doi:10.1016/j.intell.2008.12.002 The association between IQ in adolescence and a range of health outcomes at 0 in the 1!"!

#$ %ational &ongitudinal $tud' of (outh Geoff Dera, b,

a ,

, G. David Battya, b and Ian J. Dearyb

)*+ $ocial and ,ublic -ealth $ciences #nit. #ni/ersit' of 0lasgow. 0lasgow. #1

)*+ +entre for +ogniti/e 2geing and +ogniti/e 34idemiolog'. 5e4artment of ,s'cholog'. #ni/ersit' of 3dinburgh. 3dinburgh. #1 2 lin6 between 4re7morbid intelligence and all cause mortalit' is becoming well established. but the aetiolog' of the association is not understood. &ess is 6nown about lin6s with cause s4ecific mortalit' and with morbidit'. The aim of this stud' is to e8amine the association between intelligence measured in adolescence and a broad range of health outcomes ascertained at 0 'ears of age. 9e use data on " "6 4artici4ants in the #$ %ational &ongitudinal $ur/e' of (outh 1!"! who had their cogniti/e abilit' measured at baseline and com4leted the :-ealth at 0; inter/iew module between 1!!8 and 200 . The -ealth at 0 module includes assessments of general health and de4ression. nine medicall' diagnosed conditions. and << common health 4roblems. -igher mental test scores were associated with lower de4ression scores. better general health. significantl' lower odds of ha/ing fi/e of the nine diagnosed conditions and 1= of the << health 4roblems. 2 health disad/antage of higher cogniti/e abilit' was e/ident for onl' three of the << health 4roblems. Keywords: Intelligence> -ealth> +ogniti/e e4idemiolog'

oduction
The beginnings of cogniti/e e4idemiolog' can 4erha4s be traced to ?@Toole and $tan6o/@s A1!!2B finding an association between general intelligence and mid7life mortalit' in male 2ustralian Cietnam /eterans. and 9halle' and 5ear'@s A2001B demonstration that age 11 IQ 4redicted sur/i/al to age "6 in a $cottish 4o4ulation. ,rior to that. research on the association between cognition and health had been 4rimaril' focused on the o44osite causal direction. whereb' 4oor health im4airs cogniti/e functioning. 2 lin6 between mental abilit' at age 11 and deaths o/er the following si8 and a half decades immediatel' suggested the 4ossibilit' that intelligence differences might ha/e a causal effect on longe/it' and. b' im4lication. on health. 2 s'stematic re/iew ADatt'. 5ear'. E 0ottfredson. 200"B and more recentl' 4ublished wor6 AFDatt' et al.. 2008G and F,earce et al.. 2006GB ha/e confirmed the lin6 for all cause mortalit'. -owe/er. all cause mortalit' is relati/el' uninformati/e for aetiolog'. mechanisms and 4athwa's. Hor cause s4ecific mortalit' the information is s4arser and more mi8ed.

2 number of studies ha/e re4orted an association between earl' cognition and cardio/ascular. or coronar' heart disease. mortalit' AFDatt' et al.. 2006G. FDatt' et al.. 2008G. F?sler et al.. 200<G and F,a/li6 et al.. 200<GB. There is some e/idence for an association with lung and stomach cancer in $cotland AF5ear' et al.. 200<G and F-art et al.. 200<GB but not in $weden ADatt'. )odig 9ennerstad et al.. 200"B. In that stud'. almost a million men were followed u4 to earl' middle age. but there was no association between intelligence at conscri4tion and an' of a large number of cancers. e8ce4t for s6in cancer which was associated with higher intelligence. 2mong e8ternal causes of death there is also a mi8ed 4icture: lower intelligence test scores are associated with death b' suicide A0unnell. )agnusson. E *asmussen. 200=B and homicide AFDatt' et al.. 2008G and FDatt' et al.. 2008GB and to a combination of injuries and suicides A?sler et al.. 200<B. $tudies that ha/e e8amined the relationshi4 of intelligence to the ris6 factors for cardio/ascular and res4irator' disease ha/e found that higher cogniti/e test scores are associated with lower rates of smo6ing and higher smo6ing cessation> lower li6elihood of being o/erweight or obese> less hea/' alcohol consum4tion and less h'4ertension AFDatt' et al.. 2006G. FDatt' et al.. 200"G. FDatt' et al.. 200"G. F+handola et al.. 2006G. F$tarr et al.. 200 G and FTa'lor et al.. 200<GB. although one stud' found an association with greater le/els of 4roblem drin6ingADatt'. 5ear' et al.. 2008B. In summar'. there are far fewer studies of the association between earl' life intelligence and later morbidit' than there are for mortalit'. $uch studies. if the' can identif' which health outcomes are associated with 4rior abilit'. can be of assistance in identif'ing the causal 4aths between earl' life intelligence and sur/i/al. Hor e8am4le. h'4ertension. diabetes and high cholesterol are all ris6 factors for cardio/ascular disease. 5iffering 4atterns of association with intelligence might indicate 4athwa's that lin6 intelligence with later mortalit'. $tudies showing lin6 with morbidit'. rather than mortalit'. are 4rinci4all' concerned with cardio/ascular disease AF-art et al.. 200 G and F-emmingsson et al.. 200"GB and 4s'chiatric disorders AFDatt' et al.. 200=G. F9al6er et al.. 2002G and FIammit et al.. 200 GB. The literature showing lin6s with morbidit' is also the most li6el' to contain 4ublication bias. Hinding that intelligence is associated with a s4ecific disease is much more li6el' to lead to a 4ublication than an eJui/alent null finding. De'ond cardio/ascular and 4s'chiatric illness. little is 6nown about the association of earl' IQ with health more generall'. #sing data from the 1!<2 $cottish )ental $ur/e'. $tarr and colleagues A$tarr. 5ear'. &emmon. E 9halle'. 2000B e8amined the relationshi4 between IQ at age 11 and health status at age "". ?f 12 disease categories Aincluding :other;B onl' dementia was associated with childhood IQ. although sur/i/or bias ma' ha/e diluted the effects. There was a 4ositi/e association with functional inde4endence. as measured b' the Darthel score A9ade E +ollin. 1!88B. )artin and colleagues A200 B loo6ed at IQ. aged se/en. and eight diagnosed conditions at age <0K<!. 2lthough the sam4le siLe was onl' large enough to formall' anal'Le the association of IQ with ha/ing an' of the conditions and with the total number of conditions. the authors concluded that the association Ma44eared to be general and not limited to a s4ecific illnessN.

