Life course socioeconomic position and general and oral health in later life: Assessing the role of social causation and health selection pathways

Objective: To examine the pathways between life course socioeconomic position (SEP) and general and oral health, assessing the role of two competing theories, social causation and health selection, on a representative sample of individuals aged 50 years and over in England. Methods: Secondary analysis from the English Longitudinal Study of Ageing Wave 3 data (n = 8659). Structural equation models estimated the social causation pathways from childhood SEP to adult self-rated general health and total tooth loss, and the health selection pathways from childhood health to adult SEP. Results: There were direct and indirect (primarily via education, but also adult SEP, and behavior) pathways from childhood SEP to both health outcomes in older adulthood. There was a direct pathway from childhood health to adult SEP, but no indirect pathway via education. The social causation path total effect estimate was three times larger for self-rated general health and four times larger for total tooth loss than the health selection path respective estimates. Conclusions: The relationship between SEP and health is bidirectional, but with a clearly stronger role for the social causation pathway.