136 results on '"Myrskylä M"'
Search Results
2. Disparities in Quality of Life Among European Cancer Survivors Aged 50 and Over
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Li, P, primary and Myrskylä, M, additional
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- 2023
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3. Multimorbidity patterns in older migrants and natives across Europe
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Jang, S Y, primary, Oksuzyan, A, additional, van Lenthe, F J, additional, Loi, S, additional, and Myrskylä, M, additional
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- 2023
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4. The role of labor market inequalities in the gender gap in depression risk among older US adults
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Gueltzow, M, primary, Bijlsma, M J, additional, van Lenthe, F J, additional, and Myrskylä, M, additional
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- 2023
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5. Emergence of chronic diseases and comorbidity in older Finns: The sequences and social determinants: Yaoyue Hu
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Hu, Y, van Hedel, K, Myrskylä, M, and Martikainen, P
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- 2017
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6. Advantages of later motherhood
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Myrskylä, M., Barclay, K., and Goisis, A.
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- 2017
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7. Educational differences in cohort fertility across sub-national regions in Europe
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Nisén, J., Klüsener, S., Dahlberg, J., Dommermuth, L., Jasilioniene, A., Kreyenfeld, M., Lappegård, T., Li, P., Martikainen, P., Neels, K., Riederer, B., te Riele, S., Szabó, L., Trimarchi, A., Viciana, F., Wilson, B., and Myrskylä, M.
- Abstract
Educational differences in female cohort fertility have been shown to vary across high-income countries and over time, but knowledge about how educational fertility differentials play out at the sub-national regional level is limited. Examining these sub-national regional patterns might improve our understanding of national patterns, as regionally varying contextual conditions may affect fertility. This study provides for the first time for a large number of European countries a comprehensive account of educational differences in the cohort fertility rate (CFR) at the sub-national regional level. We harmonise data from population registers, censuses, and large-sample surveys for 15 countries in order to measure women’s completed fertility by educational level and region of residence at the end of the reproductive lifespan. In order to explore associations between educational differences in CFRs and levels of economic development, we link our data to regional estimates of GDP per capita. Empirical Bayesian estimation is used to reduce uncertainty in the regional fertility estimates. Our results document an overall negative gradient between the CFR and level of education, and notable variation in the gradient across regions. The gradient varies systematically by the level of economic development: moving from less to more developed regions, we observe smallergradients both across countries and within countries. However, the within-country patterns of countries differ. Our findings underline the variability of educational gradients in women’s fertility, suggest that higher levels of development may be associated with less negative gradients, and call for more in-depth fertility analyses by education at the sub-national level.
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- 2019
8. Health of immigrant children: the role of immigrant generation, exogamous family setting, and family material and social resources
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Loi, S., Pitkänen, J., Moustgaard, H., Myrskylä, M., and Martikainen, P.
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Children of first-generation immigrants tend to have better health than the native population, but over generations, the health advantage of immigrant children deteriorates. It is, however, poorly understood how family resources can explain health assimilation, whether the process of assimilation varies across health conditions, and where on the generational health assimilation spectrum children with one immigrant and one native parent (exogamous families) lie. We seek to extend our understanding of the process of health assimilation by analyzing the physical and mental health of immigrant generations, assessing the role of exogamous family arrangements, and testing the contribution of family material and social resources on the offspring’s outcomes. We use register-based longitudinal data from a 20% random sample of Finnish households with children born in years 1986-2000, free of reporting bias and loss to follow-up. We estimate the risk of being hospitalized for somatic conditions, psychopathological disorders, and injuries by immigrant generation status. Our results show a negative health assimilation process with higher prevalence of physical and, in particular, mental health problems among second-generation immigrant children than among native children, and to first-generation immigrant children, that is only partially explained by family resources. We find that the children of exogamous families are at especially high risk of developing psychopathological disorders. These results provide strong support for the hypothesis that children of exogamous families constitute a specific health risk group, especially for psychopathological disorders, and that the role of the family seems to be is secondary to other unobserved factors.
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- 2019
9. All-time low period fertility in Finland: drivers, tempo effects, and cohort implications
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Hellstrand, J., Nisén, J., and Myrskylä, M.
- Abstract
In several European countries previously characterized by relatively high and stable cohort fertility, and particularly in the Nordic countries, period total fertility rates (TFR) have declined since 2010. The largest of these declines has been observed in Finland, where the TFR reached an all-time low of 1.49 in 2017. We analyze the decrease in the TFR in Finland since 2010, and assess the consequences of this trend for the completed fertility of women currently of childbearing age using complementary approaches that build on existing parametric and novel nonparametric methods. Decomposition of the fertility decline shows that this trend has been close to universal, with all age groups and parities contributing, but with first-order births and ages 25-29 making the largest contributions. At older ages, we document an important qualitative shift in fertility dynamics: for the first time since the early 1970s, women aged 30+ are experiencing a sustained fertility decline. All of our forecasting methods suggest that cohort fertility is likely to decline from the 1.85-1.95 level that was reached by the 1940-1970 cohorts, to a level of 1.75 or below among women born in the mid-1980s. The tempo-adjusted TFR also suggests that quantum change is driving the decline. These findings are evidence of a strong quantum effect, and are particularly striking because they call into question whether Finland will continue to be part of the Nordic fertility regime, which has been characterized by high and stable fertility.
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- 2019
10. Preterm Births and Educational Disadvantage: Heterogeneous Effects Across Families and Schools
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Baranowska-Rataj, A., Barclay, K., Costa-Font, J., Myrskylä, M., and Özcan, B.
