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Background Several studies have shown that women and men with two children have lower mortality than the childless, but there is less certainty about mortality, including CVD mortality, at higher parities and meagre knowledge about factors underlying the parity–mortality relationship. Methods The association between parity and CVD mortality was analyzed by estimating discrete-time hazard models for women and men aged 40–80 in 1975–2015. Register data covering the entire Norwegian population were used, and the models included a larger number of relevant sociodemographic control variables than in many previous studies. To analyze the relationship between parity and seven CVD risk factors, logistic models including the same variables as the mortality models were estimated from the CONOR collection of health surveys, linked to the register data. Results Men (but not women) who had four or more children had higher mortality from CVD than those with two, although this excess mortality was not observed for the heart disease sub-group. Overweight, possibly in part a result of less physical activity, seems to play a role in this. All CVD risk factors except smoking and alcohol may contribute to the relatively high CVD mortality among childless. Conclusions Childbearing is related to a number of well-known CVD risk factors, and becoming a parent or having an additional child is, on the whole, associated with lower—or at least not higher—CVD mortality in Norway. However, for men family sizes beyond three children are associated with increased CVD mortality, with risks of overweight one possible pathway. [ABSTRACT FROM AUTHOR]

Objectives:Life course influences on later life depression may include parenting trajectories. We investigate associations between number and timing of births and use of antidepressant medication in late mid-life using data on the whole Norwegian population. Methods:We estimated logistic regression models to analyse variations in the purchase of antidepressants between 2004 and 2008 by timing of births and number of children among women and men aged 45–73, using Norwegian population register data. We controlled for age, education, marital and partnership status, and (in some models) family background shared among siblings. Results:Mothers and fathers of two or more children were generally less likely to purchase antidepressants than the childless. Mothers who started childbearing before age 22 were an exception, although according to sibling models they were notmorelikely to purchase antidepressants. All models showed that women who became mothers before age 26 and had only one child had higher odds of medication purchase than the childless. Older age at first birth was generally associated with lower risks of antidepressant purchase. Conclusion:This analysis of high-quality data for a national population indicates that early motherhood, childlessness and low parity are associated with higher usage of antidepressants in late mid-life. Our data did not allow identification of mediating pathways, and we lacked information on early mental and physical health and some other potentially important confounders not shared between siblings. Furthermore purchase of antidepressants is not a perfect indicator of depression. Those concerns aside, the results suggest complex effects of fertility on depression that merit further investigation. [ABSTRACT FROM AUTHOR]

Background: It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups. Methods: Using data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden. Results: The unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower. Conclusion: The most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigation. It is possible that marital status differences in use of medicines for circulatory disorders combined with an increasing importance of these medicines have contributed to the widening marital status gap in mortality observed in several countries. This also requires further investigation. [ABSTRACT FROM AUTHOR]

Background Short and very long interbirth intervals are associated with worse perinatal, infant and immediate maternal outcomes. Accumulated physiological, mental, social and economic stresses arising from raising children close in age may also mean that interbirth intervals have longer term implications for the health of mothers and fathers, but few previous studies have investigated this. Methods Discrete-time hazards models were estimated to analyse associations between interbirth intervals and mortality risks for the period 1980–2008 in complete cohorts of Norwegian men and women born during 1935–1968 who had had two to four children. Associations between interbirth intervals and use of medication during 2004–2008 were also analysed using ordinary least-squares regression. Covariates included age, year, education, age at first birth, parity and change in coparent since the previous birth. Results Mothers and fathers of two to three children with intervals between singleton births of less than 18 months, and mothers of twins, had raised mortality risks in midlife and early old age relative to parents with interbirth intervals of 30–41 months. For parents with three or four children, longer average interbirth intervals were associated with lower mortality. Short intervals between first and second births were also positively associated with medication use. Very long intervals were not associated with raised mortality or medication use when change of coparent since the previous birth was controlled. Conclusions Closely spaced and multiple births may have adverse long-term implications for parental health. Delayed entry to parenthood and increased use of fertility treatments mean that both are increasing, making this a public health issue which needs further investigation. [ABSTRACT FROM AUTHOR]

Using data on all Norwegians born 1935-68, we analyze the associations between mortality and a combined indicator of fertility and marital or partnership status and history. The focus is on ages 40-73 and the years 1980-2008 (30 million person-years of observations and 117,000 deaths). Among men in first marriages, the childless have 36 percent higher mortality than those with two or more children. The corresponding figure for women is 61 percent. The never-married have higher mortality and are differentiated even more by parenthood status. Thus, childless never-married men and women have mortality three times as high as those who are married and have two or more children. The apparent advantage associated with having at least two children is smallest among men who divorced before their oldest child's tenth birthday. Having step-children has no association with mortality for those without natural children but is associated with higher mortality among the parous. [ABSTRACT FROM AUTHOR]

Abstract: The relationship between women''s reproductive histories and later all-cause mortality has been investigated in several studies, with mixed results. Some studies have also considered cause-specific mortality and some have included men, but none has done both. We analyse associations between parity and age of first birth for women and men across 11 cause-of-death groupings using Norwegian register data for complete cohorts born 1935–1968 whose mortality was observed 1980–2003 (i.e. at ages 45–68). Age, period, educational level, marital status, region of residence and population size of municipality were included as co-variates. In total, there were 63,000 deaths. Results showed that relative to parents of two children, childless men and women and those with one child had higher mortality risks for nearly all cause of death groupings. High parity (4+ children) was associated with raised male mortality from accidents and violence and higher mortality from cancer of the cervix among women. For other cause and gender groupings there was either little difference between those with two children and those of higher parities or an overall negative association between parity and mortality. Among men with the lowest level of education, however, high parity was positively associated with mortality from circulatory diseases. For all causes except female breast cancer, there was an inverse association between age at first birth and mortality risk. Similarities observed across cause groups and for women and men suggest that much of the fertility–mortality relationship is a result of selection or effects of reproductive behaviour on lifestyle. The latter may include both beneficial effects and harmful stress responses. However, physiological mechanisms are most probably important for some causes of death for women. Research on associations between parenting histories, health related behaviours, social support exchanges and reported or measured stress is needed to clarify mechanisms underlying the associations reported here. [Copyright &y& Elsevier]

This study aimed to assess whether children's age at their parents' divorce is associated with depression in early and mid-adulthood, as indicated by medication purchase. A sibling comparison method was used to control for unobserved factors shared between siblings. The data were extracted from the Norwegian Population Register and Norwegian Prescription Database and included about 181,000 individuals aged 20-44 who had experienced parental divorce and 636,000 who had not. Controlling for age in 2004, sex, and birth order, children who were aged 15-19 when their parents divorced were 12 per cent less likely to purchase antidepressants as adults in 2004-08 than those experiencing the divorce aged 0-4. The corresponding reduction for those aged 20+ at the time of divorce was 19 per cent. However, the association between age at parental divorce and antidepressant purchases was only evident among women and those whose mothers had low education.

There is growing recognition that reproductive patterns may have long-term health implications, although most evidence is restricted to women. The authors used register data to derive fertility histories for all Norwegian men and women born in 1935-1958. Discrete-time hazard modeling was used to analyze later-life mortality by aspects of reproductive history. A total of 63,312 deaths were observed during 14.5 million person-years of follow-up in 1980-2003, when subjects were aged 45-68 years. Models included detailed information on educational qualifications and marital status. Odds of death relative to those for subjects with two children were highest for the childless (women: odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.43, 1.57; men: OR = 1.35, 95% CI: 1.30, 1.40) and next highest for those with only one child (women: OR = 1.31, 95% CI: 1.26, 1.37; men: OR = 1.20, 95% CI: 1.16, 1.24). Results for the parous showed a positive association between earlier parenthood and later mortality, a reverse association with late age at last birth, and an overall negative association between higher parity and mortality. The similarity of results for women and men suggests biosocial pathways underlying associations between reproductive history and health. The lack of any high-parity disadvantage suggests that in the "family friendly" Norwegian environment, the health benefits of having several children may outweigh the costs.