Hill Kulu’s research while affiliated with Andrew University and other places

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Publications (133)


The changing inter-relationship between partnership dynamics and fertility trends in Europe and the United States: A review
  • Article

January 2025

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16 Reads

Demographic Research

Bernice Kuang

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Ann Berrington

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Hill Kulu

Correction: All-cancer incidence and mortality in Pakistanis, Bangladeshis, and their descendants in England and Wales
  • Article
  • Full-text available

December 2024

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2 Reads

BMC Public Health

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Figure 1 Possibilities of entering and exiting the cohort for eight hypothetical individuals demonstrated in a Lexis diagram. Numbers and percentages in the diagram key are the authors' own calculations based on data from the Scottish Longitudinal Study. The green vertical line represents the starting year of follow-up (2002) after excluding the 2001 observations. Individuals can be followed up until the last year of observation, which is 2017 when they are censored (eg, individual Nos 1 and 6), until they die (eg, individual Nos 2, 4 and 5), or until they migrate without returning to Scotland during the observation period 2002-17 (eg, individual No 3) or migrate and then return to Scotland and thus to our study within the follow-up period (eg, individual Nos 7 and 8). In this context, individual No 7 was followed between 2002 and 2005 and then between 2010 and 2017, inclusive. The years spent by individual No 7 outside of Scotland (2006-09) due to migration were excluded from the analysis. Similarly, individual No 8 was present in 2002 and then was followed from 2012 to 2017, with the years spent abroad (2003-11) due to migration excluded from the analysis. This Lexis diagram further reveals that individuals can enter and exit the cohort based on four scenarios. Firstly, individuals can be followed for the whole study period (2002-17) and then be censored, migrate, or die in 2017. Secondly, individuals can exit the cohort before 2017 due to death in any year during the follow-up period (2002-17). Thirdly, individuals can exit the cohort due to migration out of Scotland, without returning during the follow-up time (2002-17). Fourthly, individuals can exit the cohort due to out migration, but then they re-enter the cohort in later years due to returning to Scotland within the follow-up time (2002-17). If individuals migrate out of Scotland and then return in the same year, this short term migration is disregarded because the individual stayed in Scotland for some months of the full calendar year. If an individual comes back to Scotland from a previous year migration and then migrates out again within the same year, the individuals' observations for that year are kept because some months out of the full calendar year have been spent in Scotland.
Description of hospital admissions (n=2 810 414 observations, study period 2002-17)
Long term exposure to ambient air pollution and hospital admission burden in Scotland: 16 year prospective population cohort study

December 2024

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7 Reads

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1 Citation

BMJ Open

Objectives Air pollution is considered a major threat for global health and is associated with various health outcomes. Previous research on long term exposure to ambient air pollution and health placed more emphasis on mortality rather than hospital admission outcomes and was characterised by heterogeneities in the size of effect estimates between studies, with less focus on mental/behavioural or infectious diseases outcomes. In this study, we investigated the association between long term exposure to ambient air pollution and all cause and cause specific hospital admissions. Design This was a prospective cohort study. Setting Individual level data from the Scottish Longitudinal Study (SLS) were linked to yearly concentrations of four pollutants (nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ), particulate matter diameter ≤10 µm (PM 10 ) and particulate matter diameter ≤2.5 µm (PM 2.5 )) at 1 km ² spatial resolution using the individual’s residential postcode for each year between 2002 and 2017. Participants The study included 202 237 adult individuals aged ≥17 years. Outcome measures The associations between air pollution and all cause, cardiovascular, respiratory, infectious, mental/behavioural disorders and other cause hospital admissions were examined using multi-level, mixed effects, negative binomial regression. Results Higher exposure to NO 2 , PM 10 and PM 2.5 was associated with a higher incidence of all cause, cardiovascular, respiratory and infectious hospital admissions before adjusting for the area of residence, and in fully adjusted models when considering cumulative exposure across time. In fully adjusted models, the incidence rate for respiratory hospital admissions increased by 4.2% (95% CI 2.1% to 6.3%) and 1.2% (95% CI 0.8% to 1.7%) per 1 µg/m ³ increase in PM 2.5 and NO 2 pollutants, respectively. SO 2 was mainly associated with respiratory hospital admissions (incidence rate ratio (IRR)=1.016; 95% CI 1.004 to 1.027) and NO 2 was related to a higher incidence of hospital admissions for mental/behavioural disorders (IRR=1.021; 95% CI 1.011 to 1.031). Average cumulative exposure to air pollution showed stronger positive associations with higher rates of hospital admissions. Conclusions The results of this study support an association between long term (16 years) exposure to ambient air pollution and increased all cause and cause specific hospital admissions for both physical and mental/behavioural illnesses. The results suggest that interventions on air pollution through stricter environmental regulations could help ease the hospital care burden in Scotland in the long term.


