The impact of early-life economic conditionson cause-specific mortality during adulthood

The aim of this study is to assess the effects of economic conditions in early life on cause-specific mortality during adulthood. The analyses are performed on a unique historical sample of 14,520 Dutch individuals born in 1880–1918, who are followed throughout life. The economic conditions in early life are characterized using cyclical variations in annual real per capital gross domestic product during pregnancy and the first year of life. Exposure to recessions in early life appears to significantly increase cancer mortality risks of older males and females. It also significantly increases other mortality risks especially for older females. The residual life expectancies are up to about 8 and 6 % lower for male and female cancer mortality, respectively, and up to about 5 % lower for female cardiovascular mortality. Our analyses show that cardiovascular and cancer mortality risks are related and that not taking this association into account leads to biased inference.     

Risk Exposure in Early Life and Mortality at Older Ages: Evidence from Union Army Veterans

This study examines the relation between risk exposures in early life and hazard of mortality among 11,978 Union Army veterans aged 50 and over in 1900. Veterans' risk exposures prior to enlistment—as approximated by birth season, country of birth, residential region, city size, and height at enlistment—significantly influenced their chance of survival after 1900. These effects are robust irrespective of whether socioeconomic well‐being in 1900 has been taken into account; however, they are sensitive to the particular age periods selected for survival analysis. Whereas some of the effects such as being born in Ireland and coming from large cities became apparent in the first decade after 1900 and then dissipated over time, the effects of birth season, being born in Germany, residential region in the United States, and height at enlistment were more salient in the post‐1910 periods. Height at enlistment shows a positive association with risk of mortality in the post‐1910 periods. Compared to corresponding findings from more recent cohorts, the exceptional robustness of the effects of risk exposures prior to enlistment on old‐age mortality among the veterans highlights the harshness of living conditions early in their lives.     

Trends in U.S. adult chronic disease mortality, 1960–1999: age,period, and cohort variations

In this paper, I examine temporal changes in U.S. adult mortality by chronic disease cause of death and by sex over a 40-year period in the second half of the twentieth century. I apply age-period-cohort (APC) analyses that combine conventional approaches and a new method of model estimation to simultaneously account for age, period, and cohort variations in mortality rates for four leading causes of deaths, including heart disease, stroke, lung cancer, and breast cancer. The results show that large reductions in mortality since the late 1960s continued well into the late 1990s and that these reductions were predominately contributed by cohort effects. Cohort effects are found to differ by specific causes of death examined, but they generally show substantial survival improvements. Implications of these results are discussed with regard to demographic theories of mortality reductions, differential cohort accumulation of health capital and lifetime exposures to socioeconomic and behavioral risk factors, and period changes in diagnostic techniques and medical treatment.     

Recent trends in multiple-caused mortality 1968 to 1982: Age and cohort components

Declines in mortality at advanced ages have been observed recently in the United States. These declines have been related to a reduction in the risk of major circulatory diseases, such as stroke and heart disease. In this paper we examine the contribution of two additional major factors in those declines. The first is the effect of conditions associated with circulatory diseases. This effect can be examined by using multiple-cause mortality data in which all conditions reported by the physician on the death certificates are recorded. The second is the contribution of cohort mortality differentials to temporal changes. If major cohort differentials are identified, we may be able to determine if recent declines in mortality are likely to continue-and to what levels. Such insights would be useful both in improving projections of the size and age structure of the U.S. elderly population and its entitlement groups and in helping to identify future patterns of needs for preventive and other health services.     

Marital protection and marital selection: Evidence from a historical-prospective sample of American men

Whether marriage causes people to live longer or whether healthier people select into marriage is an open question. In this study I followed a sample of men from age 18 to first marriage and ultimately to death. Health in early adulthood was represented by height and weight around age 20. The probability of ever marrying and the conditional probability of marriage in a given time period were lower for smaller men and greater for larger men. Marriage significantly lowered mortality risk even after controlling for health in early adulthood. Thus I found support both for selection into marriage and for protective effects of marriage.     

Uncrossing the U.S. Black-White Mortality Crossover: The Role of Cohort Forces in Life Course Mortality Risk

In this article, I examine the black-white crossover in U.S. adult all-cause mortality, emphasizing how cohort effects condition age-specific estimates of mortality risk. I employ hierarchical age-period-cohort methods on the National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to show that the black-white mortality crossover can be uncrossed by factoring out period and cohort effects of mortality risk. That is, when controlling for variations in cohort and period patterns of U.S. adult mortality, the estimated age effects of non-Hispanic black and non-Hispanic white U.S. adult mortality risk do not cross at any age. This is the case for both men and women. Further, results show that nearly all the recent temporal change in U.S. adult mortality risk was cohort driven. The findings support the contention that the non-Hispanic black and non-Hispanic white U.S. adult populations experienced disparate cohort patterns of mortality risk and that these different experiences are driving the convergence and crossover of mortality risk at older ages.     

Using Subjective Expectations to Forecast Longevity: Do Survey Respondents Know Something We Don’t Know?

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.     

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.     

