A prospective study of limiting longstanding illness in early adulthood

Background Chronic illness and disability are of increasing public health i mportance but little is known about the lifetime influences involved in the ir onset and progression. We aim to (i) establish whether an individual's r ating of limiting illness is stable over a 10-year period from age 23 to 33 ; (ii) assess the relationship, between childhood and adult disability; and (iii) identify lifecourse influences on limiting illness in early adulthoo d. Methods Data were from the 1958 British birth cohort, including the origina l birth survey and follow-ups at ages 7, 11, 16, 23 and 33 years. Limiting longstanding illness was the outcome at both ages 23 and 33. Potential pred ictors included childhood health and physical development, socioeconomic co nditions in early life and adulthood, and behavioural factor;. We estimated the effect of potential explanatory factors using logistic regression in b oth univariate and multivariate analyses, separately for limiting illness a t 23 and 33 years. Results Prevalence of limiting illness increased from 5.1% (men) and 4.1% ( women at age 23 to 6% for both sexes at age 33. Risk of limiting illness at age 33 was greater for those reporting an illness at age 27 (29.4%, compar ed with 4.7% of those without illness), though the majority (66%) of 33-yea r limiting illnesses had no previous record at age 23 or for childhood. Mul tivariate analysis of limiting illness at age 27 confirmed the high risk fo r those with childhood disability and also established two further major pr edictors, namely, injury (adjusted odds ratio [OR] = 1.42, 95% CI: 1.09-1.8 6) and intermediate socio-emotional status (adjusted OR = 1.73, 95% CI:1.29 -2.31). Additional risks were identified for limiting illness at age 33, in cluding: (i) injury in the preceding 10 years (adjusted OR = 1.55, 95% CI : 1.18-2.04); (ii) body mass index (BMI), for which the relationship was non -linear, with elevated risks for the underweight (adjusted OR = 1.53, 95% C I:1.07-2.26) and overweight (OR=1.28, 95% CI:0.87-1.89); (iii) childhood di sadvantage at either or both ages 7 and 11 (adjusted OR = 1.53, 95% CI : 1. 07-2.17); and (iv) height at age 7, with a significant non-linear relations hip (the adjusted OR for height less than 15th percentile was 1.43 and for height more than the 85th percentile, 1.30). Conclusions Both childhood and adult factors predict limiting illness in ea rly adulthood. Childhood is important because some adult illnesses originat e in early life, and also because childhood environment influences the risk of adult limiting illness several years later. Our findings suggest that s tudies seeking to understand the causes of limiting illness, that currently tend to focus exclusively on contemporary factors, need also to consider t he contribution of environment in early life.