First birth rates (per 1,000 childless women) by municipality level of urbanization, ages 18–49, 2012–2018
First birth rates (per 1,000 childless women) by economic activity, selected ages 18–49, 2012–2018
Predictive margins of economic activity, not showing students, on the probability of having a first birth by level of urbanization for a women aged 18–29 and b women ages 30–49, 2012–2018. Notes: Appendix B Table B.1 shows results from these models displayed as average marginal effects. Models control for age, education, country of birth, recent move, household income, municipality proportion unemployed, municipality TFR, municipality population density, year, and random effects of municipality
Urban–Rural Disparities in the Transition to Parenthood During Times of Uncertainty: A Multilevel Perspective on Finland

December 2024

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16 Reads

European Journal of Population

Nicholas Campisi

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Hill Kulu

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[...]

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Mikko Myrskylä

Over the last 15 years, many European countries have experienced fertility declines. Existing research on this shift in fertility behavior points to economic aspects and increased levels of uncertainty as important drivers. However, in this debate little attention has been paid to how the relevance of individual- and contextual-level dimensions for understanding the new fertility patterns varies by level of urbanization. This is surprising given that urban and rural areas not only differ strongly in fertility timing and levels, but also in economic conditions. Our paper fills this important research gap by analyzing rich register data from Finland using multi-level event history models to study the transition to first birth among younger (under age 30) and older (ages 30 or older) women. We show that urban–rural differences in the transition to parenthood are particularly pronounced among younger women. In addition, the results indicate that economic circumstances and related uncertainties are more relevant for understanding first births probabilities for younger women than older women. Finally, among younger women, the relevance of economic circumstances and related uncertainties seems to be most relevant in the capital region of Helsinki and urban areas compared to semiurban and rural areas. Our findings underline that the urban–rural dimension should receive more attention in research on fertility in times of uncertainty.


Exclusion criteria and numbers excluded. Note: Initially defined are individuals born 1920–1991, who are present at one census from 1971 to 2011, and match the origins under study. Source: ONS-LS
Hazard ratios of first adult cancer incidence. Note: Reference category is White British. 95% Confidence intervals shown. Source: Authors’ calculations using ONS-LS
Hazard Ratios of cancer death following incidence. Note: Reference category is White British. 95% Confidence intervals shown. Source: Authors’ calculations using ONS-LS
Cox proportional hazard model: first cancer incidence in adulthood
All-cancer incidence and mortality in Pakistanis, Bangladeshis, and their descendants in England and Wales

