Confounder-adjusted hazard ratios are adjusted for sex, paternal social class at age 5, birthweight, cognitive function at age 5, and history of hospital admission by age 5

A

PPENDIX

L

IFE COURSEPSYCHOLOGICALDISTRESS AND TOTALMORTALITYBY MIDDLEAGE

:

THE

1970

BIRTHCOHORT STUDY

(B

ATTY

, H

AMER

, G

ALE

)

eTable 1. Life course psychological distress by age 26 and risk of mortality by age 44 years Distress occurrence Number of deaths

/Number at risk

Hazard ratio (95% confidence intervals) Sex-adjusted Confounder-adjusted

None 38/3871 1.00 (ref) 1.00 (ref)

Childhood only 20/1286 1.48 (0.86, 2.54) 1.45 (0.84, 2.51)

Adulthood only 8/474 2.00 (0.93, 4.32) 1.95 (0.90, 4.21)

Both 8/270 3.22 (1.50, 6.91) 3.10 (1.42, 6.74)

P for trend - 0.001 0.002

Cox proportional hazards regression analyses was used to compute hazard ratios with accompanying 95% confidence intervals to summarise the relationship between the distress groups and mortality rates. Confounder-adjusted hazard ratios are adjusted for sex, paternal social class at age 5, birthweight, cognitive function at age 5, and history of hospital admission by age 5.

eTable 2. Sex-adjusted hazard ratio (95% confidence intervals) for life course psychological distress by age 26 and risk of mortality by age 44 years using different thresholds to denote

distress

Distress occurrence

Number of deaths /Number at risk

Current thresholds for

distress

(>80^th centile for Rutter scale at age 5 and/or 10 years;

>=8 for Malaise inventory at age 26

years)

Number of deaths / Number at risk

New thresholds for distress

(>50th centile for the Rutter scale at age 5 and/or 10, and the Malaise scale at age 26)

Number of deaths /Number

at risk

New thresholds for distress

(>75^th centile for the Rutter scale at age 5 and/or 10, and the Malaise scale at age 26)

None 38/3871 1.00 (ref) 12/1283 1.0 (ref) 27/2969 1.0 (ref)

Childhood only 20/1286 1.48 (0.86, 2.54) 23/2010 1.17 (0.58, 2.36) 22/1488 1.53 (0.87, 2.69) Adulthood only 8/474 2.00 (0.93, 4.32) 14/794 2.22 (1.02, 4.83) 16/821 2.51 (1.35, 4.68) Both 8/270 3.22 (1.50, 6.91) 25/1814 1.61 (0.81, 3.20) 9/623 1.69 (0.79, 3.59)

P for trend - 0.001 - 0.090 - 0.017

eTable 3. Comparison of early life characteristics and mortality rates – according to missing data status

Missing data ages 5-26 years

(N=7233*)

No missing data ages 5 -26 years (N=5091)

Distress – childhood only 27.3 (42) 21.8 (1286)

Distress – adulthood only 7.1 (11) 8.0 (474)

Distress – both 11.7 (18) 4.6 (270)

Female 55.2 (836) 54.6 (3221)

Manual paternal social class at age 5 70.2 (3995) 59.3 (3499)

Low birthweight (<2.5kg) 10.8 (780) 8.2 (483)

Cognitive function at age 5 ≤2 SD below mean 3.5 (251) 1.6 (92) History of hospital admission by age 5 27.6 (1999) 22.9 (1351)

HR (95% CI) for mortality 2.81 (2.16, 3.66) 1.0 (ref)

Results are % (N) unless otherwise indicated. Distress is denoted by (>80th centile on Rutter scale at age 5 and/or 10 years; >=8 on Malaise inventory at age 26 years)

*Number with missing data on specific characteristics ranged from n=154 to n=7233

eTable 4. Confounder-adjusted hazard ratio (95% confidence intervals) for life course psychological distress by age 26 and risk of mortality by age 44 years – with and without weighting

Distress occurrence Number of deaths /Number at

risk

Confounder- adjusted No weighting

Confounder- adjusted With weighting

None 38/3871 1.00 (ref) 1.00 (ref)

Childhood only 20/1286 1.45 (0.84, 2.51) 1.40 (0.80, 2.44) Adulthood only 8/474 1.95 (0.90, 4.21) 1.96 (0.91, 4.23)

Both 8/270 3.10 (1.42, 6.74) 2.98 (1.36, 6.53)

P for trend - 0.002 0.003

In the weighting analyses, we used all the confounding variables plus the distress score at age 5 to predict whether cohort members took part at age 26. We then saved the fitted values (i.e., probabilities) from this model and derived inverse probability weights.

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