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Impact of educational attainment on the association between social class at birth and multimorbidity in middle age in the Aberdeen Children of the 1950s cohort study
  1. Marjorie C Johnston1,
  2. Corrinda Black1,2,
  3. Stewart W Mercer3,
  4. Gordon J Prescott4,
  5. Michael A Crilly2,4
  1. 1 Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
  2. 2 Public Health Directorate, NHS Grampian, Aberdeen, UK
  3. 3 The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  4. 4 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Marjorie C Johnston; marjorie.johnston{at}


Objective Multimorbidity (the coexistence of two or more health conditions) is increasingly prevalent. No long-term cohort study has examined the impact of contemporaneously measured birth social class along with educational attainment on adult self-reported multimorbidity. We investigated the impact of educational attainment on the relationship between social class at birth and adult self-reported multimorbidity in the Aberdeen Children of the 1950s (ACONF) cohort.

Methods A prospective cohort study using the ACONF cohort. ACONF included 12 150 individuals born in Aberdeen, Scotland 1950–1956. In 2001, 7184 (64%) responded to a questionnaire providing information including self-reported morbidity and educational attainment. The exposure was father’s social class at birth from birth records and the outcome was self-reported multimorbidity.

Logistic regression assessed the association between social class and multimorbidity with adjustment for gender, then by educational attainment and finally by childhood cognition and secondary school type. ORs and 95% CIs were presented.

Results Of 7184 individuals (mean age 48, 52% female), 5.4% reported multimorbidity. Birth social class was associated with adult multimorbidity. For example, the OR of multimorbidity adjusted by gender was 0.62 (95% CI 0.39 to 1.00) in the highest social class group (I/II) in relation to the reference group (III (manual)) and was 1.85 (95% CI 1.19 to 2.88) in the lowest social class group. This was partially attenuated in all social class categories by educational attainment, for example, the OR was 0.74 (95% CI 0.45 to 1.21) in group I/II following adjustment.

Conclusion Lower social class at birth was associated with developing multimorbidity in middle age. This was partially mediated by educational attainment and future research should consider identifying the other explanatory variables. The results are relevant to researchers and to those aiming to reduce the impact of multimorbidity.

  • multimorbidity
  • cohort study
  • socio-economic status

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  • Patient consent for publication Not required.

  • Contributors Study conception: MCJ. Study design: MCJ, CB, SWM, GJP and MAC. Study analysis: MCJ. Supervision and contribution to study analysis: CB, SWM, GJP and MAC. Drafting of article: MCJ. Critical revision of the article for important intellectual content: MCJ, CB, SWM, GJP and MAC.Final approval of article: MCJ, CB, SWM, GJP and MAC.

  • Funding MCJ was funded by a Clinical Academic Fellowship from the Chief Scientist Office, Scotland (CAF/13/03) and was a PhD student affiliated with the Farr Institute of Health Informatics and Research Scotland.

  • Competing interests None declared.

  • Ethics approval The ACONF dataset is registered with the National Research Ethics Service (NRES) as a research database, meaning that the steering committee may release data for research. Permission was gained from the ACONF steering committee to use the ACONF in this study. Prior to commencing the work, it was confirmed with the North of Scotland NRES that no further ethical approval was required. NHS Grampian Research and Development (R&D) confirmed no R&D approval was required.

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

  • Data sharing statement Data can be shared via the Grampian Data Safe Haven with accredited researchers who have appropriate approvals in place.

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