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Early Life Conditions and Long-Term Sickness Absence During Adulthood – A Longitudinal Study of 9,000 Siblings in Sweden
Abstract
This study examines the influence of health conditions experienced during the individual’s first year of life on the incidence of sickness absence during adulthood. Using a sample of close to 9,000 biological siblings from 17 countries of origin and living in Sweden during the time period 1981-1991, sibling fixed effect models are estimated. This approach is combined with the use of an exogenous measurement of early life conditions, operationalized as the infant mortality rate. The link between early life conditions and later life outcomes is examined both with and without intermediary characteristics observed during the individual’s childhood and adulthood, aiming for a better understanding regarding to what extent the effect of exposure to an early life insult can be mediated. The results suggest that exposure to worse health conditions during the first year of life is associated with an elevated risk of experiencing sickness absence during adulthood. An increase in infant mortality rate by ten per thousand is associated with a four percentage point higher probability of experiencing sickness absence. Despite the importance of adulthood socioeconomic status on sickness absence propensity, these factors do not mediate the influence from the health conditions experienced during the first year of life, suggesting that the association from early life conditions on sickness absence in adulthood operates as a direct mechanism. The link between early life conditions and sickness absence is only present for children to parents with primary schooling and not for individuals with more educated parents. These findings suggest that families with more abundant resources have the ability to protect their child from exposure to adverse health conditions during early life, or to cancel out the influence from an early life insult.
... However, several papers also found that the association between early-life conditions and adult health is robust to adult characteristics. Helgertz and Persson (2014) analyse the influence of health conditions in the first year of life on sickness absence incidence in adulthood. Using a sample of 9000 biological siblings from 17 countries of origin and living in Sweden during the time period 1981e1991, they find that those who were born during a year when infant mortality rates were high have an elevated risk of sickness absence. ...
... The papers that considered effect heterogeneity find evidence for such buffering. Helgertz and Persson (2014) find that the unfavourable link between early-life conditions and later sickness absence is only present for children whose parents had low education. The paper by Helgertz and Våger€ o (2014) provides similar results: The association between being small for gestational age and adult disability was particularly strong among individuals from socioeconomically disadvantaged backgrounds. ...
... The unobserved (time-invariant) individual characteristics refer to factors that are established in childhood and young adulthood, and which remain relatively constant through adulthood. These can include genetic susceptibility (Svedberg et al., 2012), personality (Løset and Tilmann Von Soest, 2023, p. 3;Störmer & Fahr, 2013), temperament (Henderson et al., 2009), cognitive abilities (Henderson et al., 2012), childhood physical and mental health (Delaney & Smith, 2012), childhood socioeconomic environment (Helgertz & Persson, 2014;Kristensen et al., 2009;Kristensen, Bjerkedal, and Irgens 2007;Salonsalmi et al., 2019), and success in school in adolescence (Mittendorfer-Rutz et al., 2013). The magnitude of the influence of these factors on sickness absence varies across time and cohorts, and in interaction with other (time-variant) factors. ...
In this study, we assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce. Utilizing register-based panel data on Finnish wage earners aged 30–62, we examined the annual onset of compensated sickness absence (granted after 10 weekdays) in the period 2005–2016. We applied random effects models adjusting for changes in the observed sociodemographic and occupational characteristics of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for the unobserved time-invariant characteristics of the study population over the years. Of the observed characteristics, increasing educational level partly explained the decreasing trend in sickness absences, and the further contribution of the occupational class was weak. Additionally, accounting for unobserved individual characteristics further explained the decreasing trend in sickness absences among those aged 30–47 years and led to a reverse increasing trend among those aged 48–62 years irrespective of sex and employment sector. Particularly for those over 47 years old, the decrease in sickness absences appeared to be more strongly influenced by compositional changes in characteristics that are established before fully entering the labour market — such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood — than in the work environment or other factors contributing at working age. Sickness absence trends fluctuated during economic cycles, which did not appear to be explained by immediate changes in the observed or unobserved characteristics. Different mechanisms are likely to explain long-term sickness absence trends and trends around economic cycles. Attempts to improve work ability and labour market inclusion in long-term should rely more on increasing educational levels among the workforce and on interventions carried out early during the life course.
... These findings, which are based on the total population of Finland, corroborate results from neighbouring countries, which also have applied family fixed effects methods to study the interrelation between birth order and health related outcomes. In Sweden, higher birth order has been found associated with an increased risk of all-cause sickness absence, but there has not been any study using data on the underlying cause [28]. Later borns in Sweden have been found shorter than earlier borns [29], which is noteworthy, because height is a strong health predictor. ...
Background:
In working ages, sickness absence is strongly related to persons' health condition. We studied how birth order was associated with receipt of sickness allowance, distinguishing between mental disorders, musculoskeletal disorders and injuries.
Methods:
A follow-up study based on the entire Finnish population was conducted for sibling groups born 1969-1982, in which each sibling was observed from age 35 years in the period 2004-2018. Focus was on within-family variation in first-time sickness allowance receipt.