There is clearl' a need within cogniti/e e4idemiolog' for studies which e8amine the relationshi4 of earl' life intelligence to general health in mid life with a large enough sam4le siLe to detect a range of 4ossible associations. The 4resent stud' aims to do this in a large. 4o4ulation based sam4le. with a wide /ariet' of health outcomes.

2. Method
2.1. Partici ants The data are deri/ed from the #.$. %ational &ongitudinal $ur/e' of (outh 1!"! A%&$("!B A+enter for -uman *esource *esearch. 200 B. This is a 4o4ulation re4resentati/e sam4le of 12.686 'oung 4eo4le who were aged 1 to 21 on <1st 5ecember 1!"8. -ouseholds were sam4led and all inhabitants in the target age range included. ?f the 8""0 households. 2862 included more than one res4ondent. The res4ondents were first inter/iewed in 1!"! and were re7inter/iewed annuall' until 1!! and bienniall' thereafter. Hrom 1!!8 an e8tended health module was administered to res4ondents aged 0 and o/er. This com4rises four 4arts: AiB a " item /ersion of the +enter for 34idemiological $tudies 5e4ression $cale A+3$75B AF*adloff. 1!""G and F*oss and )irows6'. 1!8!GB> AiiB a number of Juestions about contact with health 4rofessionals and the health of the subject@s 4arents> AiiiB the $H12 A/ersion 1B. a brief health Juestionnaire com4rising scales for o/erall mental and 4h'sical health A9are. 1osins6i. E 1eller. 1!!6B> and Ai/B an e8tensi/e list of health conditions. The health at 0 module was re4eated in 2000. 2002 and 200 for those aged 0O who had not 4re/iousl' com4leted it. -ere we anal'Le the scores from the +3$75 and $H12. and data on the health conditions. 2.2. Measures
2.2.1. Inte!!i"ence

2t baseline 4artici4ants were administered the 2rmed $er/ices Cocational 24titude Datter' A2$C2DB which has 10 subtests: science. arithmetic. word 6nowledge. 4aragra4h com4rehension. numerical o4erations. coding s4eed. auto and sho4 information. mathematics 6nowledge. mechanical com4rehension. and electronics information. 2s our measure of intelligence we used the 1!8! re/ision of the 2rmed Horces Qualification Test A2HQTB which is deri/ed from the four 2$C2D subtests that are the most general and less /ocationall'7s4ecific. namel': arithmetic. word 6nowledge. 4aragra4h com4rehension. and mathematics 6nowledge.1 The 2HQT 4ercentile score was z transformed to Lero mean and unit $5. 2.#. $ea!th outco%es The " items of the +3$75 are each scored 0 to < and the scores summed and L transformed. The $H12 is a/ailable 4re7scored according to the manual A9are. 1osins6i. E 1eller. 1!!=B as two com4onents. 4h'sical and mental A9are et al.. 1!!6B. with higher scores indicating better health. These scores were also L transformed. ?ne of the items in

