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Original research
Childhood peer status and circulatory disease in adulthood: a prospective cohort study in Stockholm, Sweden
  1. Alexander Miething,
  2. Ylva Brännström Almquist
  1. Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
  1. Correspondence to Dr Alexander Miething; alexander.miething{at}


Objectives Childhood conditions have been recognised as important predictors of short-term and long-term health outcomes, but few studies have considered status position in the peer group as a possible determinant of adult health. Lower peer status, which often reflects experiences of marginalisation and rejection by peers, may impose inequality experiences and leave long-lasting imprints on health. The present study aimed to examine whether peer status is associated with the risk for circulatory disease in adulthood.

Design Prospective cohort study based on the Stockholm Birth Cohort Multigenerational Study

(SBC Multigen).

Setting Stockholm metropolitan area.

Participants All individuals who were born in 1953 and resident in the greater metropolitan area of Stockholm in 1963 (n=14 608). The analytical sample consisted of 5410 males and 5990 females. Peer status was sociometrically assessed in cohort members at age 13. The survey material was linked to inpatient care registers that contained information about circulatory diseases (n=1668) across ages 20–63. Cox proportional hazard models were used for the analysis.

Outcome measure Circulatory disease.

Results Peer marginalisation at age 13 resulted in significantly higher risks of circulatory disease in adulthood among males (HR 1.34; 95% CI 1.09 to 1.64) and females (HR 1.33; 95% CI 1.04 to 1.70) alike. A graded relationship between peer status and circulatory diseases was detected in females (p=0.023). Among males there was a threshold effect, showing that only those in the lowest status position had significantly increased risks of circulatory disease. The associations remained significant after adjusting for various conditions in childhood and adulthood.

Conclusions This study shows that circulatory diseases in adulthood may be traceable to low peer status and marginalisation in childhood. It is suggested that peer status in late childhood may precede social integration in adolescence and adulthood, acting as a long-term stressor that contributes to circulatory disease through biological, behavioural and psychosocial pathways.

  • epidemiology
  • public health
  • social medicine

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  • Contributors AM and YBA conceived this study. YBA prepared and compiled the data. AM performed the statistical analyses. AM and YBA wrote the manuscript. Both authors approved the final version of the manuscript.

  • Funding This work was supported by the Swedish Council for Health, Working Life and Social Research [grant no. 2016–07148], (

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Stockholm Regional Ethics Committee (reg. no. 2016/481-31/5; 2016/481-31/5). The need for consent was waived due to the retrospective nature of this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The datasets generated and/or analysed during the current study are not publicly available due to ethical regulations regarding the Stockholm Birth Cohort (SBC) study but are available from the co-author on reasonable request.

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