Results:
Results of stratified Cox regressions revealed that each increase in birth order was associated with a slightly higher risk of sickness absence from any cause. For mental disorders, associations were stronger; the hazard ratio as compared to first borns was 1.03 (95% CI: 0.98-1.08) of second borns, 1.10 (0.99-1.22) of third borns, and 1.52 (1.25-1.85) of fourth or higher borns. Corresponding numbers for musculoskeletal disorders were 1.12 (1.07-1.17), 1.19 (1.09-1.30) and 1.15 (0.96-1.38), and for injuries 1.06 (1.01-1.12), 1.09 (1.21-1.14) and 0.96 (0.77-1.20), respectively.
Conclusions:
Birth order effects were generally stronger for women than men, and to some extent influenced by educational level, occupation, income, and family composition. Possible latent mechanisms behind the associations may relate to within-family dynamics at childhood.
... Whether such factors further deteriorate their employment prospects during later life remains unclear, although immigrant-native wages, income, and wealth differentials have been examined extensively. Recent literature connects early life exposure to worse health conditions with an elevated risk of sickness absence over adulthood (Helgertz and Persson, 2014). Since immigrants from less-economically developed countries were likely born where the early life exposure to negative health conditions was higher than for Swedish born natives, their current health outcomes may accordingly differ. ...
The mean age at retirement in Sweden increased roughly one month per year
between 2000 and 2011 (Karlsson and Olsson, 2012). Empirical studies mostly
relate this increase to eligibility requirement changes in the Swedish disability
pension, which became increasingly stringent during the 1990s. Few, however,
have attributed this increase to the 1994 old-age pension reform, which affected
a broad spectrum of older workers. This paper specifically examines whether the
rising retirement age was driven by the 1994 pension reform. The key finding is
that the reform exerted a significant positive effect on the mean age at retirement
for men, yet had little effect for women. For example, the reform raised de
facto retirement age by 2.4 months for men, but merely 0.6 months for women,
among those born in 1944.
... Whether such factors further deteriorate their employment prospects during later life remains unclear, although immigrant-native wages, income, and wealth differentials have been examined extensively. Recent literature connects early life exposure to worse health conditions with an elevated risk of sickness absence over adulthood (Helgertz and Persson, 2014). Since immigrants from less-economically developed countries were likely born where the early life exposure to negative health conditions was higher than for Swedish born natives, their current health outcomes may accordingly differ. ...
Sweden, like many OECD countries, has witnessed a reversal of old-age labor sup-ply, from a trend toward early retirement to a steady increase in the age at labor market exit. This change is widely believed to be a consequence of pension reforms in the 1990s, which increased the stringency of eligibility for disability insurance,while providing financial incentives for postponing retirement. Previous literature on this topic has paid little attention to the possible impact of population compositional change on the reversing old-age labor supply. This paper examines the role of the variation in population characteristics on the changing old-age employment over time. Decomposition analyses show that population structural change explains little of the reversed old-age labor supply trend among men, but one fourth among women, due mainly to the variation in the share of educated female workers.
... Whether such factors further deteriorate their employment prospects during later life remains unclear, although immigrant-native wages, income, and wealth differentials have been examined extensively. Recent literature connects early life exposure to worse health conditions with an elevated risk of sickness absence over adulthood (Helgertz and Persson, 2014). Since immigrants from less-economically developed countries were likely born where the early life exposure to negative health conditions was higher than for Swedish born natives, their current health outcomes may accordingly differ. ...
The mean age at retirement in Sweden increased roughly one month per year between
2000 and 2011 (Karlsson and Olsson, 2012). Empirical studies mostly relate
this increase to eligibility requirement changes in the Swedish disability pension,
which became increasingly stringent during the 1990s. Few, however, have attributed
this increase to the 1994 old-age pension reform, which affected a broad
spectrum of older workers. This paper specifically examines whether the rising
retirement age was driven by the 1994 pension reform. The key finding is that the
reform exerted a significant positive effect on the mean age at retirement for men,
yet had little effect for women. For example, the reform raised de facto retirement
age by 2.4 months for men, but merely 0.6 months for women, among those born
in 1944.
... Whether such factors further deteriorate their employment prospects during later life remains unclear, although immigrant-native wages, income, and wealth differentials have been examined extensively. Recent literature connects early life exposure to worse health conditions with an elevated risk of sickness absence over adulthood (Helgertz and Persson, 2014). Since immigrants from less-economically developed countries were likely born where the early life exposure to negative health conditions was higher than for Swedish born natives, their current health outcomes may accordingly differ. ...
