The Association of Wealth over the Life Course with Health and Disease in Adulthood: An Analysis of Six Birth Cohorts from Five Low- & Middle-Income Countries Restricted; Files Only

Varghese, Jithin Sam (Spring 2022)

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Wealth has a multifactorial role in health over the life course. Most studies exploring the role of wealth and other domains of socioeconomic position (SEP) with health outcomes in low- and middle-income countries (LMICs) have been cross-sectional. The aims of this dissertation are to measure and describe the dynamics of wealth mobility over the life course, the association of wealth mobility with health, and the relative roles of subjective and objective measures of SEP in predicting health. This dissertation investigates these questions among nearly 15,000 individuals with 22 to 51 years of follow-up through the Consortium on Health-Orientated Research in Transitional Societies (COHORTS) collaboration – a consortium of six birth cohorts from five LMICs (Brazil, Guatemala, India, Philippines and South Africa). First, the temporally harmonized asset index, created from consistently collected assets and housing characteristics, shows that wealth increased over the life course in all cohorts. Second, maternal and own attained schooling predicted future relative wealth mobility as measured by conditional wealth in four cohorts (Brazil, Guatemala, Philippines and South Africa). In turn, relative wealth mobility over the life course was positively associated with intelligence, and mobility in the most recent period was associated with emotional wellbeing and psychological distress. Third, life stages when relative wealth mobility was associated with BMI varied between cohorts consistent with anticipated cohort effects of the obesity transition. Fourth, subjective social status, after adjusting for objective measures of SEP (such as schooling, wealth and employment), showed small and consistent associations with happiness, but not BMI or psychological distress, in three birth cohorts (Guatemala, Philippines and South Africa). Based on the results of this research, recommendations for improving human capital in LMIC populations are proposed.

Table of Contents

Chapter 1 Introduction. 1

Chapter 2 Background. 7

Chapter 3 Overview of methods. 38

Chapter 4 Changes in asset-based wealth across the life course in birth cohorts from five low- and middle-income countries. 49

Chapter 5 Conditional wealth to estimate association of wealth mobility with health and human capital in low- and middle-income country cohorts. 136

Chapter 6 Schooling and wealth mobility over the life course in relation to health and human capital in adulthood: an analysis of four birth cohorts from low- and middle-income countries. 177

Chapter 7 Subjective social status is associated with happiness but not weight status or psychological distress: an analysis of three prospective birth cohorts from low- and middle-income countries. 240

Chapter 8 Discussion and Next Steps. 288

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