Pathways linking combinations of early-life adversities to adult mortality: Tales that vary by gender.

Rationale: Socioeconomic disadvantage, family instability, and abuse are widely studied early-life adversities (ELAs) that may co-occur in the lives of many. The detrimental effects of these adversities may result in elevated risk of mortality in midlife and old age.

Objective: We investigate how combinations of these three ELAs affect later-life mortality and the life-course mediators that explain the associations.

Method: Data come from the first two waves of the Midlife in the United States (MIDUS) study and mortality records over a 20-year period (1995/96-2015). We used latent class analysis (LCA) to identify patterns of ELAs across the three domains and incorporated four life-course mediators: material, psychological, social resources, healthy lifestyle and substance abuse.

Results: LCA yielded six distinct combinations of ELAs, with patterns of socioeconomic status (SES) and abuse being most salient. We found that childhood abuse exists across all levels of childhood SES. For both genders, individuals who experienced low SES combined with frequent abuse have the highest risk of death. For women but not men, frequent abuse increases the risk of mortality even if they grew up in middle or high SES families. For both genders, material resource is a significant contributor on the pathway from ELAs to mortality. Life-course mediators partially accounted for the observed associations between ELAs and mortality, but attenuation was stronger for men than women. This is partially attributed to the stronger direct effects of life-course resources on mortality for men than women.

Conclusions: Our findings suggest that ELAs are an important determinant of mortality in midlife and old age. Traumatic experiences during the critical period of early life may compromise later-life heath more for women than men.