Sweden’s elderly population is growing, propelled by a continuous decline in old-age mortality, while coupled with a persistent replacement level fertility. This changing age structure increases the per worker cost of providing a given age-vector of per capita benefits, encompassing costs for pensions, health care, and all other type of old-age welfare services, which presents a looming challenge for the welfare state to sustain its social transfer system. Options for tackling this daunting challenge, such as increasing fertility and immigration levels, cutting benefits and growing public debts, present numerous obstacles, thus discussion of policy options has shifted the focus towards extending working life. This book contributes to this ongoing policy discussion by exploring the recent trends in labor supply, and investigating the underlying mechanisms driving these trends. The results of this work illustrate a recent trend of prolonging working life in Sweden, whereby average labor income has increased at older ages, and younger cohorts have increasingly postponed their retirement. While these changes are uniform across individuals of different sexes, occupations, and educational levels, the underlying mechanisms appear different. These micro mechanisms may have myriad implications concerning aggregate economic support for the ageing Swedish population. In this regard, the findings in this book are relevant inputs for assessing the welfare consequences of population ageing and deriving evidence-based policy options.
his paper presents formal models of child development that capture the essence of recent findings from the empirical literature on child development. The goal is to provide theoretical frameworks for interpreting the evidence from a vast empirical literature, for guiding the next generation of empirical studies and for formulating policy. We start from the premise that skill formation is a life-cycle process. It starts in the womb and goes on throughout most of the adult life. Families and firms have a role in this process that is at least as important as the role of schools. There are multiple skills and multiple abilities that are important for adult success. Abilities are both inherited and created, and the traditional debate of nature versus nurture is outdated and scientifically obsolete. The technology of skill formation has two additional important characteristics. The first one is that IQ and behavior are more plastic at early ages than at later ages. Furthermore, behavior is much more malleable than IQ as individuals age. The second is that human capital investments are complementary over time. Early investments increase the productivity of later investments. Early investments are not productive if they are not followed up by later investments. The returns to investing early in the life cycle are high. Remediation of inadequate early investments is difficult and very costly
Systematic data on annual infant mortality rates are of use to a variety of social science research programs in demography, economics, sociology, and political science. Infant mortality rates may be used both as a proxy measure for economic development, in lieu of energy consumption or GDP-per-capita measures, and as an indicator of the extent to which governments provide for the economic and social welfare of their citizens. Until recently, data were available for only a limited number of countries based on regional or country-level studies and time periods for years after 1950. Here, the authors introduce a new dataset reporting annual infant mortality rates for all states in the world, based on the Correlates of War state system list, between 1816 and 2002. They discuss past research programs using infant mortality rates in conflict studies and describe the dataset by exploring its geographic and temporal coverage. Next, they explain some of the limitations of the dataset as well as issues associated with the data themselves. Finally, they suggest some research areas that might benefit from the use of this dataset. This new dataset is the most comprehensive source on infant mortality rates currently available to social science researchers.
his paper presents formal models of child development that capture the essence of recent findings from the empirical literature on child development. The goal is to provide theoretical frameworks for interpreting the evidence from a vast empirical literature, for guiding the next generation of empirical studies and for formulating policy. We start from the premise that skill formation is a life-cycle process. It starts in the womb and goes on throughout most of the adult life. Families and firms have a role in this process that is at least as important as the role of schools. There are multiple skills and multiple abilities that are important for adult success. Abilities are both inherited and created, and the traditional debate of nature versus nurture is outdated and scientifically obsolete. The technology of skill formation has two additional important characteristics. The first one is that IQ and behavior are more plastic at early ages than at later ages. Furthermore, behavior is much more malleable than IQ as individuals age. The second is that human capital investments are complementary over time. Early investments increase the productivity of later investments. Early investments are not productive if they are not followed up by later investments. The returns to investing early in the life cycle are high. Remediation of inadequate early investments is difficult and very costly
To describe and explain the socioeconomic gradient in sickness absence.
Analysis of questionnaire and sickness absence data collected from the first phase of the Whitehall II study. Grade of employment was used as a measure of socioeconomic status.
20 civil service departments in London.
6900 male and 3414 female civil servants aged 35-55 years.
Rates of short spells (< or = 7 days) and long spells (> 7 days) of sickness absence.
A strong inverse relation between grade of employment and sickness absence was evident. Men in the lowest grade had rates of short and long spells of absence 6.1 (95% confidence interval 5.3 to 6.9) and 6.1 (4.8 to 7.9) times higher than those in the highest grade. For women the corresponding rate ratios were 3.0 (2.3 to 3.9) and 4.2 (2.5 to 6.8) respectively. Several risk factors were identified, including health related behaviours (smoking and frequent alcohol consumption), work characteristics (low levels of control, variety and use of skills, work pace, and support at work), low levels of job satisfaction, and adverse social circumstances outside work (financial difficulties and negative support). These risk factors accounted for about one third of the grade differences in sickness absence.
Large grade differences in sickness absence parallel socioeconomic differences in morbidity and mortality found in other studies. Identified risk factors accounted for a small proportion of the grade differences in sickness absence. More accurate measurement of the risk factors may explain some of the remaining differences in sickness absence but other factors, as yet unrecognised, are likely to be important.
