{
  "abstract": "Background Childhood poverty has been linked to adverse outcomes throughout the life course. While existing research highlights the negative impacts of poverty in later life, the impact of different income trajectories across the full distribution on adolescent social and health outcomes remain unclear. This study investigates the cumulative impact of household income dynamics on adverse outcomes in adolescence.Methods We used longitudinal data on 10,496 children from the UK Millennium Cohort Study to construct income trajectories from infancy to early adolescence, which were identified through multi-trajectory modelling. Logistic and ordered logistic regression models were used to assess associations between income trajectories and overweight/obesity, smoking, cognitive disability, socioemotional behavioural problems, failure to achieve GCSE educational qualifications at age 17, whilst controlling for confounders. Average adjusted risk ratios (aRRs) were estimated for individual and cumulative adverse outcomes. Population-attributable fractions (PAFs) were calculated to quantify the contribution of non-optimal income trajectories to each adverse outcome.Results We identified four distinct income trajectories: low (47.3%), lower-middle (33.3%), upper-middle (15.4%), and high (3.9%). The upper-middle trajectory was identified as optimal. Compared to the upper-middle-income trajectory, exposure to low income was associated with an increased risk of overweight/obesity (aRR 1.48, 95% CI 1.23–1.74), cognitive disability (aRR 1.70, 95% CI 1.06–2.33), socioemotional behavioural problems (aRR 2.33, 95% CI 1.47–3.19), and GCSE failure (aRR 1.66, 95% CI 1.39–1.94). The likelihood of experiencing two or more adverse outcomes ranged from aRR 1.43 (95% CI 1.27–1.58) to aRR 2.02 (95% CI 1.62–2.42). Non-optimal trajectories accounted for 18.8% (95% CI 9.1–28.5%) of overweight/obesity cases, 24.8% (95% CI 14.1–35.4%) of GCSE failure, 43.1% (95% CI 26.8–59.5%) of socioemotional behavioural problems, and 27.4% (95% CI 7.8–47.0%) of cognitive disability cases. Income instability among high-income households due to the 2008 financial crisis was linked to increased smoking and educational underachievement. Results remained robust after adjusting for family wealth.Conclusion In a representative UK cohort, most children are exposed to non-optimal income trajectories in childhood, which are strongly associated with adverse health and educational outcomes in adolescence. The robustness of our findings may be impacted by unobserved confounders, such as parental cognitive and non-cognitive skills, and reliance on parental reporting for socioemotional behavioural problems. Policies to optimise family income in childhood are likely to improve population health over the life course.",
  "authors": [
    {
      "affiliations": [
        "Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK"
      ],
      "name": "Gianmaria Niccodemi"
    },
    {
      "affiliations": [
        "Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK"
      ],
      "name": "Akanni Lateef"
    },
    {
      "affiliations": [
        "Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK"
      ],
      "name": "David Taylor Robinson"
    },
    {
      "affiliations": [
        "Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK"
      ],
      "name": "Nicholas Kofi Adjei"
    }
  ],
  "title": "OP57 Family income trajectories and adverse outcomes in late adolescence: evidence from the millennium cohort study",
  "uid": "a0c0422d-9eb9-5bb6-9e3e-fcb215cddb8f"
}