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Sweden ,education investments ,premature births ,education ,ddc:330 ,J13 ,human capital ,I20 ,early life investments ,I10 - Abstract
Although preterm births are the leading cause of perinatal morbidity and mortality in advanced economies, evidence about the consequences of such births later in life is limited. Using Swedish population register data on cohorts born 1982-1994 (N=1,087,750), we examine the effects of preterm births on school grades using sibling fixed effect models which compare individuals with their non-preterm siblings. We test for heterogeneous effects by degree of prematurity, as well as whether family socioeconomic resources and school characteristics can compensate for any negative effects of premature births. Our results show that preterm births can have negative effects on school grades, but these negative effects are largely confined to children born extremely preterm (
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- 2019
11. The Impact of Mental Problems on Mortality and How It Is Moderated by Education
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Bijwaard, G.E., Myrskylä, M., Tynelius, P., and Netherlands Interdisciplinary Demographic Institute (NIDI)
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education ,C41 ,I24 ,ddc:330 ,I14 ,timing-of-events ,mortality ,mental health ,inverse propensity weighting - Abstract
Mental disorders have a large impact on invalidity and mortality. Poor mental health is associated with low education, which is also associated with poor health and higher mortality. The association between mental health and mortality may, therefore, be partly explained by the increased incidence of mental problems of the low educated. An important issue is that mental health problems, education attainment and mortality may all depend on the same observed and unobserved individual factors. We account for both the selective incidence of mental health problems and selective educational attainment by using a correlated multistate model for the mental health (hospitalization) process (both admittance an discharge) and mortality with a re-weighting technique (inverse propensity weighting) based on the probability to attain higher education. We use Swedish Military Conscription Data (1951-1960), linked to the administrative Swedish death and National Hospital Discharge registers. We estimate the effect of mental hospitalization and education on the morality rate and how the effect of mental hospitalization is moderated by education. Our empirical results indicate a strong effect of both mental hospitalization and education on mortality. Mental hospitalization affects mortality due to external causes of death in particular. Only for the low educated improving education moderates the impact of mental hospitalization on mortality. We also found that ignoring confounding would overestimate the impact of mental hospitalization on mortality. Accounting for confounding in mental hospitalization seems to be more important than accounting for selective educational attainment.
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- 2018
12. Educational gain in cause-specific mortality: accounting for confounders
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Bijwaard, G.E., Myrskylä, M., Tynelius, P., Rasmussen, F., and Netherlands Interdisciplinary Demographic Institute (NIDI)
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For many causes of death a negative educational gradient has been found. This association may be partly explained by confounding factors that affect both education attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family factors, using an innovative method based on months lost due to a specific cause of death re-weighted by the probability to attain a higher education level. We use men with brothers in the Swedish Military Conscription Registry (1951-1983), linked to administrative Swedish registers. These data, comprising 700,000 men, allow us to distinguish five education levels and many causes of death. The empirical results reveal that improving education from primary to higher education would lead to 20 months longer survival between 18 and 63. The reduction in death due to external causes when improving education is attributable to most of these gains. Ignoring confounding would underestimate the educational gains, especially for the low educated. Implied by our results is that if 50,000 men from the 1951 cohort had had the 1983 education distribution they would have saved 22% of the person-years between ages 18 and 63 that were lost to death.
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- 2017
13. Diagnosis and survival of pancreatic cancer in relation to depression and diabetes history: A population-based study in Finland
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Li, P., primary, Hu, Y., additional, Scelo, G., additional, Myrskylä, M., additional, and Martikainen, P., additional
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- 2018
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14. Education, Cognitive Ability and Cause-Specific Mortality: A Structural Approac
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Bijwaard, G.E., Myrskylä, M., Tynelius, P., and Rasmussen, F.
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education ,cause-specific mortality ,cognitive ability - Abstract
Education is negatively associated with mortality for most major causes of death. The literature ignores that cause-specific hazard rates are interdependent and that education and mortality both depend on cognitive ability. We analyze the education-mortality gradient at ages 18-63 using Swedish register data. We focus on months lost due to a specific cause of death which solves the interdependence problem, and use a structural model that derives cognitive ability from military conscription IQ scores. We derive the educational gains in months lost and the selection effects for each cause of death, and quantify the selection contribution of observed characteristics and unobserved cognitive ability. In a standard Cox model that controls for observed IQ, primary education was associated with 6 months lost when compared to secondary education. In a structural model that accounts for cognitive ability the difference was 43% larger. In addition, the largest educational gains were achieved for the lowest education group in the reduction of external cause mortality. The educational gains in cardiovascular mortality was small, mainly due to large selection effects. These results suggest that educational differences in cause specific mortality may be biased by conventional Cox regression analyses.
- Published
- 2016
15. Living arrangements and 20-year trajectories of hospital use among middle-aged and older Finns
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Hu, Y, primary, Leinonen, T, additional, van Hedel, K, additional, Myrskylä, M, additional, and Martikainen, P, additional
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- 2016
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16. Cohabitation and mental health: Is cohabiting as good for your mental health as marriage is?
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van Hedel, K, primary, Martikainen, P, additional, Moustgaard, H, additional, and Myrskylä, M, additional
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- 2016
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17. Response to Carl Schmertmann Commentary-Drawing Cohort Profiles From Period Data: Improvements and Risks.
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van Raalte AA, Basellini U, Camarda CG, Nepomuceno M, and Myrskylä M
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- Humans, Cohort Studies, Demography methods
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- 2024
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18. Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States.
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Lam A, Keenan K, Cézard G, Kulu H, and Myrskylä M
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- Humans, Costa Rica epidemiology, Male, Female, Mexico epidemiology, Aged, United States epidemiology, Health Status Disparities, Activities of Daily Living, Aged, 80 and over, Middle Aged, Sex Factors, Socioeconomic Factors, Educational Status, Chronic Disease epidemiology, Chronic Disease mortality, Life Expectancy, Disabled Persons statistics & numerical data, Multimorbidity
- Abstract
Objectives: To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States (US). We also assess MMLE inequalities by sex and education., Methods: Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of 2 or more chronic diseases. Disability is defined using limitations in activities of daily living., Results: Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated., Discussion: Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)
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- 2024
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19. Trends in memory function and memory impairment among older adults in the USA and Europe, 1996-2018.