the $H12. which forms 4art of the 4h'sical com4onent. is self7assessed health AMIn general. would 'ou sa' 'our health isP. 38cellent / Cer' 0ood / 0ood / Hair / ,oorQNB. 2s this item is a widel' re4orted measure of health with good e8ternal and 4redicti/e /alidit'. we ha/e anal'Led the res4onses to this Juestion se4aratel'. ta6ing fair or 4oor health to be a health 4roblem. The section on health conditions begins with a series of nine Juestions of the form M-as a doctor e/er told 'ou that 'ou ha/e PQN 2 4ositi/e res4onse is followed b' a number of su44lementar' Juestions adding detail such as the date of diagnosis and whether the condition is current. 9e ha/e included onl' the res4onse to the initial Juestion. which we refer to as Mdiagnosed conditionsN. Hollowing these nine Juestions there are a further << Juestions of the form: M5o 'ou ha/e an' of the following health 4roblems Aother than 4roblems discussed earlierB P.QN These all ha/e a sim4le 'es/no answer and we refer to these as Mself re4orted health 4roblemsN. The wording of the Juestions used to elicit the diagnosed conditions and self re4orted 4roblems is gi/en in 244endi8 2. 2.&. 'ontro! variab!es There is little e/idence a/ailable on which to base the choice of control /ariables. 4artl' because our stud' includes a wider range of health outcomes than 4rior studies relating earl' IQ to later health. but also because e/idence about 4ossible 4athwa's. mediators and moderators is scarce e/en for the outcomes that ha/e been studied. $ome 4otential confounders which e8ert their influence o/er a range of health outcomes K such as income. education and socio7economic status A$3$B K are 4roblematic as the' ma' mediate the relationshi4 between earl' intelligence and later health. +onseJuentl'. we ha/e 6e4t control /ariables to minimum. $e8. age at baseline inter/iew and age at the later inter/iew are included. In addition. in se4arate models. we used the L transformed 4arental socioeconomic status inde8 deri/ed b' -errnstein and )urra' K a com4osite measure based on 4arental income. education and occu4ational status A-errnstein E )urra'. 1!! B. -owe/er. effect estimates adjusted for 4arental $3$ will be conser/ati/e because the geneticall' inherited com4onent of 4arental intelligence also influences the 4arents@ $3$ A*owe. Cesterdal. E *odgers. 1!!8B. 2.(. )tatistica! ana!yses )i8ed &inear regression models were used for the continuous scores and mi8ed logistic models for the dichotomous health conditions. *andom effects were included to allow for household clustering in the sam4le. 2nal'ses were carried out using 4roc mi8ed and 4roc glimmi8 within $2$ /ersion !.2.

#. *esu!ts
The %&$( 1!"! baseline sam4le of 12.686 re4resents an 8"R res4onse rate from an initial screening of households to identif' those with 'oung 4eo4le in the target age range A1 K21B. Detween 1!!8 and 200 there were ".8 6 of the %&$( 4artici4ants who com4leted the -ealth at 0 module. Those who com4leted the -ealth at 0 module had

significantl' lower 2HQT scores AS 0.1= $5B than those who did not. less education A10. /s 10." 'earsB but there was no difference in 4arental $3$. )en were less li6el' to com4lete the health at 0 module than women A60R /s 6 RB. 2HQT and $3$ data were missing for <6! of the "8 6 and $3$ data for another 1. The anal'ses are based on a sam4le of " "6 with com4lete data on 2HQT. $3$. age and se8. $mall numbers of missing data for the indi/idual health outcomes result in minor /ariations in the sam4le siLe. The wor6ing sam4le had a mean age at baseline of 1".! 'ears and at com4letion of the -ealth at 0 module of 0.6 'ears A$5s were 2.1 and 0.8 'ears. res4ecti/el'B. Hort' eight 4ercent were male. %ineteen 4ercent were -is4anic. <1R blac6 and =0R non7blac6. non7-is4anic. The results of regressing the health scores on the 2HQT score are shown in Table 1. Two sets of results are shown. the first are adjusted for age and se8 and the second for 4arental $3$ as well. ?ne standard de/iation ad/antage in 2HQT is associated with around a fifth of a standard de/iation lower +3$75 score. The $H12 4h'sical and mental health scales are scored so that a higher score indicates better health and here one standard de/iation ad/antage in 2HQT is associated with a si8th of a standard de/iation higher 4h'sical health score but onl' a fifteenth for the mental health score. 2djusting for 4arental $3$ attenuates the relationshi4 with the $H12 ,h'sical com4onent somewhat. Table 1. *egression of +3$ de4ression and $H12 4h'sical and mental health scores on 2HQT
Mode! +"e and se, ad-usted /utco%e +3$75 score $H12 ,h'sical com4onent $H12 )ental com4onent Beta ). t p +"e, se, and ).) ad-usted Beta ). t p

S 0.186 0.011 S 16.1" T 0.0001 S 0.181 0.01 0.1=" 0.061 0.012 1<. 2 0.012 =.1! T 0.0001 0.12= T 0.0001 0.0=6 0.01 0.01

S 12.!! T 0.0001 8.82 <.!8 T 0.0001 T 0.0001

$H12 com4onents are scored so that higher scores indicate better health. $am4les siLes: +3$75. ". =8> $H12. ". 2<.

