Early life and adult socioeconomic influences on mortality risk: preliminary report of a 'pauper rich' paradox in a Chilean adult cohort

Ann Epidemiol. 2010 Jun;20(6):487-92. doi: 10.1016/j.annepidem.2010.03.009.


Purpose: The inverse relationship between early life and adult socioeconomic measures and mortality risk has been well established in developed countries, but remains practically unexplored in Latin American societies. The setting was Chile; the study included 11,600 adults living in the urban center of San Francisco de Mostazal. This was a prospective cohort study of a weighted random sample of 795 subjects followed up during 8 years.

Methods: Education (elementary, high school and college), height (percentiles 50 and 75), and income (population quartiles) were assessed at baseline. Relative risks of all-cause mortality were computed in Cox regression models adjusting for age, gender, body mass index, smoking status, and joint effects of the socioeconomic measures.

Results: A graded inverse relationship with all-cause mortality was observed for education (risk: 1.0, 0.67, and 0.30, p for trend < 0.01) and height (risk: 1.0, 0.75, and 0.56, p for trend < 0.01), but not for income (p for trend = 0.94).

Conclusions: These findings suggest a 'pauper rich' paradox in transitioning Latin American economies. Income level does not seem sufficient to improve survival in cohorts exposed to adverse early life influences reflected by education and height.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Chile / epidemiology
  • Cohort Studies
  • Developing Countries
  • Educational Status
  • Health Status Disparities*
  • Humans
  • Income / statistics & numerical data
  • Kaplan-Meier Estimate
  • Middle Aged
  • Mortality / trends*
  • Multivariate Analysis
  • Poverty / statistics & numerical data*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk
  • Risk Assessment
  • Risk Factors
  • Socioeconomic Factors
  • Surveys and Questionnaires