BMC Public Health

Background This paper identifies differences in all-cancer incidence and mortality between Pakistani-born (PB), Bangladeshi-born (BB), their descendants, and the White British (WB) in England and Wales. Pakistanis and Bangladeshis are the most marginalised and disadvantaged groups in England and Wales yet, are found to have low cancer mortality and low all-cause mortality. Previous studies though have not looked at generational differences, applied individual-level data nor separated Pakistanis and Bangladeshis from each other and other Asian groups. Methods We use the Office for National Statistics Longitudinal Study of England and Wales which is a 1% representative sample of the population. We apply event history analysis on a study period from 1971 to 2016, following individuals from age 20 until a first cancer incidence, censoring at emigration or death. We observe 10,885,500 person-years and 71,926 cancer incidences for WB; 125,700 person-years and 295 events for PB; 53,900 person-years and 113 events for BB and 26,900 person-years and 24 events for descendants. Following incidence, we study a maximum of ten years until a death from cancer, or censoring. In this second analysis on mortality our sample has 329,700 person-years and 31,689 cancer deaths for WB; 1,200 person-years and 104 events for PB; 400 person-years and 50 events for BB and 100 person-years and 10 events for descendants. Results Results from the fully adjusted models show that the risk of cancer incidence is lower for PB, BB and descendants compared to the WB native group. Estimated hazard ratio (HR) equals 0.42 for PB (95% confidence interval (CI): 0.38–0.47), for BB HR is 0.38 (CI: 0.32–0.46) and, for descendants HR is 0.36 (CI: 0.24–0.54). Results for cancer mortality after incidence show HR for PB is 0.93 (CI: 0.76–1.12), for BB it is 0.95 (CI: 0.72–1.25) and for descendants HR equals 1.62 (CI: 0.87–3.02 - significant at 90%). Conclusions Using high quality representative data, we show that lower incidence of cancer and not better survival is the driver of the low cancer mortality previously found. This advantage persists across immigrant generations, but all-cancer mortality following incidence may be elevated for descendants.




Relative risks of employment entry and exit by origin and parity for women (Model 2).
Relative risks of employment entry and exit by origin and parity for men (Model 2).
Family Formation and Employment Changes Among Descendants of Immigrants in France: A Multiprocess Analysis

September 2024

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19 Reads

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1 Citation

European Journal of Population

This paper investigates the association between family formation and the labour market trajectories of immigrants’ descendants over the life course. Using rich data from the Trajectories and Origins survey from France, we apply multilevel event history models to analyse the transitions in and out of employment for both men and women by parity. We account for unobserved co-determinants of childbearing and employment by applying a simultaneous-equations modelling. Our analysis shows that women’s professional careers are negatively associated with childbirth. There are differences across descendant groups. The female descendants of Turkish immigrants are more likely to exit employment and less likely to re-enter employment following childbirth than women from other groups. The negative impact of childbearing on employment is slightly overestimated among women due to unobserved selection effects. Among men, the descendants of European immigrants are less likely to exit employment after having a child than other descendant groups. The study demonstrates the negative effect of childbearing on women’s employment, which is pronounced for some minority groups suggesting the need for further policies to help women reconcile work with family life.



Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States

May 2024

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5 Reads

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1 Citation

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

Objectives To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States. We also assess MMLE inequalities by sex and education. Methods Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of two or more chronic diseases. Disability is defined using limitations in activities of daily living. Results Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated. Discussion Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts.


Citations (75)


... Lead author Guoxing Li, an environmental toxicologist at Peking University in China, emphasizes that even very low exposure levels increased the risk of these conditions. Last month, a 16-year study of more than 200,000 residents in Scotland found that higher cumulative nitrogen dioxide exposure was associated with increased hospital admissions for mental-health and behavioural disorders 12 . ...

Reference:

Air pollution and brain damage: what the science says
Long term exposure to ambient air pollution and hospital admission burden in Scotland: 16 year prospective population cohort study

BMJ Open

... Kulu's research concerns the internal migration of people in Ukraine and how it is related to the development of specific regions, stressing the importance of providing for internally displaced persons and facilitating their integration [6]. Sundqvist [7] draws attention to the assertion that the war has compelled vast external migration, which has transformed the demographic and labour market of the country. ...

The war, refugees, and the future of Ukraine's population

Population Space and Place

... Assimilation theories posit that migrant family behaviours change based on the cultural distance between sending and destination country, time since arrival, and migrant generation . Across Europe, descendants of immigrants often exhibit the same partnership behaviours as their parents, which may be similar or markedly different to the native population depending on where the migrants come from (Rahnu et al. 2015;Hannemann et al. 2020;Delaporte and Kulu 2023;Harrison et al. 2023;Mikolai and Kulu 2023). When destination and sending country norms differ, the second generation is exposed to both their parents' values and behaviours and those of the destination country (De Valk and Liefbroer 2007): This results in 'normative conflict' between young second-generation migrants and their first-generation parents, especially around sexual mores and partnership formation (Giguère, Lalonde, and Lou 2010), and can lead to the emergence of third-culture practices -the 'minority subculture hypothesis' (Mikolai and Kulu 2023). ...