2s the remaining outcomes are binar'. indicating the 4resence or absence of a health 4roblem. the results are e84ressed as odds ratios together with their !=R confidence limits. The odds ratios themsel/es gi/e the 4ro4ortionate increase or decrease in odds of ha/ing a health 4roblem for one standard de/iation ad/antage in 2HQT score. Calues less than one indicate lower odds of a health 4roblem for higher 2HQT and those abo/e one the con/erse. 9here the !=R confidence inter/al crosses one. the odds ratio is not significantl' different from one. that is. there is no significant ad/antage or disad/antage associated with 2HQT score. Hor self assessed general health Athe Juestion from the $H12B. the odds ratio was 0. ! A!=R +I 0. " to 0.=2. p T .0001B indicating that one standard de/iation ad/antage in 2HQT was associated with a hal/ing of the odds of re4orting fair or 4oor health. 2djustment for 4arental $3$ attenuated this slightl' A?* 0.= !=R +I 0.=1 to 0.="B. The results of logistic regressions of the nine diagnosed conditions on 2HQT are summariLed in Hig. 1 as a 4lot of the odds ratios and their !=R confidence inter/als. In fi/e of the nine conditions the odds of a diagnosed health 4roblem are significantl' lower with higher 2HQT: chronic lung disease. heart 4roblems. h'4ertension. diabetes and arthritis/rheumatism. $tro6e and congesti/e heart failure are rare at these ages Aonl' 20 cases of eachB so that the confidence inter/als are /er' wide. %one of the odds ratios are significantl' greater than one: that is. there is no suggestion that higher cogniti/e abilit' is associated with greater li6elihood of ha/ing an' of the health 4roblems. The numerical results are gi/en in Table 2. These show that adjusting for 4arental $3$ attenuates the odds ratios somewhat Athat is. it brings them closer to oneB and those for diabetes and heart 4roblems were no longer significant.

Hull7siLe image A261B Hig. 1. ?dds ratios Awith bars re4resenting !=R confidence inter/alsB for a diagnosed health 4roblem 4er $5 of 2HQT score K age adjusted. Hilled circles indicate odds ratios significantl' different from 1.

Table 2. ?dds ratio for a diagnosed condition 4er $5 of 2HQT score

$ea!th rob!e%

+"e and se, ad-usted 0es )a% !e /dds 'onfidence p si1e ratio interva! 2182 " =8 " 61 " 60 0.66 0."0 0."8 0.8 0.8 0.88 0.!0 1.02 1.08

+"e, se, and ).) ad-usted /dds 'onfidence p ratio interva! 0. < to 1.=< 0.=16= 0.<2 to 1.0" 0.08< 0.6 to 0.!2 0.00<" 0."< to 1.0< 0.1116 0.8< to 0.!" 0.00 " 0.86 to 1.11 0."0<" 0.82 to 0.!! 0.0<2" 0.!1 to 1.1 0."2=1

$tro6e +ongesti/e heart failure +hronic lung disease -eart 4roblems -'4ertension 5iabetes 2rthritis/rheumatism

20 20 222 228

0.<8 to 1.1= 0.1 "0 0.81 0. 2 to 1.1= 0.1==" 0.=! 0.6" to 0.!0 0.000" 0."" 0."< to 0.!6 0.01<6 0.8" 0."! to 0.8! T.0001 0.8! 0."! to 0.!8 0.0168 0.!8 0.8< to 0.!" 0.00 8 0.!0 0.!< to 1.12 0."010 1.02 0.!1 to 1.28 0.<"=2 0.!0

12"! " 60 <!6 "!" " 61 " = " =8 " 62

3motional/ner/ous/4s'chiatric =<2 %on7s6in cancer 1 =

0."< to 1.11 0.<< !

The Juestion on $tro6e was onl' included in 200 . hence the smaller sam4le siLe.

Hig. 2 shows the com4arable results for the self7re4orted health 4roblems and the numerical results are shown in Table <. -igher 2HQT score is associated with significantl' lower odds of ha/ing the 4roblem for 1= out of the << and higher odds for four. In most cases. adjusting for bac6ground $3$ attenuates the odds somewhat and those for :6idne' or bladder 4roblems; and :tumor/growth/c'st; are no longer significant. ?dds ratios range from 0.6" for e'e 4roblems. i.e. <<R lower odds of ha/ing such 4roblems for one $5 ad/antage in 2HQT score. through 0.88 A12R lower oddsB for de4ression/an8iet'. to 1.1" for high cholesterol A1"R greater oddsB. and 1.<" A<"R higher oddsB for tumor/growth/c'st.