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Myrskylä M, Hale JM, Schneider DC, and Mehta NK
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Background: Single-country studies document varying time trends in memory function and impairment. Comparative analyses are limited., Methods: We used self-respondent data on adults aged 50+ years in 13 countries from three surveys (USA: HRS, 1998-2018; England: ELSA, 2002-2018; 11 European countries: SHARE, 2004-2019). Memory is measured with tests of immediate and delayed word recall. Unweighted age- and gender-adjusted mixed effects regression models as well as models with adjustments for additional socio-demographic characteristics and health behaviors were examined. Heterogeneity in trends by gender, age group, and educational attainment were measured., Results: The age-adjusted 10-year improvement in average test score is 0.04 standard deviations (SDs) (95% confidence interval (CI): 0.03, 0.05) in the USA, 0.17 SDs (95% CI: 0.15, 0.19) in England, and 0.24 SDs (95% CI: 0.23, 0.25) in SHARE countries. Trends are largely similar across gender, age groups, and educational attainment. Regional differences in trends remain after adjustment for potential mechanisms. Difference between the USA and other countries is particularly large under aged 75 years compared to over aged 75 years., Conclusions: Pace of improvement in memory function varies strongly across countries. On average, the 11 European countries studied had the fastest improvement, followed by England. The trend in the USA indicates improvement, but at a much slower pace compared to that in England and other European countries. Uncovering the causes for the cross-country heterogeneity in time trends, and in particular the reasons for the comparatively poor performance of the USA, should be both a research and public health priority., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)
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- 2024
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20. Sibling relatedness and pubertal development in girls and boys: A population-based cohort study.
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Andersen K, Rothausen KW, Håberg SE, Myrskylä M, Ramlau-Hansen CH, and Gaml-Sørensen A
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- Humans, Male, Female, Denmark, Child, Adolescent, Cohort Studies, Sibling Relations, Siblings psychology, Puberty psychology, Puberty physiology
- Abstract
Purpose: To investigate the association between sibling relatedness and pubertal development in girls and boys., Methods: This cohort study consisted of 10,657 children from the Puberty Cohort, Denmark. Information on sibling relatedness was obtained by self-report. Information on pubertal markers was obtained half yearly from age 11 and throughout puberty. Mean age difference at attaining pubertal markers was estimated using interval-censored regression models according to sibling relatedness (full, half and/or step siblings; half and/or step siblings; no siblings; relative to full siblings)., Results: Girls with both full, half and/or step siblings (-1.2 (CI 95 %: -2.5; 0.1) months), only half- and/or stepsiblings (-2.2 (CI 95 %: -3.7; -0.7) months), and no siblings (-5.5 (CI 95 %: -8.5; -2.5) months) entered puberty earlier than girls with full siblings. Boys with full, half and/or step siblings (-1.4 (CI 95 %: -2.7; -0.1) months), only half and/or step siblings (-1.2 (CI 95 %: -3.0; 0.6) months), and no siblings (-4.5 (CI 95 %: -8.8; -0.3) months) entered puberty earlier than boys with full siblings., Conclusions: Children with sibling relatedness other than full siblings entered puberty earlier than their peers with full siblings even after adjustment for parental cohabitation status, childhood body mass index and childhood internalizing and externalizing symptoms., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Cecilia H. Ramlau-Hansen, Siri Eldevik Haberg, Mikko Myrskyla reports financial support was provided by European Research Council. Cecilia Ramlau-Hansen reports financial support was provided by Independent Research Fund Denmark. Cecilia H. Ramlau-Hansen reports financial support was provided by Independent Research Fund Denmark Health and Disease. Mikko Myrskyla reports financial support was provided by Strategic Research Council. Mikko Myrskyla reports financial support was provided by National Institute on Aging. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Disclosure of interest All authors declare no conflicts of interest. CHR declares to have received funding from the Danish Council for Independent Research (DFF 4183–00152), the Independent Research Fund Denmark (FSS 0602–02738B), the European Union (ERC, BIOSFER, 101071773). SEH declares to have received funding from the Research Council of Norway through its Centres of Excellence funding scheme (project No 262700), the European Union (ERC, BIOSFER, 101071773). MM declares to have received funding from the European Union (ERC, BIOSFER, 101071773), the Strategic Research Council (SRC), FLUX consortium, decision numbers 345130 and 345131; by the National Institute on Aging (R01AG075208); from any grants to the Max Planck – University of Helsinki Center from the Max Planck Society, Jane and Aatos Erkko Foundation, Faculty of Social Sciences at the University of Helsinki, and Cities of Helsinki, Vantaa and Espoo. The funding sources were not involved in the preparation, analysis, and interpretation of the data or submission of this report., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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21. Reply to Timonin and Cooley: Varied effects of counterfactuals in 42 countries underscore value of within-country counterfactual.
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Abrams LR, Myrskylä M, and Mehta NK
- Abstract
Competing Interests: Competing interests statement:The authors declare no competing interest.
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- 2024
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22. Genetic propensity to depression and the role of partnership status.
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Gueltzow M, Lahtinen H, Bijlsma MJ, Myrskylä M, and Martikainen P
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- Humans, Male, Female, Middle Aged, Finland epidemiology, Adult, Aged, Depression epidemiology, Antidepressive Agents therapeutic use, Marital Status statistics & numerical data
- Abstract
Social relationships and genetic propensity are known to affect depression risk, but their joint effects are poorly understood. This study examined the association of a polygenic index for depression with time to antidepressant (AD) purchasing and the moderating role of partnership status. We analysed data from 30,192 Finnish individuals who participated in the FINRISK and Health 2000 and 2011 surveys and had register and medication data available. We measured genetic risk with a polygenic index (PGI) for depression. Depression was assessed through antidepressant purchases. We estimated an accelerated failure time model with partnership status as time-varying and different sets of confounder adjustments. The predicted cumulative hazard of antidepressant purchasing varied across PGI and partnership status. At follow-up year 10, being widowed was associated with the largest cumulative hazard of 0.34 (95%CI: 0.28-0.39) in the 80th and 0.20 (95%CI: 0.17-0.23) in the 20th PGI percentile, followed by divorced, single, married and cohabiting. Cohabiting was associated with a cumulative hazard of 0.19 (95%CI: 0.16-0.23) in the 80th and 0.11 (95%CI: 0.1-0.13) in the 20th PGI percentile. We found no evidence for an interaction between the PGI and partnership status. Results were robust to different model specifications, gender stratification, and the choice of PGI. Although antidepressant purchasing correlated with both PGI and partnership status, we found no evidence that partnership status could partially offset or amplify the association between the PGI for depression and antidepressant purchasing incidence., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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23. At the Intersection of Adverse Life Course Pathways: The Effects on Health by Migration Status.