This paper investigates the social and economic circumstances of childhood that predict the probability of survival to age 85 among African-Americans. It uses a unique study design in which survivors are linked to their records in U.S. Censuses of 1900 and 1910. A control group of age and race-matched children is drawn from Public Use Samples for these censuses. It concludes that the factors most predictive of survival are farm background, having literate parents, and living in a two-parent household. Results support the interpretation that death risks are positively correlated over the life cycle.
We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient.
This longitudinal study of 2 occupational cohorts-5825 London civil servants and 6818 French office-based employees-used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health.
Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health.
Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.
The importance of early life conditions and current conditions for mortality in later life was assessed using historical data from four rural parishes in southern Sweden. Both demographic and economic data are valid.
Longitudinal demographic and socioeconomic data for individuals and household socioeconomic data from parish registers were combined with local area data on food costs and disease load using a Cox regression framework to analyse the 55-80 year age group mortality (number of deaths = 1398).
In a previous paper, the disease load experienced during the birth year, measured as the infant mortality rate, was strongly associated with old-age mortality, particularly the outcome of airborne infectious diseases. In the present paper, this impact persisted after controlling for variations in food prices during pregnancy and the birth year, and the disease load on mothers during pregnancy. The impact on mortality in later life stems from both the short-term cycles and the long-term decline in infant mortality. An asymmetrical effect and strong threshold effects were found for the cycles. Years with very high infant mortality, dominated by smallpox and whooping cough, had a strong impact, while modest changes had almost no impact at all. The effects of the disease load during the year of birth were particularly strong for children born during the winter and summer. Children severely exposed to airborne infectious diseases during their birth year had a much higher risk of dying of airborne infectious diseases in their old age.
This study suggests that exposure to airborne infectious diseases during the first year of life increases mortality at ages 55-80.
Most explanations of the increase in life expectancy at older ages over history emphasize the importance of medical and public health factors of a particular historical period. We propose that the reduction in lifetime exposure to infectious diseases and other sources of inflammation--a cohort mechanism--has also made an important contribution to the historical decline in old-age mortality. Analysis of birth cohorts across the life-span since 1751 in Sweden reveals strong associations between early-age mortality and subsequent mortality in the same cohorts. We propose that a "cohort morbidity phenotype" represents inflammatory processes that persist from early age into adult life.
This paper examines absence behaviour in relation to the working environment. A theoretical model is built in order to separate the effects of voluntary absences and absences related to ill health, where health effects are assumed to be tied to working conditions. This model is based on the Shapiro and Stiglitz efficiency wage model. In addition, work environment is introduced as a part of the compensation package. The model gives a testable hypothesis of compensating wage differentials. A panel of quarterly firm level data from 1990 to 1998 are used and the theoretical model is supported by the empirical findings. The result indicates that the workers may not be fully compensated when experiencing high levels of noise in the work area, or when the job involves a high degree of monotonous work, heavy or frequent lifting or poor work postures. Ill health, and thus increased long-term absence, is not highly related to economic variables. However, long-term absence is relatively higher if the firm is troubled with many accidents or near misses. In addition, disamenities for which workers are not fully compensated cause ill health and increased long-term absence.
Using historical data from cohorts born before the 20th century in four northern European countries, we show that increasing longevity and declining mortality in the elderly occurred among the same birth cohorts that experienced a reduction in mortality at younger ages. Concurrently, these cohorts also experienced increasing adult height. We hypothesize that both the decline in old-age mortality and the increase in height were promoted by the reduced burden of infections and inflammation. Thus, early growth and cardiovascular diseases of old age may share infectious and inflammatory causes rooted in the external environment.
• aging
• vascular disease
• mortality
• historical cohorts
A long latency period between an environmental trigger and the onset of subsequent disease is widely recognized in the etiology of certain cancers, yet this phenomenon is not generally considered in the etiology of other conditions such as cardiovascular disease, metabolic disease, or osteoporosis. However, many lines of evidence, including epidemiologic data and data from extensive clinical and experimental studies, indicate that early life events play a powerful role in influencing later susceptibility to certain chronic diseases.
We analyze the effect of economic incentives on worker absenteeism, using panel data on work absence for 1990 and 1991 with a sample of 1,396 Swedish blue-collar workers. During this period Sweden implemented major reforms of both its national income replacement program for short-term sickness and income taxes. Both affected the worker's cost of missing work. Our econometric model allows for state-dependent dynamic behavior and control for unobserved heterogeneity. The latter proves to be an important consideration. We find that the cost of being absent significantly affects work absence behavior.
We analyze the effect of economic conditions early in life on individual mortality rate later in life, using business cycle conditions early in life as an exogenous indicator. Individual records from Dutch registers of birth, marriage, and death, covering a window of unprecedented size (1912-2000) are merged with historical data on macroeconomic and health indicators. We correct for secular changes over time and other mortality determinants. We nonparametrically compare those born in a recession to those born in the preceding boom, and we estimate duration models where the individual's mortality rate depends on current conditions, conditions early in life, age individual characteristics, including individual socio-economic indicators, and interaction terms. The results indicate a significant negative effect of economic conditions early in life on individual mortality rates at all ages.