Hull7siLe image A=!1B Hig. 2. ?dds ratios for a self7re4orted health 4roblem 4er $5 of 2HQT score K age adjusted. Hilled circles indicate odds ratios significantl' different from 1.

Table <. ?dds ratio for a self re4orted condition 4er $5 of 2HQT score
$ea!th rob!e% +"e and se, ad-usted 0es 3'e trouble Anot glassesB #lcer $e/ere tooth or gum trouble 34ile4s' or fits $tomach or intestinal ulcers <80 202 62 8 <!6 )a% !e /dds 'onfidence p si1e ratio interva! " = " =0 " == " =2 " =0 " =2 0.6" 0."1 0."< 0." 0."6 0."6 0."" 0.80 0.80 0.8< +"e, se, and ).) ad-usted /dds 'onfidence p ratio interva! 0.6< to 0.8< T .0001 0.6 to 0.!< 0.006! 0.68 to 0.88 T .0001 0. ! to 0.8" 0.00<! 0.6! to 0.!0 0.000 0.=6 to 0.!6 0.02<1 0."< to 0.86 T .0001 0."" to 0.! 0.0010

0.60 to 0."6 T .0001 0."2 0.61 to 0.8< T .0001 0."" 0.66 to 0.81 T .0001 0."" 0.=8 to 0.! 0.012= 0.6=

0.68 to 0.8= T .0001 0."! 0.61 to 0.!= 0.01=< 0."<

&ameness/4aral'sis/4olio != HreJ trouble slee4ing HreJ headaches/diLL'/fainting +hest 4ain/4al4itations 2nemia

11!1 " =< 812 28 <! " == " =1 " 8

0."2 to 0.82 T .0001 0."! 0." to 0.8" T .0001 0.8= 0."2 to 0.8! T.0001 0." to 0.!< 0.001< 0.86 0.82

0."6 to 0.!" 0.01"2 0."1 to 0.! 0.00 !

$ea!th rob!e%

+"e and se, ad-usted 0es )a% !e /dds 'onfidence p si1e ratio interva! 0.8< 0.8 0.8 0.8" 0.88 0.88 0.8! 0.!0 0.!< 0.!6 0.!! 1.01 1.02 1.02 1.0 1.0! 1.11 1.1< 1.1 1.1" 1.18 0."8 to 0.8! T.0001 0."! to 0.8! T.0001 0.60 to 1.1" 0.<0<! 0.80 to 0.!6 0.00<= 0.82 to 0.!= 0.000" 0."! to 0.!! 0.0<12 0.=" to 1.<8 0.=!1= 0."= to 1.0" 0.21"< 0."" to 1.11 0. 220 0.!1 to 1.01 0.1<0" 0."" to 1.2" 0.! 0.!< to 1.0! 0.88!8 0.8 to 1.22 0.868! 0.!< to 1.1< 0.6<28 0.! to 1.16 0. <! 0.!= to 1.26 0.20<2 1.0= to 1.1" 0.0002 0.!6 to 1.<2 0.1 "2 0."" to 1.68 0.=2= 1.0! to 1.26 T.0001 1.0 to 1.<< 0.012

+"e, se, and ).) ad-usted /dds 'onfidence p ratio interva! 0.88 0.8! 0.86 0.8 0.88 0.!2 0.!" 0.!1 0.!1 0.!6 1.01 1.02 1.0 1.02 0.! 1.16 1.08 1.06 0.8 1.26 1.2< 0.81 to 0.!= 0.001! 0.8< to 0.!6 0.002! 0.=8 to 1.28 0. ="< 0."= to 0.! 0.0022

&eg 4ain/bursitis Hoot and leg 4roblems %euritis 2sthma 5e4ression/an8iet' 1idne' or bladder 4robs -ardening of arteries HreJ #TIs $carlet fe/er etc. Dac6 4roblems ?steo4orosis

110" " == 1 80 " == 0 =80 !60 <=2 2< 1=2 12 " <! " 8 " ! " =2 " 2 " == " !

