Contribution of lifelong adverse experiences to social health inequalities : findings from a population survey in France

Background: Recent research shows that adverse experiences, such as economic hardships or exclusion, contribute to deterioration of health status. However, individuals currently experiencing adverse experiences are excluded from conventional health surveys, which, in addition, often focus on current social situation but rarely address past adverse experiences. This research explores the role of such experiences on health and related social inequalities based on a new set of ad hoc questions included in a regular health survey. Methods: In 2004, the National Health, Health Care and Insurance Survey included three questions on lifelong adverse experiences (LAE): financial difficulties, housing difficulties due to financial hardship, isolation. Logistic regressions were used to analyse associations between LAE, current socio-economic status (SES) (education, occupation, income) and health status (self-perceived health, activity limitation, chronic morbidity), on a sample of 4308 men and women aged ≥35 years. Results: LAE were reported by 20% of the sample. They were more frequent in low SES groups but concerned >10% of the highest income group. LAE increased the risk of poor self-perceived health, diseases and activity limitations, even after controlling for current SES [odds ratio (OR) > 2]. LAE experienced only during childhood are also linked to health. LAE account for up to 32% of the OR of activity limitations associated with the lowest quintile among women and 26% among men. Conclusions: LAE contribute to the social health gradient and explain variability within social groups. It is useful to take lifetime social factors into account when monitoring health inequalities.