Utilizing the 'Metropolitan' database, which provides unique longitudinal data on a cohort of 15,000 individuals born in Stockholm in 1953, the paper tests various hypotheses on how conditions in childhood and social upbringing influence sickness absence in adulthood. The hypotheses were derived from different perspectives within the social sciences. The findings suggest that the effects of social background are transmitted via several mechanisms, and that it is useful to see some of the competing hypotheses on social class and health-related phenomena as complementary rather than contradictory. However, the results also suggest that both 'the culture of poverty hypothesis' and the 'biological imprint hypothesis' should be rejected. Because effects of social background are mediated by career variables such as school performance, educational level and current socio-economic status, the results support the 'unfavourable life career hypothesis'. In addition to these effects, an influence of being brought up in a family with serious domestic problems is found. This is congruent with 'the social imprint hypothesis', that childhood conditions may have lasting effects on conditions and behaviours in adult life, irrespective of later exposure.
Serious life events, such as the loss of a relative or the onset of a chronic condition may influence cognitive functioning. We examine whether the cognitive impact of such events is stronger if conditions very early in life were adverse, using Dutch longitudinal data of older persons. We exploit exogenous variation in early-life conditions as generated by the business cycle. Copyright © 2010 TheAuthor(s). The Economic Journal © 2010 Royal Economic Society.
This study identifies factors influencing the differences in utilization of sickness benefits between immigrants and natives in Sweden. The main conclusion is that the differences in consumption of sickness benefits between foreign born and Swedes, as well as between various immigrant groups are large and persist after accounting for standard human capital factors. In fact, the difference due to country of birth is larger than differences due to other human capital factors such as education and sex. It is also larger than income position and urban/rural differences. It is, however, not simply a matter of arriving as labor immigrant or asylum seeker but has a more complex pattern. This study utilizes a register-based panel containing economic and demographic information on a sample of 110,000 Swedes and immigrants from 16 countries.
Using a linear demand function, frequently used in labour supply studies, absenteeism is modelled as an individual day-to-day decision. The parameters in the econometric model are consistently estimated, using the (time-aggregated) number of days absent in 1981 as the dependent variable for a sample of Swedish blue-collar workers (both men and women), under some assumptions on unobserved heterogeneity and serial correlation. Implications of compensating wage differentials and efficiency wage hypotheses are discussed. The results for the male subsample reveal a negative effect on work absence of the direct cost of being absent. However, for the female subsample, the Slutsky condition is rejected.
This article analyzes the role of age at immigration for the school performance gap between native and immigrant pupils in Sweden. The analysis exploits within-family variation in a large set of register data on immigrant siblings (and native children) graduating from compulsory school (normally at age 16) between 1988 and 2003. The critical age at arrival is about nine, above which there is a strong negative impact on performance. The slopes of these age-at-immigration performance profiles are similar for boys and girls as well as for children from different family backgrounds, but they vary widely by region of origin. Moreover, the estimated profiles are flatter for Mathematics than for a range of subjects taken together. This demonstrates the importance of Sweden-specific skills. A comparison of sibling-difference and cross-sectional estimates reveals that they are strikingly similar.
An empirical investigation of trade-offs between number of children and their scholastic performance confirms that family size directly affects children's achievement. Though parents show no favoritism to first-born children, being early in the birth order implies a distinct advantage, entirely because of the higher probability of being in a small family. Recent large changes in family size explain a portion of aggregate test score declines, but increased divorce rates and market work by mothers have no apparent impact. Finally, teachers are shown to differ enormously, even though performance differences are poorly captured by commonly measured teacher characteristics. Copyright 1992 by University of Chicago Press.
Norwegian counties show considerable variations in their rates of mortality from arteriosclerotic heart disease. These variations cannot be explained by present-day differences in standard of living. Such differences did exist in the past as was shown by large variations in infant mortality. A significant positive correlation has been found between the county age-adjusted mortality from arteriosclerotic heart disease in people aged between 40 and 69 years and county infant mortality relating to the early years in the same cohorts. The findings suggest that great poverty in childhood and adolescence followed by prosperity, is a risk factor for arteriosclerotic heart disease.
PIP
Researchers analyzed data from the National Child Development Study--a cohort of every child born in England, Scotland, and Wales during the 1st week of March 1953 with follow up studies in 1965, 1969, 1973, and 1980-1981 to examine the relationship between health status and birth order and whether children with low birth orders were less likely to experience illness than those with older siblings. 1st born children tended to have received the needed number of immunizations, but children of higher birth order did not tend to have received them. Further they were more likely to have attended infant welfare and toddler clinics for health care than children of higher birth order. The only childhood contagious disease which demonstrated a social class effect was pertussis. It tended to afflict children from nonmanual homes regardless of birth order. Absences from school lasting between 1 week-1 month of 1st born children were less frequent than for other children. The leading reasons for 1st, 3rd, and later born 11 year old children who experienced such long absences included infectious diseases; bronchitis; ear, nose, and throat complaints; pneumonia; tonsillitis, or viral influenza. After age 15, 1st and 2nd born children were less likely to be absent and, if absent, they tended to only miss 1 week of school. Significantly more 3rd and 4th born children were absent from school for 1 week-3 months. 1st and 2nd born children from more affluent families tended to have early childhood asthma. In conclusion, the health experiences of the later birth orders were different than those of the 1st born. This did not mean, however, that later birth order children were in poorer health than 1st born children.