0.81 to 0.!6 0.00=< 0.80 to 1.0= 0.22" 0.=" to 1.6< 0.8!8! 0." to 1.1< 0.<8" 0."< to 1.1< 0.<860 0.!0 to 1.02 0.1!!0 0."= to 1.<8 0.!<21 0.!2 to 1.1< 0."081 0.82 to 1.<1 0."=60 0.!1 to 1.1= 0."="= 0.8< to 1.0" 0.<61= 0.!8 to 1.<" 0.0!08 1.01 to 1.1= 0.026" 0.88 to 1.2! 0.=<1! 0.=1 to 1.<" 0. "!8 1.1= to 1.<8 T.0001 1.0= to 1. < 0.010"

1820 " =2 68 " " " =2 12 1 " =< " <= " ==

Indigestion/stomach/li/er 681 etc ,ainful shoulder/elbow/6nee 3%T trouble &ow blood 4ressure $6in diseases +hronic colds/sinus etc. 2d/erse drug reaction Done/joint deformit' -igh cholesterol Th'roid trouble or goiter 112 "6 <!" 20"

181< " =1 1"6 2< "!! 266 12 0 12 1 "<=1 " 8

$ea!th rob!e%

+"e and se, ad-usted 0es )a% !e /dds 'onfidence p si1e ratio interva! 12 1 12 1 1.<" 1.<8 1.10 to 1."0 0.00"= 0.82 to 2.<0 0.228

+"e, se, and ).) ad-usted /dds 'onfidence p ratio interva! 1.2" 1.6 0.!" to 1.66 0.0862 0.8" to <.0" 0.1<20

Tumor/growth/c'st &oss of finger or toe

86 1<

+onditions with N U 12 1 were onl' included in 1!!8.

&. Discussion
+ogniti/e abilit' assessed with the 2HQT in 'outh is significantl' associated with a wide /ariet' of 4h'sical and mental health outcomes at 0 'ears of age. ?/erall. those with higher mental abilit' tended to re4ort better health. The health outcomes were ascertained using /arious methods: from established scalesVsuch as the +3$75 and $H12Vthrough medicall' diagnosed conditions to self7re4orted 4roblems. The range of health conditions and 4roblems includes both 4s'chological and somatic health and the latter encom4asses numerous bodil' s'stems. 9hilst 0 'ears of age is still relati/el' 'oung for the major causes of death Ae.g. cardio/ascular and res4irator' diseaseB a relationshi4 with intelligence is alread' e/ident. The results ha/e a number of im4lications for cogniti/e e4idemiolog'. in 4articular. and e4idemiolog' more widel'. Hirst. the' suggest that the associations obser/ed between intelligence test scores and later mortalit' are li6el' to be mirrored b' similar associations with morbidit' in mid and later life. 2lthough unsur4rising. this nonetheless gi/es su44ort to the e/idence from mortalit'. In 4articular. the significant associations with diagnosed h'4ertension and self7 re4orted chest 4ain agree with studies showing an association of 4re7morbid intelligence with cardio/ascular morbidit' and mortalit' and with their ris6 factors. The e8ce4tion is the in/erse association with self7re4orted Mhigh cholesterolN. The results for the +3$75 score and self7re4orted de4ression/an8iet' accord with 4re/ious studies AFDatt' et al.. 200=G. F9al6er et al.. 2002G and FIammit et al.. 200 GB but that for diagnosed Memotional. ner/ous. or 4s'chiatric 4roblemsN does not. $econd. the results indicate that the effect of intelligence e8tends more widel'. for e8am4le to res4irator' disease Adiagnosed chronic lung diseaseB> musculos6eletal 4roblems Adiagnosed arthritis/rheumatism> self re4orted :leg 4ain/bursitis; and :foot and leg 4roblems;B and to other. miscellaneous. self re4orted 4roblems Ae.g. anemia. asthma. ulcers. teeth and e'e 4roblemsB. The result for res4irator' disease mirrors the finding of *ichards. $trachan. -ard'. 1uh and 9adsworth A200=B that cogniti/e abilit' at 1= 'ears was related to lung function at < 'ears. The associations with freJuent headaches and

