Processes of cumulative adversity: Childhood disadvantage and increased risk of heart attack across the life course

Objectives. This article examines how processes of cumulative adversity shape heart attack risk trajectories across the life course. Methods. Our sample includes 9760 Health and Retirement Study respondents born between 1931 and 1941. Using self-reported retrospective measures of respondents' early background, we first identify three latent classes with differential exposure to childhood disadvantage. Intervening covariates associated with educational attainment, employment status, income attainment, marital history, and health behaviors are added to capture sequential processes of adversity. Final latent-class cluster models estimate the cumulative impact of these covariates on three different heart attack risk trajectories between 1992 and 2002: high, increasing, and low. Results. Early disadvantage and childhood illness have severe enduring effects and increase the risk for heart attack. Adult pathways, however, differentially influence trajectories of heart attack risk and mediate the effects of early disadvantage. Discussion. Findings suggest that future research should consider how processes of cumulative adversity initiated in childhood influence health outcomes in older ages.