A preliminary examination of the relationship between the infant mortality of US birth cohorts and their mortality in later life suggested that infant mortality from diarrhoea and enteritis was particularly influential. In the 1917-21 birth cohorts of 17 US Registration States, infant mortality from diarrhoea and enteritis was significantly related to arteriosclerosis heart disease at ages 40-44 and 50-54 in both sexes, and to respiratory cancer at the same ages in men, after controlling for contemporary infant mortality. Hypotheses suggest by these relationships are put forward.
The certified sickness absence of 4482 employees in one plant of a large manufacturing company in South-east England was studied for 12 months. The absences in the principal ethnic groups, Caucasian, Asian, and West Indian were compared. After standardisation for age and job grade in each department the Asians had twice the spells per man and nearly twice the days lost per man compared with the Caucasians. Compared with the Caucasians there was slightly more absence in West Indians. Various factors affect absence, and one reason for these differences may be that the three ethnic groups appreciate painful or unpleasant stimuli to a different degree.
In a nationally representative British sample of over 3000 men and women aged 36 years, those in the best or worst of health were identified on the basis of measured blood pressure, lung function and body weight, self reported health problems and disability, and recent hospital admission. Serious illness in earlier life was strongly predictive of current adult health status. Even after adjusting for this and for current social circumstances and health related behaviour, those who came from poorer family backgrounds or were least well educated did not have an equal chance of being in the best of health at 36 years. Living in adverse social circumstances in adult life increased the risk of having the worst health. The analysis suggests that a number of pathways link childhood experiences to adult health and shows the need for a lifetime research perspective on health.
Evidence is presented for a pathways model linking early life factors and adult disease, which takes account of the inter-relationships between social and biological risks throughout the lifecourse. Few studies, if any, have yet recorded adequate birth to death information which could be used to quantify the effects of different factors and their timing. Hence, there is only limited understanding of the extent to which biological and social risks experienced at different life stages combine to influence adult disease. However, some of the pathways between early and later life are suggested when evidence from earlier stages of the lifecourse is linked to that from studies at older ages, in which adult disease risk factors have been established. Further support for pathway effects is provided by studies showing that health outcomes of early biological insults can depend on the subsequent social and biological environment. Thus, it is argued that adult disease will be more fully understood when account is taken of the combined effects of social and biological risk occurring at different life stages.
The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.
To investigate the association between social circumstances in childhood and mortality from various causes of death in adulthood.
Prospective observational study.
27 workplaces in the west of Scotland.
5645 men aged 35-64 years at the time of examination.
Death from various causes.
Men whose fathers had manual occupations when they were children were more likely as adults to have manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all P<0.05), generally increasing from men whose fathers had professional and managerial occupations (social class I and II) to those whose fathers had semiskilled and unskilled manual occupations (social class IV and V). Relative rates of mortality adjusted for age for men with fathers in manual versus non-manual occupations were 1.52 (95% confidence interval 1.24 to 1.87) for coronary heart disease, 1.83 (1.13 to 2. 94) for stroke, 1.65 (1.12 to 2.43) for lung cancer, 2.06 (0.93 to 4. 57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratory disease. Mortality from other cancers and accidental and violent death showed no association with fathers' social class. Adjustment for adult socioeconomic circumstances and risk factors did not alter results for mortality from stroke and stomach cancer, attenuated the increased risk of coronary heart disease and respiratory disease, and essentially eliminated the association with lung cancer.
Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood.
Following population reconstructions, age-specific death rates and life tables are computed for five-year periods during 1816-1905 for the three largest urban departements of France. During the early decades of the period, life expectancy at birth in the urban departements is about five to ten years lower than that of France as a whole. At some point after the mid-century, the gap in each of the three is reduced. However, the timing of accelerated mortality reduction varies considerably and appears to be related to the timing of improvements in water supply and sewerage. This inference is supported by cross-sectional and time series records on causes of death. In Bouches-du-Rhone, where water-support systems were not modernised until the 1890s, life expectancy in 1871-90 was only 1.5 years higher than in 1816-45; and water- and food-borne diseases account for a major amount of its disadvantage relative to the other departements. A striking tendency is revealed for mortality gains after mid-century to proceed in a cohort-specific fashion. The hypothesis is put forward that water and sewerage improvements, by reducing the burden of intestinal (and probably respiratory) diseases among young children, resulted in improved physical growth and development. These improvements, in turn, led to mortality reductions at later ages. Nutritional advances cannot be ruled out as important contributors to the revealed patterns. However, the independent role of the early disease environment seems to deserve greater emphasis than it has often received.