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Loi S, Li P, and Myrskylä M
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- Humans, Male, Female, Germany, Middle Aged, Adult, Aged, Unemployment statistics & numerical data, Sex Factors, Age Factors, Young Adult, Adolescent, Emigrants and Immigrants statistics & numerical data, Life Change Events, Health Status, Divorce statistics & numerical data, Socioeconomic Factors
- Abstract
Adverse life events are major causes of declining health and well-being, but the effects vary across subpopulations. We analyze how the intersection of migration status and sex relates to two main adverse life events-job loss and divorce-thereby affecting individual health and well-being trajectories. Using data from the German Socio-Economic Panel (1984-2017), we apply descriptive techniques and individual fixed-effects regressions to analyze how job loss and divorce influence the health of immigrants and nonimmigrants. Our results support the hypothesis that immigrants suffer more from adverse life events than nonimmigrants in both the short and the long run. Relative to nonimmigrants, immigrants have a health advantage at younger ages, which becomes a disadvantage at older ages, and this faster decline at older ages is particularly steep among immigrants who experience adverse life events. These results help explain the vanishing health advantage of immigrants by showing that they are exposed to a double disadvantage over the life course: immigrants are more likely than nonimmigrants to suffer from adverse life events, such as job loss, and these events typically have a larger impact on their health. Our findings are the first to provide evidence regarding the consequences of different adverse life events and how they relate to the intersection of migration status and sex. Moreover, our results highlight the importance of intersectional analyses in research on immigrant health., (Copyright © 2024 The Authors.)
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- 2024
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24. Gendered Parenthood-Employment Gaps from Midlife: A Demographic Perspective Across Three Different Welfare Systems.
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Lorenti A, Nisén J, Mencarini L, and Myrskylä M
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Women's labor force participation has increased in Western countries, but gender gaps remain, especially among parents. Using a novel comparative perspective, we assess women's and men's employment trajectories from midlife onward by parity and education. We provide insights into the gendered parenthood-employment gaps examining the long-term implications of parenthood beyond the core childbearing ages by decomposing years lived between ages 40-74, in years of employment, joblessness, and retirement. Using multistate incidence-based life tables, we compare different cultural and institutional contexts: Finland, Italy, and the USA. Our results document large cross-national variation, with education playing a key role. In Finland, the number of years of employment increases with parity for women and men, and the gender gap is small; in the USA, the relationship between parity and years of employment is relatively flat, although a gender gap emerges among those with two or more children; in Italy, the number of years of employment decreases sharply for women as parity increases, while it increases for men. Notably, education has a similar positive impact on years of employment across all groups in Finland. In contrast, in the USA and Italy, the gender gap is only half as large among highly educated mothers as it is among low educated mothers. The employment trajectories of childless women and men differ greatly across countries., (© 2024. The Author(s).)
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- 2024
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25. Multimorbid life expectancy across race, socio-economic status, and sex in South Africa.
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Lam A, Keenan K, Myrskylä M, and Kulu H
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Multimorbidity is increasing globally as populations age. However, it is unclear how long individuals live with multimorbidity and how it varies by social and economic factors. We investigate this in South Africa, whose apartheid history further complicates race, socio-economic, and sex inequalities. We introduce the term 'multimorbid life expectancy' (MMLE) to describe the years lived with multimorbidity. Using data from the South African National Income Dynamics Study (2008-17) and incidence-based multistate Markov modelling, we find that females experience higher MMLE than males (17.3 vs 9.8 years), and this disparity is consistent across all race and education groups. MMLE is highest among Asian/Indian people and the post-secondary educated relative to other groups and lowest among African people. These findings suggest there are associations between structural inequalities and MMLE, highlighting the need for health-system and educational policies to be implemented in a way proportional to each group's level of need.
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- 2024
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26. Cognitive impairment and partnership status in the United States, 1998-2016, by sex, race/ethnicity, and education.
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Sharma S, Hale JM, Myrskylä M, and Kulu H
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- Female, Humans, Male, Middle Aged, Black People, Educational Status, Family Characteristics, United States epidemiology, White, Black or African American, Cognitive Dysfunction, Ethnicity
- Abstract
Cognitively impaired adults without a partner are highly disadvantaged, as partners constitute an important source of caregiving and emotional support. With the application of innovative multistate models to the Health and Retirement Study, this paper is the first to estimate joint expectancies of cognitive and partnership status at age 50 by sex, race/ethnicity, and education in the United States. We find that women live a decade longer unpartnered than men. Women are also disadvantaged as they experience three more years as both cognitively impaired and unpartnered than men. Black women live over twice as long as cognitively impaired and unpartnered compared with White women. Lower-educated men and women live around three and five years longer, respectively, as cognitively impaired and unpartnered than more highly educated men and women. This study addresses a novel facet of partnership and cognitive status dynamics and examines their variations by key socio-demographic factors.
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- 2024
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27. Reply to Polizzi and Dowd: Within-country counterfactual reveals importance of retirement age mortality in addition to established concern about working ages.
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Abrams LR, Myrskylä M, and Mehta NK
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- Age Factors, Retirement, Employment
- Abstract
Competing Interests: Competing interests statement:The authors declare no competing interest.
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- 2024
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28. Maternal pre-pregnancy BMI and reproductive health in adult sons: a study in the Danish National Birth Cohort.
