摘要：Objectives. We examined the relation between low birth weight and childhood family and neighborhood socioeconomic disadvantage and disease onset in adulthood. Methods. Using US nationally representative longitudinal data, we estimated hazard models of the onset of asthma, hypertension, diabetes, and stroke, heart attack, or heart disease. The sample contained 4387 children who were members of the Panel Study of Income Dynamics in 1968; they were followed up to 2007, when they were aged 39 to 56 years. Our research design included sibling comparisons of disease onset among siblings with different birth weights. Results. The odds ratios of having asthma, hypertension, diabetes, and stroke, heart attack, or heart disease by age 50 years for low–birth weight babies vs others were 1.64 ( P < .01), 1.51 ( P < .01), 2.09 ( P < .01), and 2.16 ( P < .01), respectively. Adult disease prevalence differed substantially by childhood socioeconomic status (SES). After accounting for childhood socioeconomic factors, we found a substantial hazard ratio of disease onset associated with low birth weight, which persisted for sibling comparisons. Conclusions. Childhood SES is strongly associated with the onset of chronic disease in adulthood. Low birth weight plays an important role in disease onset; this relation persists after an array of childhood socioeconomic factors is accounted for. The fetal origins hypothesis, developed by David Barker, 1 proposes that when nutritional intake of a fetus is limited, the body's physiology and metabolism are changed fundamentally, and some of the consequences of these changes become apparent much later in life. Health insults in utero may lead to greater physiological deterioration of metabolic and immune systems. Early-life health may influence a broad range of subsequent disease risks over the life cycle. Over the past 2 decades, a voluminous empirical literature has documented associations between early-life health outcomes—most often, but not exclusively, low birth weight—and adult mortality and disease onset. 1 – 5 The fetal origins hypothesis provides an explanation of why there may be important interactions between parental health status and parental economic status in their children's subsequent risk of onset of disease in adulthood. At the same time, evidence from human and animal studies highlights the importance of other early-life factors that set in place the structures that shape future health outcomes. 6 Specifically, limited parental resources and childhood poverty can reduce investments in children's health and learning, shape the neurobiology of the developing child, and lead to worse health later in life. 7 – 10 Lack of health insurance for childhood can discourage the use of medical care, particularly in the early and more treatable stages of a health problem. High levels of neighborhood poverty and associated stressors can limit development and lead to poor health, and they can also compound and amplify the neurobiological disadvantages that many poor children already face. 11 These various factors in early life—health status (e.g., low birth weight may serve as a marker for poor infant health), familial socioeconomic disadvantage, health insurance coverage, and neighborhood disadvantage—are highly correlated in most populations; children living in poor families disproportionately live in poor neighborhoods, lack high-quality health care, and have poor health. As a result, the typically estimated statistical association between birth weight and adult health status may be spurious and instead reflect the lasting influence of hereditary risk factors and childhood family and neighborhood socioeconomic disadvantage, which are correlated with both low birth weight and onset of chronic disease. The evidence to date remains inconclusive in distinguishing between these competing explanations, and there is ongoing debate regarding the source of reported associations between low birth weight and risks of chronic diseases later in life. 12 – 15 Assessing the relative importance of these competing explanations has implications for our understanding of the early-life origins of adult disease. We examined the long-term consequences of low birth weight and childhood socioeconomic disadvantage on the onset of fatal chronic conditions in adulthood in the United States. We used nationally representative longitudinal data from the United States spanning nearly 4 decades to estimate the onset of chronic health conditions that are among the leading causes of mortality and disability.
