RESUMO
Demographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study (N = 5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.69, 0.92), but childhood SES was not (OR = 1.03, 95% CI = 0.94, 1.13). Identifying as Black/African American (OR = 0.56, 95% CI = 0.40, 0.80) was associated with lower odds, and identifying as female (OR = 7.22, 95% CI = 5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
RESUMO
Chronic stress from social/environmental pressures has been proposed to affect bone health through increased inflammation. We demonstrate that inflammation from prolonged stress does not cause changes to bone health through inflammation but instead impacts access to health care, social inequalities, and overall health, which in turn impact bone health. PURPOSE: The study provides a comprehensive assessment of how determinants of health across demographic, psychological, mobility-related, health, environmental, and economic domains are associated with the diagnosis of osteoporosis and tests three hypotheses: (1) a diverse set of variables across domains will predict osteoporosis, (2) chronic inflammation as a result of stress (represented by high-sensitivity C-reactive protein) will not be associated with osteoporosis, and (3) the model developed will have high accuracy in predicting osteoporosis. METHODS: Logistic regression and Cox proportional hazards models of osteoporosis diagnosis were estimated using data from 14,792 and 13,169 participants (depending on model) in the 2012-2016 waves of the Health and Retirement Study, including the Biomarker Study, the Contextual Data Resource, and validated measures of childhood socioeconomic status. Predictive accuracy was assessed using k-Nearest Neighbors Discriminant Analysis. RESULTS: Demographic, environmental, and health-related factors were associated with osteoporosis diagnosis, and predictive accuracy of the models was good. High-sensitivity C-reactive protein was not associated with osteoporosis diagnosis. CONCLUSION: Social determinants identified indicate access to health care, inequalities in the greater social environment (e.g., access to resources), and overall health (i.e., underlying medical conditions) are key components for developing osteoporosis and indicate underlying health inequities in this sample. There is a need to further address the interplay between primary health care and social determinants of health.