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Gaml-Sørensen A, Thomsen AH, Tøttenborg SS, Brix N, Hougaard KS, Toft G, Håberg SE, Myrskylä M, Bonde JP, and Ramlau-Hansen CH
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- Male, Young Adult, Humans, Female, Pregnancy, Adult, Overweight complications, Body Mass Index, Follow-Up Studies, Adult Children, Reproductive Health, Birth Cohort, Birth Weight, Pilot Projects, Obesity, Estradiol, Denmark epidemiology, Semen Analysis, Testosterone
- Abstract
Study Question: Is maternal pre-pregnancy BMI associated with semen quality, testes volume, and reproductive hormone levels in sons?, Summary Answer: Maternal pre-pregnancy BMI was associated with an altered reproductive hormone profile in young adult sons, characterized by higher levels of oestradiol, LH, and free androgen index (FAI) and lower levels of sex hormone-binding globulin (SHBG) in sons born of mothers with pre-pregnancy overweight and obesity., What Is Known Already: Evidence suggests that maternal pre-pregnancy BMI may influence reproductive health later in life. Only one pilot study has investigated the association between maternal pre-pregnancy BMI and reproductive health outcomes in sons, suggesting that a high BMI was associated with impaired reproductive function in the adult sons., Study Design, Size, Duration: A population-based follow-up study of 1058 young men from the Fetal Programming of Semen Quality (FEPOS) cohort nested within the Danish National Birth Cohort (DNBC), 1998-2019, was carried out., Participants/materials, Setting, Methods: In total, 1058 adult sons (median age 19 years, 2 months), born 1998-2000 by mothers included in the DNBC, participated in FEPOS. At a clinical examination, they provided a semen and blood sample, measured their testes volume, and had height and weight measured. Maternal pre-pregnancy BMI was obtained by self-report in early pregnancy. Semen characteristics, testes volume, and reproductive hormone levels were analysed according to maternal pre-pregnancy BMI categories and as restricted cubic splines using negative binomial and ordinary least square regression models. Mediation analyses examined potential mediation by the sons' birthweight, pubertal timing, fat mass, and BMI. Additional analyses investigated the role of paternal BMI in the potential associations between maternal BMI and reproductive health outcomes., Main Results and the Role of Chance: We found no consistent associations between maternal pre-pregnancy BMI and semen characteristics or testes volume. Sons of mothers with higher pre-pregnancy BMI had higher oestradiol and lower SHBG levels, both in a dose-dependent manner. Sons of mothers with pre-pregnancy obesity (≥30 kg/m2) had higher LH levels and a higher FAI than sons born by mothers with normal pre-pregnancy BMI (18.5-24.9 kg/m2). The mediation analyses suggested that the effect of maternal pre-pregnancy BMI on higher levels of oestrogen, LH, and FAI was partly mediated by the sons' birthweight, in addition to adult fat mass and BMI measured at the clinical examination, whereas most of the effect on lower levels of SHBG was primarily mediated by the sons' own fat mass and BMI. Paternal BMI was not a strong confounder of the associations in this study., Limitations, Reasons for Caution: This study was based in a population-based cohort with a low prevalence of overweight and obesity in both mothers and adult sons. Some men (10%) had blood for reproductive hormone assessment drawn in the evening. While several potential confounding factors were accounted for, this study's inherent risk of residual and unmeasured confounding precludes provision of causal estimates. Therefore, caution should be given when interpreting the causal effect of maternal BMI on sons' reproductive health., Wider Implications of the Findings: Given the widespread occurrence of overweight and obesity among pregnant women, it is imperative to thoroughly examine the potential consequences for reproductive hormone levels in adult sons. The potential effects of maternal pre-pregnancy obesity on sons' reproductive hormone profile may potentially be partly avoided by the prevention of overweight and obesity in the sons., Study Funding/competing Interest(s): The project was funded by the Lundbeck Foundation (R170-2014-855), the Capital Region of Denmark, Medical doctor Sofus Carl Emil Friis and spouse Olga Doris Friis's Grant, Axel Muusfeldt's Foundation (2016-491), AP Møller Foundation (16-37), the Health Foundation, Dagmar Marshall's Fond, Aarhus University, Independent Research Fund Denmark (9039-00128B), and the European Union (ERC, BIOSFER, 101071773). Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible. The authors declare that they have no conflict of interest., Trial Registration Number: N/A., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)
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- 2024
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29. The Dangers of Drawing Cohort Profiles From Period Data: A Research Note.
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van Raalte AA, Basellini U, Camarda CG, Nepomuceno MR, and Myrskylä M
- Subjects
- Humans, Forecasting, Population Dynamics, Fertility, Life Expectancy, Mortality
- Abstract
Drawing cohort profiles and cohort forecasts from grids of age-period data is common practice in demography. In this research note, we (1) show how demographic measures artificially fluctuate when calculated from the diagonals of age-period rates because of timing and cohort-size bias, (2) estimate the magnitude of these biases, and (3) illustrate how prediction intervals for cohort indicators of mortality may become implausible when drawn from Lee-Carter methods and age-period grids. These biases are surprisingly large, even when the cohort profiles are created from single-age, single-year period data. The danger is that we overinterpret deviations from expected trends that were induced by our own data manipulation., (Copyright © 2023 The Authors.)
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- 2023
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30. Birth size, school performance and family social position: a study of 650,000 children.
