Life-course influences on health and mortality

The importance of early life conditions for health in later life has been known for many years. Recent developments in modelling techniques have given rise to a series of in-depth studies that focused on educational attainment, labour market outcomes, adult health, the incidence of particular diseases and old-age mortality. However, not many studies look at the impact on health during early adulthood and, in particular, the literature that analyses how early life conditions affect female reproductive health is scant and often inconclusive. Using data from the Scanian Economic Demographic Database for women born between 1813 and 1898, this work studies the impact of exposure to insufficient nutrition while in-utero or to epidemics in the first year of life on offspring sex ratios at birth. We find that women of low socioeconomic status who were exposed in infancy to whooping cough give birth to a lower proportion of boys, probably as a result of a higher incidence of spontaneous abortions. Infant mortality is also higher for offspring born to women exposed to epidemics, and because of gender specific fetal mortality, it is lower for males in comparison to females.

This paper examines the relationship between marital status and mortality by sex and age, as well as the change in this relationship during the past twenty years in Korea. Relative Mortality Ratios and abridged life tables were conducted from 1990 to 2010 for every five years. They were calculated using population by marital status from the Population and Household Census and deaths by marital status from vital statistics. Findings are as follows. First, mortality is different by marital status and the differences are greater for males than females in Korea. In 2010, life expectancy was 6.6 years shorter for single males than married males, 4.0 years shorter for single females than married females. Divorced people’s life spans were shorter than those of married people by 6.1 years for males and 2.1 years for females. Second, mortality differences by marital status for males are greater in the younger age group, while female’s differences are consistent over all age groups. Third, all unmarried people’s life expectancy disadvantages have decreased. The largest decrease happened to single females, with a life span difference of 20.4 years in 1990 to 4.0 years in 2010. The smallest reduction has happened to divorced males, from 8.1 years in 1990 to 6.1 years in 2010.

Studies on malaria related maternal mortality in Nigeria have focused largely on preventive behaviours and healthcare providers’ knowledge of treatment regimen. Negligible attention has been paid to the proximate determinants and patterns of treatment adopted by care seekers in relevant contexts. Employing both qualitative and quantitative data collection techniques, the study established that malaria treatment among pregnant women in the area was influenced by social, residential and demographic factors in both rural and urban areas of the state. Expectant mothers without formal education reported high adherence to medication (r=-631 p< .034) than those of higher educational status, indicating that the level of education does not necessarily influence adherence to medication. Mother in-laws contributed remarkably to household social and counseling support and were the major determinants of choice of treatment options. Informal care providers remained essential part of maternal healthcare delivery in the absence of a functional formal medical system.

In India, stigma driven discrimination due to diseases, low status of women in family and decision making power for treatment seeking has impact on health outcome of women which has been largely ignored in TB research and control efforts. In present paper attempt has been made to study the linkages between gender, social discrimination attached to TB and its influence on health outcome. Study uses small scale data collected from 367 tuberculosis patients living in slums of M-ward, Mumbai. Result reveals that female tend to hide their disease status and experiences more discrimination compared to male. Bi-variate and multivariate result shows that among women lower gap in knowledge about TB, adherence, shorter health system delay and experience of no discrimination likely to result with positive health outcome. Whilst among male, working, adherence, lesser symptoms of TB is significantly linked with successful outcome. Differences in factors of male and female in successful outcome show that condition of women is poor in accessing effective treatment due to social barriers attached. This clearly brings the need to focus on stigma and discrimination attached to TB in the community. Knowledge programs need to emphasis more on educating women about TB.

Under-five mortality rates (U5MR) have been declining slowly in Sub-Saharan Africa: between 1990 and 2008 the U5MR declined by only 22%. If there is a strong relationship between birth month and U5MR, then policies that help women conceive during optimal periods or that improve the health of pregnant women may help reduce U5MR. But the effectiveness of such policies will depend on whether the birth month effects are the result of structural differences in fertility patterns, or due to differences in pre and post-natal environments.
We use piecewise exponential hazard models to analyze the relationship between birth month and U5MR, in 30 SSA countries using data from the Demographic and Health Surveys. We also use logistic regression models to analyze the relationship between birth month and stunting.
The birth month effects on child mortality and stunting are large and statistically significant. On average, the U5MR associated with the birth month with the highest cumulative hazard is 39% higher than the U5MR for the birth month with lowest cumulative hazard. The maximum difference in predicted probabilities of being stunted between two birth months is on average nine percentage points. The birth month effects are not due to social-demographic differences in fertility patterns.

