title: Cumulative contextual and individual disadvantages over the life course and adult functional somatic symptoms in Sweden.
abstract: BACKGROUND
  Disadvantage, originating in one's residential context or in one's past life course, has been shown to impact on health in adulthood. There is however little research on the accumulated health impact of both neighbourhood and individual conditions over the life course. This study aims to examine whether the accumulation of contextual and individual disadvantages from adolescence to middle-age predicts functional somatic symptoms (FSS) in middle-age, taking baseline health into account.
  
  
  METHODS
  The sample is the age 16, 21, 30 and 42 surveys of the prospective Northern Swedish Cohort, with analytical sample size n = 910 (85% of the original cohort). FSS at age 16 and 42, and cumulative socioeconomic disadvantage, social adversity and material adversity between 16 and 42 years were operationalized from questionnaires, and cumulative neighbourhood disadvantage between 16 and 42 years from register data.
  
  
  RESULTS
  Results showed accumulation of disadvantages jointly explained 9-12% of FSS variance. In the total sample, cumulative neighbourhood and socioeconomic disadvantage significantly predicted FSS at age 42 in the total sample. In women, neighbourhood disadvantage but not socioeconomic disadvantage contributed significantly, whereas in men, socioeconomic but not neighbourhood disadvantage contributed significantly. In all analyses, associations were largely explained by the parallel accumulation of social and material adversities, but not by symptoms at baseline.
  
  
  CONCLUSIONS
  In conclusion, the accumulation of diverse forms of disadvantages together plays an important role for somatic complaints in adulthood, independently of baseline health.
authors.affiliation: 1 Division of Social Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden per.e.gustafsson@umu.se.
authors.forename: Per E
authors.initials: PE
authors.lastname: Gustafsson
authors.affiliation: 1 Division of Social Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Hammarström
authors.affiliation: 2 Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastian
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult