Pathways to health: direct and indirect effects of early life conditions on later health

We study mortality selection in the first 90 days of life. Using micro-data for a region with internal strong mortality differences before mortality transition, we try to understand if children who survived a strong risk of death during the first three months of life (q0-2) were “selected”, i.e. they had higher probability of surviving during the following 33 months (q3-35). The neonatal selection process played a non negligible role in determining the post-neonatal mortality level in Veneto during 1816-35. For the cohorts where neonatal mortality selection was severe (q0-2>40%), the hazard ratio of surviving during the following 33 months was 20/30% lower than for the cohort where neonatal mortality selection was relatively small (q0-2<20%). This result suggests a sort of homeostatic mechanism, as the mortality differences in q0-35 are lower than the mortality differences in q0-2 and q3-35.

Objectives. This article examines whether adverse childhood conditions have lasting effects on health status at advanced ages both directly and indirectly through adult socio-economic status among Chinese oldest-old and young-old.
Methods. The data is derived from 2008-2009 wave of Chinese Longitudinal Healthy Longevity Survey, including 12,281 oldest-old aged 80+ and 4,285 young-old aged 65-79. Structural equation models are applied to estimate the effects.
Results. Adverse childhood conditions have left an indelible direct and indirect imprint on current health among the oldest-old, while childhood conditions only show a significant indirect effect through adulthood socio-economic status among the young-old. It’s also found that the total effect of childhood conditions on current health is more prominent among the oldest-old than those among the young-old, consistent with the cumulative disadvantage theoretical framework.
Discussions. Our findings suggest an important role of childhood conditions in shaping health profiles at advanced ages. Public policies that target the child welfare may have persistent effects on health improvement over the entire life cycle.

Background
Risk factors, early diagnosis and treatment for colorectal cancer (CRC) vary, and results in differences in incidence and outcomes across societies. To assess the influence of early diagnosis, we compare survival after CRC in a screened vs an unscreened population.

Methods
Relative survival (RS) analyses were performed to assess differences in outcomes for all CRC patients diagnosed in US SEER (2004, N=9349) and Norway (2004-05, N=8318). 39% died within three years.

Results
Stage distributions at diagnosis were different in US vs Norway (42% vs 22% localized; 35% vs 48% regional; 19% vs 23% distant). No (13%), minor (16%) or large (71%) resection rates were similar, but age and stage dependent. Overall 3-year RS was 72% in US and 67% in Norway. In multivariate models of age, sex, stage, and treatment, a weak country-effect was observed (excess mortality ratio (EMR) 0.9, CI 0.9-1.0), indicating better survival in the US, but this was significant for the youngest patients only (EMR 0.9, CI 0.8-0.9) for whom screening is an option.

Conclusion
The advantageous RS observed for US patients, and particularly for patients <80 years, likely reflects the earlier stage distribution, perhaps explained by different CRC screening practices as the US recommends screening whereas Norway does not.

A growing body of literature has shown that early life conditions have strong implications for later life health and wellbeing. There are not many existing works, however, that analyse whether exposure to disease in infancy affects reproductive health. Using data from Southern Sweden for women born between 1813 and 1898 this work intends to cover some of these gaps. Previous research that used the same data showed that individuals exposed to whooping cough in infancy had greater risks of dying from early adulthood and until old age. An impact was also observed on the reproductive health of low SES women, who experienced lower proportions of male births, possibly due to a higher incidence of miscarriages, as well as higher offspring infant mortality. Using dynamic path analysis, the current work analyses whether exposure to whooping cough in infancy affects female fertility directly and/or indirectly. Besides possibly having direct impacts on fecundity, the effect that early life conditions have on the survival of the preceding child could, in fact, have physiological and behavioural implications on the hazard of experiencing a successive birth and on its timing. SES will also be considered as a further intermediate variable.