trouble slee4ing are ambiguous as those ma' be s'm4toms of somatic illness or more e/idence of a lin6 with an8iet' and de4ression. The association with e4ile4s' is well established A5odrill E 9ilens6'. 1!!0B e/en to the e8tent that the different subt'4es ma' be distinguished b' the degree of intellectual im4airment A%olan et al.. 200<B. but in this case it is more li6el' either that e4ile4s' has a negati/e im4act on cogniti/e test scores or that both share a common cause. Third. the association of intelligence with di/erse health outcomes together with its 4er/asi/e influence on other im4ortant as4ects of adult life AF0ottfredson. 200 G and F-errnstein and )urra'. 1!! GB suggests that its effect on health ma' also be 4er/asi/e and act through a /ariet' of mechanisms. 9halle' and 5ear' A2001B suggest four t'4es of mechanism b' which intelligence could affect health and longe/it': as a record of bodil' insults> as an indicator of s'stem integrit'> as a 4redictor of health' beha/iours> and as a 4redictor of entr' to safer en/ironments. The lin6 with musculos6eletal 4roblems could be an e8am4le of the latter. with indi/iduals ha/ing lower mental test scores being more li6el' to be in/ol/ed in hea/' manual wor6. +ardio/ascular disease is related. amongst other things. to health beha/iours such as smo6ing AFDatt' et al.. 200"G. FDatt' et al.. 200"G and FTa'lor et al.. 200<GB. alcohol consum4tion AFDatt' et al.. 2006G and FDatt' et al.. 2008GB and diet A0ale. 5ear'. $choon. Datt'. E Datt'. 200"B. The lin6 with e4ile4s' could come under either of the first two mechanisms. 2t least three of the four t'4es of mechanism ha/e been suggested as 4ossible e84lanations for the lin6 with 4s'chiatric disorders AFDatt' et al.. 200=G. F9al6er et al.. 2002G and FIammit et al.. 200 GB. In short. when a broad range of health outcomes is considered. as we do here. the results suggest that multi4le mechanisms ma' well be o4erating. This stud' has a number of notable strengths. The sam4le is large and 4o4ulation based. +ogniti/e abilit' was measured earl' in adolescence when the effects of morbidit' on test scores will ha/e been small. Thus re/erse causation bias will be low. The measure of intelligence used. the 1!8! re/ision of the 2rmed Horces Qualification Test. is highl' g loaded. Wensen A1!80. Table 8.=B estimated the median correlation with other standardiLed tests at 0.81 K higher than the 92I$ and the $tanford Dinet. The stud' has a wide range of outcomes chosen to re4resent a broad 4icture of health in mid life and determined inde4endentl' of an' relation to intelligence. The results include statistical control for bac6ground socio7economic status. There are also some wea6nesses. ,rinci4al amongst these is the fact that the health outcomes are all self7re4orted. The' are. therefore. li6el' to ha/e lower reliabilit' and /alidit' than more objecti/e measures of health. although the use of established scales A+3$75. $H12B and the inclusion of medicall' diagnosed conditions will ha/e mitigated this to a certain e8tent. There is also the 4ossibilit' of intelligence7related bias in both ascertainment and re4orting of health 4roblems. If indi/iduals with higher mental test scores are more li6el' to undergo routine medical chec6u4s and screening. the' would be more li6el' to ha/e health 4roblems disco/ered and diagnosed. 0reater :health literac'; AFDeier and 2c6erman. 200<G and F0ottfredson. 200 GB might also enable them to recall and re4ort these 4roblems at a later date. These tendencies would lead to higher rates

among those with higher intelligence so that the effects re4orted here K generall' in the o44osite direction K would be underestimates. Hor some of the outcomes. the stud' clearl' lac6s statistical 4ower. either because the outcome is rare at the age of 0 Astro6e. congesti/e heart failure. osteo4orosis and hardening of the arteriesB or because enJuiries concerning its 4resence were onl' included 1!!8 A4ainful shoulder/elbow/6nee. ad/erse drug reaction. bone/joint deformit' and loss of finger/toeB. -owe/er. while this lac6 of 4ower is a wea6ness. discounting the outcomes with low 4ower would reinforce the conclusion of a 4er/asi/e. 4redominantl' 4ositi/e. influence of intelligence. The remaining health 4roblems not associated. either wa'. with intelligence would then include se/eral where infection 4la's a large 4art AHreJuent #TIs. $carlet fe/er etc.. 3%T trouble. +hronic coldsB. In some cases. it is not clear what the health 4roblems include. The notable e8am4le is :tumor/growth/c'st; which could include s6in cancer. as this is s4ecificall' e8cluded from the diagnosed cancer. If so. the finding would agree with that of Datt' et al. A200"B. The fact that the odds ratio for :tumor/growth/c'st; is mar6edl' attenuated b' adjusting for 4arental $3$ might also suggest this. but it is not 4ossible to be sure. There are also some differences in com4osition between the baseline sam4le of the %&$("! and that anal'Led here. 2lthough these are small. the 4ossibilit' of some attrition bias cannot be ruled out. +ogniti/e e4idemiolog' is a thri/ing. /igorous. 'oungster showing e/er' sign of a long and 4roducti/e life to come. This ma' be as well. because there is still a great deal to e84lain. The 4resent stud' has begun to fill the e84lanator' ga4 concerning the intelligence7related morbidities that come between the intriguing and im4ortant childhood intelligence7later life mortalit' association.

+c2now!ed"e%ents
0eoff 5er is em4lo'ed b' the #1 )edical *esearch +ouncil. 5a/id Datt' is a 9ellcome Trust Hellow. The #1 )edical *esearch +ouncil and the #ni/ersit' of 3dinburgh 4ro/ide core funding for the )*+ +entre for +ogniti/e 2geing and +ogniti/e 34idemiolog'.