Short inter-pregnancy intervals are associated with poorer birth outcomes and child survival. Adverse effects of short intervals for maternal outcomes have also been reported. Stresses arising from depleted nutrition or strains associated with raising two children close in age might be hypothesised to also have longer term effects on parental health. Such possible longer term implications have rarely been investigated but two UK studies suggest negative effects of short birth intervals for mortality and disability in later life. We investigate associations between inter-birth intervals and mortality risks in late middle age using high quality register data for the whole Norwegian population. Associations with use of prescription medication are also investigated. We focus on parents of two-four children and control for age, year of observation, education, marital status, age at first birth, parity and, in some models, change in co-parent since the previous birth. Results show negative effects of birth intervals of less than 18 months on mortality risks, and medication use, for mothers and fathers later in the life course and raised risks for mothers of twins. Results suggests the operation of biosocial pathways which, together with possible confounding via various selective influences, need further investigation.

This study used Swedish population register data to investigate the relationship between birth order and mortality risk in adulthood for Swedish cohorts born between 1938 and 1960. We investigate both all-cause mortality as well as cause-specific mortality attributable to neoplasms, cancers of the respiratory system, diseases of the circulatory system, and accidents, suicides, and events of undetermined intent. The follow-up period is from 1960 to 2007 for all-cause mortality, and from 1968 to 2007 for cause-specific mortality. The analyses are conducted using piece-wise constant survival models, with age as the baseline hazard, and the estimates are adjusted for mother's age at the time of birth, sibship size, and cohort effects. Focusing on sibships ranging in size from two to six, we find that mortality risk in adulthood increases with later birth order. This pattern is also consistent for cause-specific mortality risk, but is particularly pronounced for mortality attributable to cancers of the respiratory system. These results suggest that social pathways play an important role in the relationship between birth order and mortality risk in adulthood.

The aim of the study is to investigate relations between religion, health and coping in ageing societies. We focus our work on seniors in chosen European countries. Increasing proportion of older people can have a significant impact of health conditions and quality of life of those populations. Many seniors have health conditions that can impair the quality of life, including disabling conditions, depressions and mental health problems.
We use data from the Survey of Health, Ageing and Retirement in Europe (SHARE), which gives representative data on non-institutionalized sample of the 50 plus population in Europe and detailed information on health, work, household-situation, cognition and financial situation.
Tentative results suggest that both being less religious and having high cognitive function seems to be associated with lower risk of depression. However, among those who have experienced a heart attack higher religiosity is positively correlated with an absence of depression. These findings hold for all regions in Europe and for both women and men.

Although there has been a large body of research looking at migrant health issues, there is little understanding of migrant health in Australia due to limited research. Australia is among the top migration countries, where about half of the population is a first- or second-generation migrant, and where more than quarter of the labour force consists of migrants. This study adds to our understanding of migrant health in Australia by looking at the health of migrants upon their arrival in the destination and at the change in their health status in the next 6-18 months since migration. The study uses two waves of second Longitudinal Study of Immigrants in Australia, including about 3000 migrants and 1000 of their partners. The preliminary findings show that migrants entering the country on humanitarian visas report disproportionately worse health outcomes than other migrants and their health is more likely to change over time.

Background- This paper is an effort to analyze the influence of education and occupation as critical determinants to using smokeless tobacco among male adults in India and its selected states. By using the Global Adult Tobacco Survey (GATS), India, 2009-10 data the study presents a distinct picture of tobacco use among male adults for different background characteristics. Methods& Results- The treatment of Bi-variate and Multivariate (Cox proportion hazards model) analysis in the study evidently suggest that majority of Indian male adults are using Khaini and Gutkha (Local names for tobacco). The analysis also shows that education and occupation are two critical predictors of use of smokeless tobacco. The males at young age with less education, self employed and from rural area use more smokeless tobacco than their counter part from urban area. This distinction is mainly due to the lack of education and ignorance about the consequences of tobacco consumption among the rural males. The states of backward region have higher use of smokeless tobacco compared to the developed states. Conclusion- Hence, there is an urgent need to minimize this gap between different regions and other subgroups to ensure an overall growth environment for all citizens in the India.