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Silventoinen K, Luukkonen J, Myrskylä M, and Martikainen P
- Subjects
- Male, Female, Adolescent, Humans, Child, Adult, Birth Weight, Siblings, Cognition, Linear Models, Gestational Age, Academic Performance
- Abstract
Background: Low birth weight (BW) is associated with lower cognitive functioning, but less is known of these associations across the full range of the BW distribution and its components. We analyzed how BW, birth length (BL) and birth ponderal index (BPI, kg/m
3 ) are associated with school performance and how childhood family social position modifies these associations., Methods: Medical birth records of all Finnish children born in 1987-1997 were linked to school performance records at 16 years of age (N = 642,425). We used population averaged and within-siblings fixed-effects linear regression models., Results: BL showed a linear and BW a curvilinear association with school performance whereas for BPI the association was weak. The strongest association was found for BL explaining 0.08% of the variation in school performance in boys and 0.14% in girls. Demographic, gestational and social factors partly explained these associations. Similar but weaker associations were found within sibships. The association of BL with school performance was stronger at lower levels of family social position., Conclusion: BL shows a linear association with school performance and can explain more school performance variation than BW. At the population level, BL can offer useful information on intrauterine environmental factors relevant for cognitive performance., Impact: Birth length is linearly associated with school performance in late adolescence and explains a larger proportion of school performance variation than birth weight. The association between birth length and school performance is stronger in families with lower socio-economic position. At the population level, birth length can offer information on the intrauterine environment relevant for later cognitive performance., (© 2023. The Author(s).)- Published
- 2023
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31. Preterm birth and educational disadvantage: Heterogeneous effects.
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Baranowska-Rataj A, Barclay K, Costa-Font J, Myrskylä M, and Özcan B
- Subjects
- Child, Pregnancy, Female, Humans, Infant, Newborn, Adolescent, Gestational Age, Cohort Studies, Infant, Premature, Educational Status, Premature Birth epidemiology
- Abstract
Although preterm birth is the leading cause of perinatal morbidity and mortality in advanced economies, evidence about the consequences of prematurity in later life is limited. Using Swedish registers for cohorts born 1982-94 ( N = 1,087,750), we examine the effects of preterm birth on school grades at age 16 using sibling fixed effects models. We further examine how school grades are affected by degree of prematurity and the compensating roles of family socio-economic resources and characteristics of school districts. Our results show that the negative effects of preterm birth are observed mostly among children born extremely preterm (<28 weeks); children born moderately preterm (32-<37 weeks) suffer no ill effects. We do not find any evidence for a moderating effect of parental socio-economic resources. Children born extremely preterm and in the top decile of school districts achieve as good grades as children born at full term in an average school district.Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2022.2080247.
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- 2023
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32. The "double jeopardy" of midlife and old age mortality trends in the United States.
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Abrams LR, Myrskylä M, and Mehta NK
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- Adult, Humans, United States epidemiology, Ethical Theory, Retirement, Mortality, Cause of Death, Life Expectancy, Drug Overdose
- Abstract
Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the United States is experiencing a "double jeopardy" that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the United States had experienced for decades.
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- 2023
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33. Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016.
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Sharma S, Hale JM, Myrskylä M, and Kulu H
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- Male, Humans, Female, United States epidemiology, Ethnicity, Educational Status, Retirement, Activities of Daily Living, Cognitive Dysfunction epidemiology
- Abstract
Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population., (Copyright © 2023 The Authors.)
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- 2023
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34. The role of labor market inequalities in explaining the gender gap in depression risk among older US adults.
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Gueltzow M, Bijlsma MJ, van Lenthe FJ, and Myrskylä M
- Subjects
- Male, Adult, Humans, Female, Middle Aged, Aged, Sex Factors, Income, Retirement, Socioeconomic Factors, Depression epidemiology, Occupations
- Abstract
We aim to investigate to what extent gender inequality at the labor market explains higher depression risk for older US women compared to men. We analyze data from 35,699 US adults aged 50-80 years that participated in the Health and Retirement Study. The gender gap is calculated as the difference in prevalence in elevated depressive symptoms (score ≥ 3 on the 8-item Center for Epidemiological Studies Depression Scale) between women and men. We employ a dynamic causal decomposition and simulate the life course of a synthetic cohort from ages 50-80 with the longitudinal g-formula and introduce four nested interventions by assigning women the same probabilities of A) being in an employment category, B) occupation class, C) current income and D) prior income group as men, conditional on women's health and family status until age 70. The gender gap in depression risk is 2.9%-points at ages 50-51 which increases to 7.6%-points at ages 70-71. Intervention A decreases the gender gap over ages 50-71 by 1.2%-points (95%CI for change: 2.81 to 0.4), intervention D by 1.64%-points (95%CI for change: 3.28 to -0.15) or 32% (95%CI: 1.39 to 62.83), and the effects of interventions B and C are in between those of A and D. The impact is particularly large for Hispanics and low educated groups. Gender inequalities at the labor market substantially explain the gender gap in depression risk in older US adults. Reducing these inequalities has the potential to narrow the gender gap in depression., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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35. The Extension of Late Working Life in Germany: Trends, Inequalities, and the East-West Divide.
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Dudel C, Loichinger E, Klüsener S, Sulak H, and Myrskylä M
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- Male, Humans, Female, Middle Aged, Germany epidemiology, Socioeconomic Factors, Germany, East epidemiology, Life Expectancy, Employment
- Abstract
The extension of late working life has been proposed as a potential remedy for the challenges of aging societies. For Germany, surprisingly little is known about trends and social inequalities in the length of late working life. We use data from the German Microcensus to estimate working life expectancy from age 55 onward for the 1941‒1955 birth cohorts. We adjust our calculations of working life expectancy for working hours and present results for western and eastern Germany by gender, education, and occupation. While working life expectancy has increased across cohorts, we find strong regional and socioeconomic disparities. Decomposition analyses show that among males, socioeconomic differences are predominantly driven by variation in employment rates; among women, variation in both employment rates and working hours are highly relevant. Older eastern German women have longer working lives than older western German women, which is likely attributable to the German Democratic Republic legacy of high female employment., (Copyright © 2023 The Authors.)
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- 2023
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36. Healthy immigrants, unhealthy ageing? Analysis of health decline among older migrants and natives across European countries.