Early life exposures and the occurrence and timing of heart disease among the older adult Puerto Rican population

Few studies have examined the effects of early life conditions on the timing of the onset of heart disease. We use the remarkable example of a representative sample of the population of older Puerto Ricans aged 60– 74 who lived in the countryside during childhood (n = 1,438) to examine the effects of seasonal exposures to poor nutrition and infectious diseases during late gestation on the timing of the onset and the probability of ever experiencing adult heart disease. Cox and log logistic hazard models controlling for childhood conditions (self-reported childhood health status and socioeconomic status [SES], rheumatic fever, and knee height) and adult risk factors (adult SES, obesity, smoking, texercise, and self-reported diabetes) showed that the risk of onset of heart disease was 65% higher among those born during high-exposure periods compared with unexposed individuals. However, there were no significant differences in median time of onset for those ever experiencing heart disease. As a comparison, we found that there were no significant seasonality effects for those who lived in urban areas during childhood. We conclude that early exposures in utero have important ramifications for adult heart disease among the older Puerto Rican population. We show, however, that while exposure is associated with the probability of ever experiencing adult heart disease, it is not associated with the timing of onset among those who do experience it.     

Race Disparities in Pubertal Timing: Implications for Cardiovascular Disease Risk Among African American Women

Compared to white girls, sexual maturation is accelerated in African American girls as measured by indicators of pubertal development, including age at first menses. Increasing epidemiological evidence suggests that the timing of pubertal development may have strong implications for cardio-metabolic health in adolescence and adulthood. In fact, younger menarcheal age has been related prospectively to poorer cardiovascular risk factor profiles, a worsening of these profiles over time, and an increase in risk for cardiovascular events, including non-fatal incident cardiovascular disease and cardiovascular-specific and all-cause mortality. Yet, because this literature has been limited almost exclusively to white girls/women, whether this same association is present among African American girls/women has not been clarified. In the current narrative review, the well-established vulnerability of African American girls to experience earlier pubertal onset is discussed as are findings from literatures examining the health outcomes of earlier pubertal timing and its antecedents, including early life adversity exposures often experienced disproportionately in African American girls. Gaps in these literatures are highlighted especially with respect to the paucity of research among minority girls/women, and a conceptual framework is posited suggesting disparities in pubertal timing between African American and white girls may partially contribute to well-established disparities in adulthood risk for cardio-metabolic disease between African American and white women. Future research in these areas may point to novel areas for intervention in preventing or lessening the heightened cardio-metabolic risk among African American women, an important public health objective.     

Long-term effect of in utero conditions on maternal survival later in life: evidence from Sub-Saharan Africa

Sub-Saharan African countries have some of the world’s highest rates of maternal mortality. Most research on maternal mortality focuses on factors during pregnancy and delivery. However, consistent with the fetal programming hypothesis, a woman’s maternal survival may also be related to conditions she experienced while in utero. I examine this hypothesis in 14 African countries by relating rainfall when a woman was in utero with her maternal survival later in her life. High levels of rainfall, representing better in utero conditions, decrease the probability of maternal death by 1.1 percentage points, a 58 % decrease from a mean of 1.9 %. Higher rainfall while in utero reduces the probability of anemia during pregnancy, a risk factor for postpartum hemorrhage. Another plausible pathway is through a reduction in body mass index, a predictor of pregnancy-induced hypertension. Improving conditions for pregnant women will have inter-generational effects, benefiting pregnant women today and improving their daughters’ maternal survival.     

Debt,Cohabitation, and Marriage in Young Adulthood

Despite growing evidence that debt influences pivotal life events in early and young adulthood, the role of debt in the familial lives of young adults has received relatively little attention. Using data from the NLSY 1997 cohort (N = 6,749) and a discrete-time competing risks hazard model framework, I test whether the transition to first union is influenced by a young adult’s credit card and education loan debt above and beyond traditional educational and labor market characteristics. I find that credit card debt is positively associated with cohabitation for men and women, and that women with education loan debt are more likely than women without such debt to delay marriage and transition into cohabitation. Single life may be difficult to afford, but marital life is unaffordable as well. Cohabitation presents an alternative to single life, but not necessarily a marital substitute for these young adults.     

The Life Course,Cohort Dynamics,and International Differences in Aging Trajectories

In recent years, population health research has focused on understanding the determinants of later-life health. Two strands of that work have focused on (1) international comparisons of later-life health and (2) assessing the early-life origins of disease and disability and the importance of life course processes. However, the less frequently examined intersection of these approaches remains an important frontier. The present study contributes to the integration of these approaches. We use the Health and Retirement Study family of data sets and a cohort dynamic approach to compare functional health trajectories across 12 high-income countries and to examine the role of life course processes and cohort dynamics in contributing to variation in those trajectories. We find substantial international variation in functional health trajectories and an important role of cohort dynamics in generating that variation, with younger cohorts often less healthy at comparable ages than the older cohorts they are replacing. We further find evidence of heterogeneous effects of life course processes on health trajectories. The results have important implications for future trends in morbidity and mortality as well as public policy.     

