title: Early socioeconomic position and self-rated health among civil servants in Brazil: a cross-sectional analysis from the Pró-Saúde cohort study.
abstract: OBJECTIVE
  Although there is evidence that socioeconomic conditions in adulthood are associated with worse self-rated health, the putative effect of early adverse life circumstances on adult self-rated health is not consistent. Besides, little is known on this subject in the context of middle-income countries. We aimed to investigate the association between indicators of socioeconomic position in early life and self-rated health in adulthood, taking into account the influence of current socioeconomic position.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  3339 civil servants (44.5% male) working at a public university in Rio de Janeiro, Brazil, participants of the Pró-Saúde cohort study.
  
  
  METHODS
  Through a lifecourse approach, we evaluated if seven indicators of participants' socioeconomic position earlier in life were associated with worse self-rated health in adulthood. Ordinal logistic regression analysis with a proportional odds model was used.
  
  
  RESULTS
  After adjusting for socioeconomic position in adulthood (education and income), the indicators of early socioeconomic position associated with poor self-rated health were as follows: not eating at home due to lack of money at the age of 12 (OR=1.29 95% CI 1.06 to 1.57) and having lived in a small city or rural area at the age of 12 (OR=1.51 95% CI 1.21 to 1.89).
  
  
  CONCLUSIONS
  Self-rated health was associated with two indicators of remarkable experiences of poverty in early life, even when socioeconomic conditions improved throughout life. Our findings have shown a long-term impact of extreme socioeconomic hardship during childhood and/or adolescence on the development of social inequalities in health. In terms of implications for public health, our work emphasises that health policies, usually focused on adult lifestyle interventions, should be complemented by initiatives aimed at reducing socioeconomic inequalities during the earliest stages of development, such as childhood and adolescence.
authors.affiliation: Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: Joanna Miguez Nery
authors.initials: JM
authors.lastname: Guimarães
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Guilherme Loureiro
authors.initials: GL
authors.lastname: Werneck
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Faerstein
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Lopes
authors.affiliation: Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: Dora
authors.initials: D
authors.lastname: Chor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006304:Health Status; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009790:Occupations; D011203:Poverty / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D012923:Social Class; D012959:Socioeconomic Factors; D014495:Universities; D055815:Young Adult
keywords: EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH