Objectives
To quantify the relation between prenatal famine exposure and adult mortality, taking into account mediating effects of intermediary life conditions.
Design
Historical follow-up study.
Setting
The Dutch famine (Hunger Winter) of 1944–1945 which occurred towards the end of WWII in occupied Netherlands.
Study population
From 408,015 Dutch male births born 1944–1947, examined for military service at age 18, we selected for follow-up all men born at the time of the famine in six affected cities in the Western Netherlands (n=25,283), and a sample of unexposed time (n=10,667) and place (n=9,087) controls. These men were traced and followed for mortality through the national population and death record systems.
Outcome measure
All-cause mortality between ages 18 and 63 years using Cox proportional hazards models adjusted for intermediary life conditions.
Results
An increase in mortality was seen after famine exposure in early gestation (HR 1.12; 95% confidence interval (CI): 1.01 to 1.24) but not late gestation (HR 1.04; 95% CI: 0.96 to 1.13). Among intermediary life conditions at age 18 years, educational level was inversely associated with mortality and mortality was elevated in men with fathers with a manual versus non-manual occupations (HR 1.08; CI: 1.02 to 1.16) and in men who were declared unfit for military service (HR 1.44; CI: 1.31 to 1.58). Associations of intermediate factors with mortality were independent of famine exposure in early life and associations between prenatal famine exposure and adult mortality were independent of social class and education at age 18.
Conclusions
Timing of exposure in relation to the stage of pregnancy may be of critical importance for later health outcomes independent of intermediary life conditions.
Nutritional conditions in early life may affect adult health, but prior studies of mortality have been limited to small samples. We evaluated the relationship between pre-/perinatal famine exposure during the Dutch Hunger Winter of 1944-1945 and mortality through age 63 years among 41,096 men born in 1944-1947 and examined at age 18 years for universal military service in the Netherlands. Of these men, 22,952 had been born around the time of the Dutch famine in 6 affected cities; the remainder served as unexposed controls. Cox proportional hazards models were used to estimate hazard ratios for death from cancer, heart disease, other natural causes, and external causes. After 1,853,023 person-years of follow-up, we recorded 1,938 deaths from cancer, 1,040 from heart disease, 1,418 from other natural causes, and 523 from external causes. We found no increase in mortality from cancer or cardiovascular disease after prenatal famine exposure. However, there were increases in mortality from other natural causes (hazard ratio = 1.24, 95% confidence interval: 1.03, 1.49) and external causes (hazard ratio = 1.46, 95% confidence interval: 1.09, 1.97) after famine exposure in the first trimester of gestation. Further follow-up of the cohort is needed to provide more accurate risk estimates of mortality from specific causes of death after nutritional disturbances during gestation and very early life.
This article presents the results of projections of older people's living arrangements in 2030 in nine European countries. It analyses expected changes due to future trends in health and marital status. Future changes in the marital status of the older people will result in a higher proportion living in their own homes: women in each age group will more often grow old living with their partner, and this will also apply, to a lesser extent, to men aged 85 and over. Both men and women will be less likely to live alone, with people other than a partner, or in institutions. But for men aged 74-84 the likelihood of choosing one or another type of living arrangement will remain remarkably stable in the future. Further, an improvement in health will lead to older people living alone slightly more often, and they will also more often do so in good health. A comparison of two health scenarios shows that changes in marital status have a major impact on overall trends in living arrangements whereas an improvement in health-which is not certain to occur-will affect them only marginally.
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