This paper assesses the importance of early-life conditions relative to the prevailing conditions for mortality by cause of death in later life using historical data for four rural parishes in southern Sweden for which both demographic and economic data are very good. Longitudinal demographic data for individuals are combined with household socio-economic data and community data on food costs and the disease load using a Cox regression framework. We find strong support for the hypothesis that the disease load experienced during the first year of life has a strong impact on mortality in later life, in particular on the outcome of airborne infectious diseases. Hypotheses about the effects of the disease load on mothers during pregnancy and access to nutrition during the first years of life are not supported. Contemporary short-term economic stress on the elderly was generally of limited importance although mortality varied by socio-economic group.
To quantify the impact of publication criteria on differences in published national perinatal mortality rates among Western European countries.
Descriptive study of perinatal mortality rates in Western European countries with adjustments for international differences in publication data.
All live births and perinatal deaths in 1994 in Western European countries.
The 1994 perinatal mortality rates were obtained from national and Eurostat publications for Belgium, Denmark, Finland, France, Germany, Greece, The Netherlands. Norway, Portugal, Spain, Sweden, United Kingdom (England, Wales, Scotland, Northern Ireland). Two methods, one direct and one indirect, were used for adjusting these officially published rates for differences in registration laws or publication practices. For the indirect method adjustment factors were derived from an analysis of a large Finnish database using different cutoff points for gestational age and birthweight. For the direct method a common cutoff point was imposed for birthweight (1000g) and gestational age (28 completed weeks) on national perinatal mortality data, obtained from civil registration or hospital/obstetrics databases in each country.
The published perinatal mortality rates ranged from 5.4 per 1000 total births in Sweden and Finland to 9.7 in Greece and Northern Ireland. The indirect adjustment method showed that some countries apply cutoff points for registration or publication of perinatal mortality which may raise the perinatal mortality rate by up to 17% above the most commonly used threshold for including live and stillbirths. The direct adjustment method showed that a common lower limit of 1000g for birthweight or 28 weeks for gestational age would reduce the perinatal mortality rate, but by a differing extent ranging from 14% to 40%. Both adjustment methods reduced the contrast between the countries' perinatal mortality rates, and changed their rank order.
These quantitative results confirm that international differences in countries' published perinatal mortality rates partly reflect differences between countries' criteria for registration and publication of perinatal deaths.
"This paper considers the effects of health conditions in childhood on an individual's mortality risks as an adult. It examines epidemiologic evidence on some of the major mechanisms expected to create a linkage between childhood and adult mortality and reviews demographic and epidemiologic studies for evidence of the hypothesized linkages....Many empirical studies support the notion that childhood conditions play a major role in adult mortality, but only in the case of respiratory tuberculosis has the demographic importance of a specific mechanism been established by cohort studies. One's date and place of birth also appear to be persistently associated with risks of adult death in a wide variety of circumstances. An individual's height, perhaps the single best indicator of nutritional and disease environment in childhood, has recently been linked to adult mortality, especially from cardiovascular diseases. Further research is needed, however, before causal mechanisms can be identified."
This study uses microdata from the 1972-1981 National Health Interview Surveys (NHIS) to examine how health status and medical care utilization fluctuate with state macroeconomic conditions. Personal characteristics, location fixed-effects, general time effects and (usually) state-specific time trends are controlled for. The major finding is that there is a counter-cyclical variation in physical health that is especially pronounced for individuals of prime-working age, employed persons, and males. The negative health effects of economic expansions persist or accumulate over time, are larger for acute than chronic ailments, and occur despite a protective effect of income and a possible increase in the use of medical care. Finally, there is some suggestion that mental health may be procyclical, in sharp contrast to physical well-being.
To determine the extent to which sickness absence is predictive of mortality.
Prospective cohort study. Data on medically certified long term absences (>3 days), self certified short term absences (1-3 days), and sick days were derived from employers' records and data on mortality from the national mortality register.
10 towns in Finland.
12821 male and 28915 female Finnish municipal employees with a job contract of five consecutive years. The mean follow up was 4.5 years.
After adjustment for age, occupational status, and type of employment contract, the overall mortality rate was 4.3 (95% confidence intervals 2.6 to 7.0) and 3.3 (2.1 to 5.3) times greater in men and women with more than one long term absences per year than in those with no absence. The corresponding hazard ratios for more than 15 annual sick days were 4.7 (2.3 to 9.6) and 3.7 (1.5 to 9.1). Both these measures of sickness absence were also predictive of deaths from cardiovascular disease, cancer, alcohol related causes, and suicide. Associations between short term sickness absences and mortality were weaker and changed to non-significant after adjustment for long term sickness absence.
These findings suggest that measures of sickness absence, such as long term absence spells and sick days, are strong predictors of all cause mortality and mortality due to cardiovascular disease, cancer, alcohol related causes, and suicide.
