摘要：Objectives. We examined how early life conditions influence midlife overall and cause-specific mortality in a community cohort of disadvantaged African Americans. Methods. Using a prospective design, we assessed first-grade children and their teachers and families when children were 6 years old, with follow-up at ages 16, 32, and 42 years. We obtained information on death from family members, neighbors, and the National Death Index (NDI). We conducted a survival analysis and competing risk analysis to examine early life predictors of mortality. Results. Of 1242 participants, 87 (7%) had died by 2004. In multivariate Cox proportional hazards regression, males who lived in foster care and females with lower math grades in first grade were more likely to die by age 42 years. In multivariate competing risks analysis, hospitalization by the time of first grade was related to mortality from acute and chronic illness. Male gender, being in foster care, and aggressive behavior in first grade were related to mortality from drug use, violence, or suicide. Conclusions. Early classroom, environmental, and family-level interventions are potentially beneficial in reducing later overall and cause-specific mortality. African Americans historically have had the highest mortality rates among American racial and ethnic groups. 1 This gap has remained fairly stable over the last 40 years and may have even widened between Whites and African Americans. 1–3 Satcher et al. estimated that, as of 2002, approximately 83 570 excess deaths could be avoided by eliminating this disparity between African Americans and Whites. 3 African Americans also have much higher years of potential life lost, a measure that takes into account the years of life lost due to early deaths. 4,5 Years of potential life lost is an especially important comparison measure because it documents early mortality. African Americans have higher mortality for most leading causes of death in the United States, including heart disease, stroke, and cancers, as well as homicide and HIV/AIDS. 1 Many of these racial differences in mortality are attributed to inequalities in economic status, education, and occupation. 1,5–7 However, few studies have examined the effect of conditions and behaviors as early as age 6 on later overall and cause-specific mortality among African Americans. Research on early factors as related to mortality has primarily focused on infant and childhood mortality rather than mortality that extends into early and mid-adulthood. However, the possible impact of early childhood circumstances on longevity into early and mid-adulthood has been understudied. Early life circumstances initiate trajectories that progressively may increase the risks for later morbidity and mortality, making the identification of early life risk factors important for understanding later mortality. Early life factors such as low socioeconomic status (SES), 1,6–8 being in foster care, 5,9 childhood cognitive ability (i.e., childhood IQ), 10–12 and poor childhood health 13,14 have been shown to increase the risk of later mortality. However, much of the work thus far has retrospectively assessed early life circumstances using reports from older adults, making these findings subject to survivor and recall bias. We extended and updated previous research by prospectively examining the impact of childhood socioeconomic and family disadvantage, early cognitive and classroom behavior, and physical and mental health on overall and cause-specific time to midlife mortality among a community of urban African Americans younger than 42 years. We used data from a longitudinal cohort study, the Woodlawn Project.
