Residence in a Coastal communities in adolescence and health in young adulthood: an 11-year follow-up of English UKHLS youth questionnaire respondents

Background The Chief Medical Officer (CMO) for England’s 2021 report showed ecological correlations between small areas in England that were coastal and worse population health outcomes. A burgeoning social epidemiological literature shows that where you grow up plays a role in adulthood health, but there is scant research on how coastal areas impact health. Methods In this retrospective, population-based cohort study (the UK Household Longitudinal Study [UKHLS]), we included all people who had completed a youth questionnaire at age 15 years (or next closest age 10-14), linked to community type (inland or coastal) by lower-super output area (LSOA) of residence in adolescence, and who had responded to at least one adult (age 16+) UKHLS questionnaire during eleven waves of follow-up (2009-2022). The analysis fitted associations of five health outcomes with living in a coastal community in adolescence using regressions models with fixed effects at the individual and study wave, adjusting for clustering of individuals within LSOAs and longitudinal study weighting. We also tested for effect modification between coastal residence and community deprivation (Townsend index). Findings Of 4,921 adolescents aged 10–15 years (at baseline) with follow-up young adult health data, approximately 15.5% resided in a coastal community in adolescence. The median age at baseline was 14.8 years (SD 0.6), the median follow-up was 3.7 waves (range 1-11), and across all 18,324 observations: 22.3% self-reported their health as excellent, 40.4% very good, 28.1% good and 9.3% fair or poor, 15.3% reported a long-standing impairment, illness or disability (LSIID), with mean GHQ-12 scores 11.5 (SD 6.0), mean SF-12 mental component scores (MCS) 46.1 (SD 11.5) and mean SF-12 physical component scores (PCS) 54.9 (SD 6.8). When only community type was fitted in age-adjusted models, coastal community residence was associated with a 1.23 (95% CI: 1.01, 1.49) higher odds of lower SRH and 1.41 (1.03, 1.92) higher odds of LSIID, and no association with GHQ-12, MCS or PCS scores. However, when community deprivation was taken into consideration, all health outcomes except PCS showed worse health in increasingly more deprived communities, and to a greater extent in the most deprived communities that are coastal. Interpretation Young people who grow up in deprived coastal communities have worse health outcomes in young adulthood, than those who grow up in equivalent inland communities. This is especially the case for mental health and wellbeing outcomes, which themselves are often embedded in early life and cause poor physical and mental health in later life. Future research and policy should endeavour to determine what it is about living in a coastal community in adolescence that possibly triggers poor health. Funding UK Economic and Social Research Council.