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Jang SY, Oksuzyan A, Myrskylä M, van Lenthe FJ, and Loi S
- Abstract
The probability of having multiple chronic conditions simultaneously, or multimorbidity, tends to increase with age. Immigrants face a particularly high risk of unhealthy ageing. This study investigates the immigrant-native disparities in the speed of age-related chronic disease accumulation, focusing on the number of chronic health conditions; and considers the heterogeneity of this trajectory within immigrant populations by origin and receiving country. We use data from the Survey of Health, Ageing and Retirement in Europe from 2004 to 2020 on adults aged 50 to 79 from 28 European countries and employ both cross-sectional and longitudinal analyses. For longitudinal panel analyses, we use fixed-effects regression models to account for the unobserved heterogeneity related to individual characteristics including migration background. Our results indicate that immigrants report a higher number of chronic conditions at all ages relative to their native-born peers, but also that the immigrant-native differential in the number of chronic conditions decreases from age 65 onwards. When considering differences by origin country, we find that the speed of chronic disease accumulation is slower among immigrants from the Americas and the Asia and Oceania country groups than it is among natives. When looking at differences by receiving country group, we observe that the speed of accumulating chronic diseases is slower among immigrants in Eastern Europe than among natives, particularly at older ages. Our findings suggest that age-related trajectories of health vary substantially among immigrant populations by origin and destination country, which underscore that individual migration histories play a persistent role in shaping the health of ageing immigrant populations throughout the life course., Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© 2023 The Authors.)
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- 2023
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37. Forecasting of cohort fertility by educational level in countries with limited data availability: The case of Brazil.
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Batyra E, Leone T, and Myrskylä M
- Subjects
- Female, Humans, Brazil, Demography, Educational Status, Developing Countries, Population Dynamics, Forecasting, Fertility, Birth Rate
- Abstract
The Brazilian period total fertility rate (PTFR) dropped to 1.8 in 2010 (1.5 among those with high education). Due to shifts in fertility timing, the PTFR may provide a misleading picture of fertility levels. The consequences of these changes for the cohort total fertility rate (CTFR)-a measure free from tempo distortions-and for educational differences in completed fertility remain unknown. Due to data limitations, CTFR forecasts in low- and middle-income countries are rare. We use Brazilian censuses to reconstruct fertility rates indirectly and forecast the CTFR for all women and by educational level. Four forecasting methods indicate that the CTFR is unlikely to fall to the level of the PTFR. Educational differences in the CTFR are likely to be stark, at 0.7-0.9, larger than in many high-income countries with comparable CTFRs. We show how the CTFR can be forecasted in settings with limited data and call for more research on educational differences in completed fertility in low- and middle-income countries.
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- 2023
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38. US Racial-Ethnic Mortality Gap Adjusted for Population Structure.
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Pifarré I Arolas H, Acosta E, Dudel C, Mhairi Hale J, and Myrskylä M
- Subjects
- Female, Humans, Male, American Indian or Alaska Native, Hispanic or Latino, Life Expectancy, United States epidemiology, White, Black or African American, Health Status Disparities, Racial Groups, Mortality
- Abstract
Background: US racial-ethnic mortality disparities are well documented and central to debates on social inequalities in health. Standard measures, such as life expectancy or years of life lost, are based on synthetic populations and do not account for the real underlying populations experiencing the inequalities., Methods: We analyze US mortality disparities comparing Asian Americans, Blacks, Hispanics, and Native Americans/Alaska Natives to Whites using 2019 CDC and NCHS data, using a novel approach that estimates the mortality gap, adjusted for population structure by accounting for real-population exposures. This measure is tailored for analyses where age structures are fundamental, not merely a confounder. We highlight the magnitude of inequalities by comparing the population structure-adjusted mortality gap against standard metrics' estimates of loss of life due to leading causes., Results: Based on the population structure-adjusted mortality gap, Black and Native American mortality disadvantage exceedsmortality from circulatory diseases. The disadvantage is 72% among Blacks (men: 47%, women: 98%) and 65% among Native Americans (men: 45%, women: 92%), larger than life expectancy measured disadvantage. In contrast, estimated advantages for Asian Americans are over three times (men: 176%, women: 283%) and, for Hispanics, two times (men: 123%; women: 190%) larger than those based on life expectancy., Conclusions: Mortality inequalities based on standard metrics' synthetic populations can differ markedly from estimates of the population structure-adjusted mortality gap. We demonstrate that standard metrics underestimate racial-ethnic disparities through disregarding actual population age structures. Exposure-corrected measures of inequality may better inform health policies around allocation of scarce resources., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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39. Flexible transition timing in discrete-time multistate life tables using Markov chains with rewards.
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Schneider DC, Myrskylä M, and van Raalte A
- Abstract
Discrete-time multistate life tables are attractive because they are easier to understand and apply in comparison with their continuous-time counterparts. While such models are based on a discrete time grid, it is often useful to calculate derived magnitudes (e.g. state occupation times), under assumptions which posit that transitions take place at other times, such as mid-period. Unfortunately, currently available models allow very few choices about transition timing. We propose the use of Markov chains with rewards as a general way of incorporating information on the timing of transitions into the model. We illustrate the usefulness of rewards-based multistate life tables by estimating working life expectancies using different retirement transition timings. We also demonstrate that for the single-state case, the rewards approach matches traditional life-table methods exactly. Finally, we provide code to replicate all results from the paper plus R and Stata packages for general use of the method proposed.
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- 2023
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40. Medically assisted reproduction and mental health: a 24-year longitudinal analysis using Finnish register data.
