Socioeconomic, educational, family, perinatal and developmental early life domains as predictors of obesity and hypertension comorbidity: findings from the 1970 British cohort study (BCS70)

Early life experiences can interact with each other and shape long-term health outcomes. To inform prevention strategies, we grouped early life risk factors into conceptual domains and investigated how exposures across five predefined early life domains predict the development of obesity and hypertension comorbidity in adulthood. This paper builds on a previously published conceptual framework which views early-life influences as multidimensional and interrelated. This framework guided the grouping of risk factors into five domains for analysis. The sample included 7858 participants in the 1970 British Cohort Study. The outcome was obesity (BMI ≥30) and hypertension (blood pressure > 140/90 mmHg or self-reported doctor’s diagnosis) comorbidity at age 46. Early life domains included: ‘prenatal to birth’, ‘developmental attributes’, ‘child education’, ‘socioeconomic factors’ and ‘family environment’. We conducted prediction analysis in three stages:(1) stepwise backward elimination to select variables for inclusion, (2) calculation of predicted risk scores, (3) multivariable logistic regression analysis including domain-specific risk scores, sex and ethnicity. We included potential adult predictors in the sensitivity analysis. The area under the curve (AUC) was 0.63 (95%CI 0.61-0.65). Including adult predictors increases the AUC to 0.68 (95%CI 0.66-0.70). Three early life domains - the family environment (OR 1.11, 95% CI 1.05-1.17), socioeconomic factors (OR 1.09, 95% CI 1.04-1.16), and education ability (OR 1.07, 95% CI 1.02-1.13) were predictors of obesity-hypertension comorbidity. Three early life domains predicted obesity-hypertension comorbidity. Interventions addressing these domains could reduce the burden of comorbidity.