Union formation and fertility amongst immigrants from Pakistan and their descendants in the United Kingdom: A multichannel sequence analysis
  • Citing Article
  • February 2023

Demographic Research

... Recently, joint examination of childbearing and partnership transitions has further revealed that changes in fertility behaviours across generations occur more rapidly than changes in partnership behaviours . While fertility decisions seem more affected by structural-economic factors and individuals' life circumstances, partnership behaviours appear to be more influenced by normative cultural factors (Andersson, 2020;Kulu et al., 2022). Nevertheless, what is often perceived as family ideals or cultural preferences may be induced by the migration process itself, which involves strict legal requirements, especially in the family domain. ...

Family trajectories among immigrants and their descendants in three European countries: A multistate approach in comparative research
  • Citing Article
  • August 2024

Population Studies

... Costa Rica's 2018 National Disability Survey revealed that 24% of people aged 60 years and older with multimorbidity were in a situation of dependency for the performance of basic activities of daily living. This figure was 38% among those over 80 years of age (Medellín et al., 2019 (Lam et al., 2024). ...

Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States
  • Citing Article
  • May 2024

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

... Race differences in socio-economic status are also associated with persistent race differences in life expectancy over the post-apartheid period (Bredenkamp et al., 2021;Lam et al., 2024), and Table 1 shows that older African adults are significantly younger than older white adults. These differences help to explain why older whites are more likely than other older adults to report a disability or health condition. ...

Multimorbid life expectancy across race, socio-economic status, and sex in South Africa
  • Citing Article
  • May 2024

Population Studies

... 44 Furthermore, there is evidence that partnered individuals have better health and lower mortality rates, with a slightly higher protection effect among men. 45,46 Conversely, recent research has found that less social support is associated with frailty and falls. 47,48 The current study has been the largest registry-based study assessing the prevalence of frailty in long-term PCa survivors after RP. ...

Partnership Status, Health, and Mortality: Selection or Protection?
  • Citing Article
  • January 2024

Demography

... In England, between March 2020 and February 2023, there were 154,030 deaths in excess of what might have been expected had the pandemic not occurred [1]. The risk of mortality following COVID-19 is known to differ between individuals, with various factors impacting the risk including, but not limited to, sex, ethnicity, deprivation, and certain health conditions [2][3][4][5][6]. Risk of death also varied between waves of the pandemic, due to changing virulence of the dominant viral strain and the impact of counter measures such as shielding for those at greatest risk, specific treatments for diagnosed cases, and vaccine protection [2,3,7]. ...

Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland
  • Citing Article
  • October 2023

Social Science & Medicine

... Open access cardiovascular, respiratory and cancer diseases. [2][3][4][5][6][7][8] For example, in Italy, long term exposure to NO 2 (nitrogen dioxide) and PM 2.5 (particulate matter diameter ≤2.5 µm) was associated with increased hospital admissions for circulatory diseases, myocardial infarction, lung cancer, kidney cancer and lower respiratory tract infections. 9 Results from the Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) project have shown elevated asthma, chronic obstructive pulmonary disease and stroke incidence with higher long term exposure to NO 2, PM 2.5 and black carbon pollutants, [10][11][12] and elevated lung cancer incidence with higher exposure to PM 2.5 . ...

Long-term exposure to air pollution and mortality in Scotland: A register-based individual-level longitudinal study
  • Citing Article
  • October 2023

Environmental Research

... Social science systematic reviews often focus on a policy question with a limited number of directly relevant articles (Gauthier 2007;Bergsvik, Fauske, and Hart 2021) or on a very specific topic -e.g., gender equity within the household and fertility (Raybould and Sear 2021), or gender differentials in the risk of suicide following relationship breakdown (Evans, Scourfield, and Moore 2014). Literature reviews of broader, more exploratory issues, such as the predictors of union dissolution (Lyngstad and Jalovaara 2010) and determinants of fertility (Balbo, Billari, and Mills 2013;Vasireddy et al. 2023), do not document the use of systematic methods in the same way because an exhaustive detailed review of all papers is much less feasible and key word searches yield a large number of results, many of which are not relevant. ...

Education and Fertility: A Review of Recent Research in Europe

Comparative Population Studies