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. 2017 Dec 28;17(1):980.
doi: 10.1186/s12889-017-4990-4.

Adolescent reserve capacity, socioeconomic status and school achievement as predictors of mortality in Finland - a longitudinal study

Paulyn Jean Acacio-Claro  1 , Leena Kristiina Koivusilta  2 , Judith Rafaelita Borja  3 , Arja Hannele Rimpelä  4   5   6
Affiliations

Adolescent reserve capacity, socioeconomic status and school achievement as predictors of mortality in Finland - a longitudinal study

Paulyn Jean Acacio-Claro et al. BMC Public Health. .

Abstract

Background: Despite robust evidence on the inverse relationship between socioeconomic status (SES) and mortality, deviations from expected results have been observed likely due to school achievement and psychosocial resources, termed as "reserve capacity." Since adolescence is a critical period in developing sound psychological and behavioural patterns and adolescent markers of SES were seldom used, we determine if family SES in adolescence predicts later mortality. We also study how reserve capacity (perceived health, health-promoting behaviour and social support) and school achievement modify this relationship and reduce the negative effects of low SES.

Methods: A longitudinal study was designed by linking baseline data on 12 to 18 year-old Finns in 1985-95 (N = 41,833) from the Adolescent Health and Lifestyle Surveys with register data on mortality and SES from Statistics Finland. Average follow-up time was 18.4 years with a total of 770,161 person-years. Cox regression models, stratified by sex, were fitted to determine the effects of variables measured during adolescence: family SES, reserve capacity and school achievement on mortality risk.

Results: All reserve capacity dimensions significantly predicted mortality in boys. Perceived health and social support predicted that in girls. Adolescents with the lowest school achievement were more than twice at risk of dying compared to those with better school performance. Low SES increased the risk of death in boys (Hazard ratios: 1.6, 95% CI 1.1-2.4) but not in girls. Reserve capacity and school achievement weakened the effects of low SES on boys' risk of death.

Conclusions: High reserve capacity and good school achievement in adolescence significantly reduce the risk of mortality. In boys, these also mitigate the negative effect of low SES on mortality. These findings underscore the roles of reserve capacity and school achievement during adolescence as likely causal or modifying factors in SES-health inequalities.

Keywords: Life course epidemiology; Mortality; Psychosocial resources; Reserve capacity; Socioeconomic status.

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Conflict of interest statement

Ethics approval and consent to participate

Statistics Finland performed the data linkage of the national registries and the data of the Adolescent Health and Lifestyle Surveys (AHLS) from the years 1979–1997 according to a contract specifying the rights and duties of both parties. The study protocol was approved by its Institutional Review Board and the Data Protection Ombudsman. The Joint Commission on Ethics of the University of Turku and the Turku University Hospital stated that no human rights were violated in the research protocol and approved it. Identification of the study participants was withheld from the investigators at all stages of the study. The survey data used in the study were gathered in 1979–1997. The first review boards at the universities were established in Finland in the 1980s. AHLS was reviewed by the Ethical Review Board of the University of Helsinki, Department of Public Health in 1986. Parental consent was not considered by the ethics review board at that time. In later surveys, the latest in 2017, the relevant review boards have waived the parental consent for the now adult participants and the consent of the participants was assumed upon return of the completed questionnaire.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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