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 reproductive period of female begins with first menstruation and continuous till menopause. When menstruation ceases finally, the female is said to have attend menopause, which terminate permanently the reproductive period of the female. Obviously, age at menopause varies from female to female and also according to their socio-demographic characteristics. Perhaps no minimum and maximum age has been defined as yet. It occurs at varying ages within a certain range usually 30 to 50 year. It is difficult to identify the exact age at which menopause occurs, since it happens gradually and even post menopausal female do not remember the correct age at menopause. An index for the proportion of females in menopause at a given age may be obtained if the number of females at certain age and among them those females who are in menopause is known. This index is being used as a measure to indicate the distribution of age at menopause. The objectives of the study are to observe the level of menopause among different socio-demographic characteristics of females and also to determine the nature of the distribution of age at menopause over the time by using NFHS-I and III data for Uttar Pradesh.

Early-life effects on old-age mortality and how these effects may be
mediated by intermediate events are studied. Data come from 19th century northern Sweden in the form of digitized life trajectories from the Demographic Data Base, Umeå University, more specifically the Sundsvall region. The causal pathway from an exposure to an outcome is a topic that lately has been attracting strong attention. Of special interest is how to measure and estimate the mediating effect of factors on the causal pathway. We use infant mortality (IMR) at birth as a proxy for early-life conditions, and the mediator is socio-economic status (SES) in mid-life. The research question is thus: Is there an effect of IMR at birth on life expectancy after age 60, and if so, is this effect mediated by SES in mid-life, say around the age of 50?

We find strong direct effects from early-life conditions measured by IMR, but the indirect effects under investigation are weak.

This paper attempts a comparative analysis between disease and disability burden of elderly men and women in the context of relative deprivations of women in nutrition, health care, education etc. in childhood and adult ages, taking India as a case.

The data are culled out from Indian censuses and large scale surveys carried out during last three decades. The study variables are identified through a correlation analysis depicting linkage between disease and disability burden in old age and access to necessities of life in childhood and adult ages.

A time series analysis of prevalence of chronic diseases among elderly men and women at two points of time indicates that gender specific difference in the prevalence of chronic diseases in old age was quite minimal.

A multiple regression analysis between disease and disability burden of men and women and variables depicting deprivation to quality of life in childhood and adult ages did not show any significant effect of deprivation in childhood and adult ages on health status of women in old ages. Not only women are living longer, their health status is also at par with men.

The aims of the study are survey, collect and disseminate information on violation of the Thailand Code of Marketing of Breastmilk Substitutes and Related Products (Thailand Code). The survey is conducted in the year 2010 with adoption of survey research in 2 aspects (the Thailand Code violation in 74 hospitals and 269 mothers of children aged up to one year). The questionnaire has been adapted from a survey form of compliance with the Code Monitoring Kit of the International Baby Food Action Network.

Results on Thailand Code violation are almost all companies violate Thailand Code. A drugstore is the most popular venue where violation by manufacturer and distributor companies is found. Advertisement is the most important reason that mothers feed their children with breastmilk substitutes. Most of mothers receive breastmilk substitutes from milk companies. Places where breastmilk substitutes are given included markets, shops, department stores and clinic. The majority of mothers receive products when they seek medical service during pregnancy, delivery and after delivery. The apparent lack of impact of the Thailand Code of Ethnics on the breast feeding practices may be because the Thailand Code has no legal backing for enforcement. Therefore, Thailand Code should be developing to be law or regulation.

It has been shown that detrimental birth contexts, for instance famines, can exert long-lasting effects over female fertility outcomes. Such events, however, are rare, too extreme with respect to the strength of exposure, and therefore offer few policy implications. Moreover, they instrument just one feature of birth environments – nutritional shortage. The role of non-acute characteristics of birth contexts which encompass more than just the effects of under-nutrition for entry into motherhood is still unknown. This study relates first-time fertility with non-extreme, exogenously-determined contextual characteristics of female birth environments captured by regional-level infant mortality in Sweden in 1970-1976. Doing so allows us to asses not just the nutritional effects, but rather the totality of early health environments, taking pollution, standard of living, and infectious disease burden also into account. Our preliminary results indicate that even mildly severe birth contexts are associated with a reduced hazard of transitioning into motherhood.