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endi, +. 8uestion wordin" for hea!th conditions

Question wording for diagnosed health conditions

+bbreviated !abe! $tro6e +ongesti/e heart failure +hronic lung disease 9u!! :uestion wordin" -as a doctor e/er told 'ou that 'ou had a stro6eQ -as a doctor e/er told 'ou that 'ou ha/e congesti/e heart failureQ %ot including asthma. has a doctor e/er told 'ou that 'ou ha/e chronic lung disease such as chronic bronchitis or em4h'semaQ -as a doctor e/er told 'ou that 'ou had a heart attac6. coronar' heart disease. angina. congesti/e heart failure. or other heart 4roblemsQ -as a doctor e/er told 'ou that 'ou ha/e high blood 4ressure or h'4ertensionQ -as a doctor e/er told 'ou that 'ou ha/e diabetes or high blood sugarQ

-eart 4roblems

-'4ertension 5iabetes

+bbreviated !abe! 2rthritis/rheumatism

9u!! :uestion wordin" -a/e 'ou e/er had. or has a doctor e/er told 'ou that 'ou ha/e. arthritis or rheumatismQ In what month and 'ear was 'our arthritis or rheumatism diagnosedQ AThis Juestion was used to e8clude re4orts of arthritis or rheumatism from the 4re/ious Juestion that had not been diagnosed.B

3motional/ner/ous/4s'chiatric -as a doctor e/er told 'ou that 'ou had emotional. ner/ous. or 4s'chiatric 4roblemsQ %on7s6in cancer -as a doctor e/er told 'ou that 'ou ha/e cancer or malignant tumor of an' 6ind e8ce4t s6in cancerQ

Question wording for self re4orted health 4roblems 5o 'ou ha/e an' of the following health 4roblemsQ Aother than 4roblems discussed earlierB
+bbreviated !abe! 3'e trouble Anot glassesB #lcer 9u!! :uestion wordin" 3'e trouble. other than glasses or contactsQ #lcerQ

$e/ere tooth or gum trouble $e/ere tooth or gum troubleQ 34ile4s' or fits 34ile4s' or fitsQ

$tomach or intestinal ulcers $tomach or intestinal ulcersQ &ameness/4aral'sis/4olio HreJ trouble slee4ing HreJ headaches/diLL'/fainting +hest 4ain/4al4itations 2nemia &eg 4ain/bursitis &ameness or 4aral'sis Aincluding 4olioBQ HreJuent trouble slee4ingQ HreJuent or se/ere headaches. diLLiness or fainting s4ellsQ ,ain or 4ressure in 'our chest. 4al4itation or 4ounding heart. or heart troubleQ 2nemiaQ $wollen or 4ainful joints. freJuent cram4s in 'our legs or bursitisQ Aarthritis and rheumatism alread' addressedB

+bbreviated !abe! Hoot and leg 4roblems %euritis 2sthma 5e4ression/an8iet' 1idne' or bladder 4robs -ardening of arteries HreJ #TIs $carlet fe/er etc. Dac6 4roblems ?steo4orosis Indigestion/stomach/li/er etc ,ainful shoulder/elbow/6nee 3%T trouble &ow blood 4ressure $6in diseases +hronic colds/sinus etc. 2d/erse drug reaction Done/joint deformit' -igh cholesterol Th'roid trouble or goiter Tumor/growth/c'st

9u!! :uestion wordin" ,roblems with 'our feet and legsQ %euritisQ 2sthmaQ A$hortness of breath or chronic coughQB 5e4ression or e8cessi/e worr' or ner/ous trouble of an' 6indQ 1idne' or bladder 4roblemsQ -ardening of the arteriesQ HreJuent urinar' tract infectionsQ Aother than 6idne' 4roblems discussed earlierB $carlet fe/er. rheumatic fe/er. tuberculosis. jaundice or he4atitisQ ,roblems with 'our bac6Q ?steo4orosisQ HreJuent indigestion. stomach. li/er or intestinal trouble. gall bladder trouble or gallstonesQ ,ainful or Mtric6N shoulder or elbow. Mtric6N or loc6ed 6neeQ 3ar. nose. or throat troubleQ &ow blood 4ressureQ $6in diseasesQ +hronic or freJuent colds. sinus 4roblems. ha' fe/er or allergiesQ 2d/erse or allergic reaction to an' serum. drug or medicineQ Done. joint or other deformit'Q -igh cholesterolQ Th'roid trouble or goiterQ Tumor. growth. or c'stQ Acancerous or non7cancerous. other than those cancers discussed earlierB

+bbreviated !abe! &oss of finger or toe

9u!! :uestion wordin" &oss of finger or toeQ

+orres4onding author. )*+ $ocial and ,ublic -ealth $ciences #nit. 0ardens. 0lasgow. #1.

&il'ban6