 1st quartile), as well as downward and stable low educational and socio-occupational trajectories, were also associated with higher mortality. To a lesser degree, an upward socio-occupational trajectory (vs. stable high) increased the risk of death. No multiplicative interaction was found between socioeconomic position and race/skin color regarding risk of death. Lifelong exposure to socioeconomic disadvantages throughout the course of life as well as the accumulation of adverse social experiences and unfavorable intergenerational educational and socio-occupational mobility, increased the risk of mortality, demonstrating the long-term effect of a low socioeconomic position, especially with prolonged exposure.