There is convincing evidence that exposures acting across the life course influence adult health outcomes (1–3). Lifecourse epidemiology examines a range of potential processes through which exposures acting at different stages of life can, singly or in combination, influence disease risk (table 1) (4). In the critical period model, an exposure acting at a specific time has long-lasting effects on the structure or function of the body. The fetal origins hypothesis, in its original formulation, took this approach (5). Other examples of processes where outcomes appear to depend upon the time window during which an exposure acts are limb development (in relation to maternal thalidomide use); infection with hepatitis B and risk of adulthood liver cancer (with very early postnatal infection being most implicated); and environmental lead exposure, which results in serious neurodevelopmental deficits only if occurring in infancy and childhood (3). However, the influence of exposures acting during critical periods of susceptibility may be modified by later life exposures. This is the case for the associations of birth weight with coronary heart disease, high blood pressure, and insulin resistance, where associations are stronger (or only evident) among those who become obese during adolescence or adulthood (6–8).
We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age-the years in which they themselves become parents.
Sickness absence tends to be negatively correlated with unemployment rates. In addition to pure health effects, this may be due to moral hazard behavior by workers who are fully insured against income loss during sickness and to physicians who meet demand for medical certificates. Alternatively, it may reflect changes in the composition of the labor force, with more sickness-prone workers entering the labor force in upturns. A panel of Norwegian register data is used to analyze long-term sickness absences. The unemployment rate is shown to be negatively associated with the probability of absence, and with the number of days of sick leave. Restricting the sample to workers who are present in the whole sample period, the negative relationship between absence and unemployment becomes clearer. This indicates that procyclical variations in sickness absence are caused by established workers and not by the composition of the labor force.
In order to investigate the extent to which musculoskeletal sickness absence was influenced by a range of circumstances concerning family background and health in early life, we established a register-based cohort of all live-born in Norway between 1967 and 1976. Personal data on parental factors and health early in life were recorded prospectively from birth onward in the Medical Birth Registry of Norway, the National Insurance Administration, Statistics Norway, and the Central Population Register. We collected data in the National Insurance Administration on the first spell of medically certified long-term (>16 days) musculoskeletal (International Classification of Primary Care group L) sickness absence in 2000-2003 among 378, 356 participants who were considered to be at risk of sickness absence on January 1st, 2000. The 4-year musculoskeletal absence risk was 0.264 for women and 0.156 for men. Parental education level was associated with musculoskeletal sickness absence, with increasing adjusted relative risks by decreasing educational level for both genders. Associations with other early determinants (birth weight, childhood disease, parental survival, parental disability, parental income, and parental marital status) were all close to unity. Parental education level attributed 36% (95% confidence interval 33-38) to the population risk for women and 67% (64-70) for men. The parental education association was partly mediated through own educational attainment, which was strongly associated with musculoskeletal sickness absence in itself. Our data suggest that mechanisms acting early in life could influence later risk of musculoskeletal sickness absence.
This article begins the synthesis of two currently unrelated literatures: the human capital approach to health economics and the economics of cognitive and noncognitive skill formation. A lifecycle investment framework is the foundation for understanding the origins of human inequality and for devising policies to reduce it.
• Barker hypothesis
• critical periods
• early childhood
• sensitive periods
To update a systematic review on the association between childhood socioeconomic circumstances and cause-specific mortality. Studies published since 2003 include a far greater number of deaths than was previously available justifying an update of the previous systematic review.
Individual-level studies examining childhood socioeconomic circumstances and adult overall and cause-specific mortality published between 2003 and April 2007.
The new studies confirmed that mortality risk for all causes was higher among those who experienced poorer socioeconomic circumstances during childhood. As already suggested in the original systematic review, not all causes of death were equally related to childhood socioeconomic circumstances. A greater proportion of new studies included women and showed that a similar pattern is valid for both genders. In addition, the new studies show that this association persists among younger birth cohorts, despite temporal general improvements in childhood conditions across successive birth cohorts. The difficulties of establishing a particular life-course model were highlighted.
There are many possible pathways between parental education, income, and health, and between child health and education, but only some of them have been explored in the literature. This essay focuses on links between parental socioeconomic status (as measured by education, income, occupation, or in some cases area of residence) and child health, and between child health and adult education or income. Specifically, I ask two questions: What is the evidence regarding whether parental socioeconomic status affects child health? And, what is the evidence relating child health to future educational and labor market outcomes? I show that there is now strong evidence of both links, suggesting that health could play a role in the intergenerational transmission of economic status.
Sickness absence as a predictor of mortality among male and female employees Economic conditions early in life and individual mortality. The American Economic Review, 290e302 The role of early-life conditions in the cognitive decline due to adverse events later in life
- M Susser
- Z Stein
- e
- J Vahtera
- J Pentti
- M Kivimäki
- G J Berg
- M Lindeboom
- F Portrait
- Van
- G J Berg
- D J H Deeg
- M Lindeboom
- F J Portrait
- M R Helgertz
- Persson
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