br Conclusion br Acknowledgments br Introduction Studies

Conclusion
Acknowledgments
Introduction Studies that extend across multiple life stages promote an understanding of the factors that influence health across the life span (Braveman & Barclay, 2009). A growing literature has examined not only the individual-level socioeconomic factors in early life that influence health outcomes (Glymour, Avendaño, Haas & Berkman, 2008; Merkin, Karlamangla, Diez Roux, Shrager & Seeman, 2014; Pereira, Li & Power, 2014; Turrell, Lynch, Leite, Raghunathan & Kaplan, 2007), but also the influence of place. Studies in the U.S. have found that a person׳s state or region of birth is associated with later life development of cancer, dementia, diabetes, melanocortin receptor disease, and other illnesses (Datta, Glymour, Kosheleva & Chen, 2012; Glymour et al., 2013; Greenberg & Schneider, 1998; Patton, Benjamin, Kosheleva, Curtis & Glymour, 2011). Fewer have examined the specific characteristics of early life state-of-residence that are predictive of adult health, although one recent study found small associations of state socioeconomic characteristics with chronic disease during working life (Rehkopf et al., 2015). Prior work has suggested multiple types of trajectories through which early life factors may influence health and mortality in later life (Ben-Shlomo, Mishra & Kuh, 2014). “Critical period” and “sensitive period” models assume that an exposure in a time window during fetal life or childhood alters an individual׳s health trajectory early on (Ben-Shlomo & Kuh, 2002). “Accumulation of risk” models suggest that correlated or uncorrelated exposures across the life course interact additively or synergistically to bring about later disease. Meanwhile, “chains of risk” models hypothesize that initial adverse exposures bring about disease in later life because they increase the risk of additional adverse exposures throughout life (Ben-Shlomo et al., 2014). Adverse exposures have been conceptualized not only in terms of chemical or metabolic risk factors, but also social factors (Halfon, Larson, Lu, Tullis & Russ, 2014). Numerous studies have begun to examine how early and later life socioeconomic status (SES) interact, and systematic reviews have suggested that childhood SES may be as important in determining later life cause-specific mortality and cardiovascular disease as adulthood SES, depending on the disease process and contextual factors (Galobardes, Lynch & Smith, 2008; Galobardes, Smith & Lynch, 2006). In general, however, a life course perspective is not frequently applied, and researchers have recently called for increased attention to how socioeconomic exposures are “sustained, exacerbated, or attenuated over time” (Corna, 2013). Moreover, most studies focus on individual-level socioeconomic factors, with less attention to the ways in which contextual factors interact across the life course. For example, area-level socioeconomic factors during childhood may influence educational and economic opportunities or may be associated with poorer housing and environmental conditions (Bartley, Blane & Montgomery, 1997). With regard to macro-level factors that differ across states and countries, differences in social and economic policies may affect how well the safety net buffers vulnerable individuals from adverse conditions (Currie & Rossin-Slater, 2015; Eikemo, Bambra, Judge & Ringdal, 2008). In this study, we build upon this prior literature by examining how state characteristics in early life predict health status and mortality decades later (Fig. 1). We use composite indices representing socioeconomic characteristics of early state-of-residence as the predictors of interest. We take advantage of multiple large linked data sets among a cohort of U.S. workers, employing in-sample and out-of-sample models to strengthen results. We adjust for potential mediating individual- and area-level factors during adulthood, testing the hypothesis that early life state environment remains important even after controlling for socioeconomic factors during adulthood.