Methods for combining ancillary data in stochastic compartment models of cancer mortality: Generalization of heterogeneity models∗

In analyzing mortality data there may be available information from survey and other sources that describe the marginal distribution of risk factors. We present a mortality model where nationally representative survey data on risk factor distributions are combined with data on cohort mortality rates to increase information, i.e., a fixed marginal risk factor distribution is combined with a cohort model representing unobserved individual risk heterogeneity. The model is applied to lung cancer mortality in nine U.S. white male cohorts aged 30 to 70 in 1950 and followed 38 years. Estimates of the cohort specific proportions of smokers were made from the National Health Interview Survey. Comparisons are made for models with different patterns of changes with age of individual heterogeneity.     

Being Born Under Adverse Economic Conditions Leads to a Higher Cardiovascular Mortality Rate Later in Life: Evidence Based on Individuals Born at Different Stages of the Business Cycle

We connect the recent medical and economic literatures on the long-run effects of early-life conditions by analyzing the effects of economic conditions on the individual cardiovascular (CV) mortality rate later in life, using individual data records from the Danish Twin Registry covering births since the 1870s and including the cause of death. To capture exogenous variation of conditions early in life, we use the state of the business cycle around birth. We find significant negative effects of economic conditions around birth on the individual CV mortality rate at higher ages. There is no effect on the cancer-specific mortality rate. From variation within and between monozygotic and dizygotic twin pairs born under different conditions, we conclude that the fate of an individual is more strongly determined by genetic and household-environmental factors if early-life conditions are poor. Individual-specific qualities come more to fruition if the starting position in life is better.     

Methods for combining ancillary data in stochastic compartment models of cancer mortality: generalization of heterogeneity models

"We present a mortality model where nationally representative survey data on risk factor distributions are combined with data on cohort mortality rates to increase information, i.e., a fixed marginal risk factor distribution is combined with a cohort model representing unobserved individual risk heterogeneity. The model is applied to lung cancer mortality in nine U.S. white male cohorts aged 30 to 70 in 1950 and followed 38 years. Estimates of the cohort specific proportions of smokers were made from the National Health Interview Survey. Comparisons are made for models with different patterns of changes with age of individual heterogeneity." (SUMMARY IN FRE)     

Trends in Education-Specific Life Expectancy,Data Quality,and Shifting Education Distributions: A Note on Recent Research

Several recent articles have reported conflicting conclusions about educational differences in life expectancy, and this is partly due to the use of unreliable data subject to a numerator-denominator bias previously reported as ranging from 20 % to 40 %. This article presents estimates of life expectancy and lifespan variation by education in the United States using more reliable data from the National Health Interview Survey. Contrary to prior conclusions in the literature, I find that life expectancy increased or stagnated since 1990 among all education-race-sex groups except for non-Hispanic white women with less than a high school education; there has been a robust increase in life expectancy among white high school graduates and a smaller increase among black female high school graduates; lifespan variation did not increase appreciably among high school graduates; and lifespan variation plays a very limited role in explaining educational gradients in mortality. I also discuss the key role that educational expansion may play in driving future changes in mortality gradients. Because of shifting education distributions, within an education-specific synthetic cohort, older age groups are less negatively selected than younger age groups. We could thus expect a greater concentration of mortality at younger ages among people with a high school education or less, which would be reflected in increasing lifespan variability for this group. Future studies of educational gradients in mortality should use more reliable data and should be mindful of the effects of shifting education distributions.     

Period‐Based Mortality Change: Turning Points in Trends since 1950

We investigate a major turning point in mortality trends at adult ages that occurred for many low‐mortality countries in the late 1960s or early 1970s. We analyze patterns of total and cause‐specific mortality over the past 60 years using data from the Human Mortality Database and the World Health Organization. We focus on four broad categories of causes of death: heart diseases, cerebrovascular diseases, smoking‐related cancers, and all other cancers. We use a two‐slope regression model to assess the timing and magnitude of turning points in mortality trends over this era, making separate analyses by sex, age, and cause of death. The age pattern of temporal changes is given particular attention. Our results demonstrate convincingly that period‐based factors were very significant in the onset of the “cardiovascular revolution” in the years around 1970. In general, although cohort processes cannot be ruled out as a driver of mortality change in recent decades (especially for mortality due to smoking‐related cancers), the evidence reviewed here suggests that period factors have been the dominant force behind the mortality trends of high‐income countries during this era.     

An integrative approach to health

In this article, I make the case for using an integrative approach to health, broadly defined as social, emotional, mental, and physical well-being; for studying health among the young as an important marker for future health and well-being across the life course; and for understanding health disparities among the young as both causes and consequences of social stratification. An integrative approach bridges biomedical sciences with social and behavioral sciences by understanding the linkages between social, behavioral, psychological, and biological factors in health. It is furthermore vital that integration occur in all steps of the research process: in theory, design, data collection, and analysis. I use the National Longitudinal Study of Adolescent Health, or Add Health, as an example of an integrative approach to health and of the importance of adolescence and the transition to adulthood years for setting health trajectories into adulthood. Evidence is also presented on the linkages between health trajectories during adolescence and the transition to adulthood and social stratification in adulthood.