- Author
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Goisis A, Palma M, Metsä-Simola N, Klemetti R, Martikainen P, Myrskylä M, Pelikh A, Tosi M, and Remes H
- Subjects
- Pregnancy, Humans, Female, Finland, Live Birth epidemiology, Birth Order, Mental Health, Fertilization
- Abstract
Background: Medically assisted reproduction can negatively affect women's mental health, particularly when the treatments do not result in a live birth. Although the number of women relying on medically assisted reproduction to conceive has grown rapidly, our knowledge about the mental health effects before, during, and after treatment is limited., Objective: This study aimed to understand the long-term association between medically assisted reproduction and mental health outcomes for women before, during, and after their treatments, and according to whether the treatment resulted in a live birth., Study Design: Using Finnish register data for the period from 1995 to 2018, we estimated the probability of psychotropic purchases (antidepressants, anxiolytics, hypnotics, and sedatives) for 3 groups of women who: (1) gave birth after natural conception, (2) gave birth after medically assisted reproduction treatments, or (3) underwent medically assisted reproduction but remained childless. We followed up women for up to 12 years before and 12 years after the reference date, which corresponded to the conception date for women who had a first live birth either after a natural or a medically assisted conception, or the date of the last medically assisted reproduction treatment for women with no live birth by the end of 2017. We estimated linear probability models before and after adjustment for sociodemographic characteristics., Results: The results show that women who did not have a live birth after undergoing medically assisted reproduction treatments purchased more psychotropics than women who gave birth after conceiving naturally or through medically assisted reproduction, and that these differences did not attenuate over time. Twelve years after the reference date, 17.73% (95% confidence interval, 16.82-18.63) of women who underwent medically assisted reproduction but remained childless purchased psychotropics vs 11.11% of women who gave birth after natural conception (95% confidence interval, 10.98-11.26) and 12.17% (95% confidence interval, 11.65-12.69) of women who gave birth after medically assisted reproduction treatments. In addition, women who conceived naturally and through medically assisted reproduction had very similar psychotropic use patterns from 3 years before conception to 4 years after, and over the long term. Adjustment for women's sociodemographic characteristics did not change the results., Conclusion: The similarities in psychotropic purchases of women who had a live birth, whether naturally or through medically assisted reproduction, suggest that the higher psychotropic use among women who remained childless after undergoing medically assisted reproduction were likely driven more by involuntary childlessness than by treatment-related stress. The results highlight the importance of counseling for women undergoing medically assisted reproduction treatments, especially if their attempts to conceive are unsuccessful., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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41. Maternal age and the risk of low birthweight and pre-term delivery: a pan-Nordic comparison.
- Author
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Aradhya S, Tegunimataka A, Kravdal Ø, Martikainen P, Myrskylä M, Barclay K, and Goisis A
- Subjects
- Infant, Newborn, Pregnancy, Female, Humans, Adult, Maternal Age, Birth Weight, Parity, Risk Factors, Infant, Low Birth Weight
- Abstract
Background: Advanced maternal age at birth is considered a risk factor for adverse birth outcomes. A recent study applying a sibling design has shown, however, that the association might be confounded by unobserved maternal characteristics., Methods: Using total population register data on all live singleton births during the period 1999-2012 in Denmark (N = 580 133; 90% population coverage), Norway (N = 540 890) and Sweden (N = 941 403) and from 2001-2014 in Finland (N = 568 026), we test whether advanced maternal age at birth independently increases the risk of low birthweight (LBW) (<2500 g) and pre-term birth (<37 weeks gestation). We estimated within-family models to reduce confounding by unobserved maternal characteristics shared by siblings using three model specifications: Model 0 examines the bivariate association; Model 1 adjusts for parity and sex; Model 2 for parity, sex and birth year., Results: The main results (Model 1) show an increased risk in LBW and pre-term delivery with increasing maternal ages. For example, compared with maternal ages of 26-27 years, maternal ages of 38-39 years display a 2.2, 0.9, 2.1 and 2.4 percentage point increase in the risk of LBW in Denmark, Finland, Norway and Sweden, respectively. The same patterns hold for pre-term delivery., Conclusions: Advanced maternal age is independently associated with higher risk of poor perinatal health outcomes even after adjusting for all observed and unobserved factors shared between siblings., (© The Author(s) 2022. Published by Oxford University Press on behalf of the International Epidemiological Association.)
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- 2023
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42. Pre-existing psychological disorders, diabetes, and pancreatic cancer: A population-based study of 38,952 Finns.
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Li P, Hu Y, Scelo G, Myrskylä M, and Martikainen P
- Subjects
- Humans, Finland epidemiology, Anxiety complications, Anxiety epidemiology, Anxiety psychology, Depression complications, Depression epidemiology, Depression therapy, Pancreatic Neoplasms, Diabetes Mellitus, Pancreatic Neoplasms epidemiology, Pancreatic Neoplasms diagnosis
- Abstract
Background: It remains unclear how pre-existing depression, anxiety, and diabetes of different durations are associated with the risk of pancreatic cancer, its clinical characteristics, treatment modalities, and subsequent survival., Methods: From a register-based random sample of Finns residing in Finland at the end of the period 1987-2007, 6492 patients diagnosed with primary pancreatic cancer in 2000-2014, and 32 460 controls matched for birth cohort and sex, were identified. Pre-existing depression, anxiety, and diabetes were ascertained from the records of prescribed medication purchases. Information on pancreatic cancer outcomes was obtained from the Finnish cancer register. Data were analyzed using logistic and Cox regressions., Results: The risk of developing pancreatic cancer was found to be associated with long-term anxiety (treatment started 36 + months before the cancer diagnosis) (odds ratio (OR): 1.13, 95% confidence interval (95%CI): 1.04-1.22) and long-term diabetes (OR 1.72, 95%CI 1.55-1.90), as well as with new-onset (treatment started 0-24 months before the cancer diagnosis) depression (OR 1.59, 95%CI 1.34-1.88), anxiety (OR 1.76, 95%CI 1.50-2.07), and diabetes (OR 3.92, 95%CI 3.44-4.48). However, the effects of these new-onset conditions were driven by cases that began treatment within 3 months before the cancer diagnosis (concomitant period). Patients with long-term depression, anxiety and diabetes and those with new-onset anxiety had a higher risk of not receiving standard treatments. Lower survival was found for pancreatic cancer patients with new-onset depression (hazards ratio (HR) 1.38, 95%CI 1.16-1.64). Survival was not associated with pre-existing anxiety or diabetes., Conclusions: The associations between pancreatic cancer risk and pre-existing depression and anxiety were mostly driven by concomitant effects. Individuals with diabetes, regardless of duration, should be closely monitored for pancreatic cancer. Pancreatic cancer patients with new-onset depression should be targeted to improve their survival., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2023
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43. The Contribution of Health Behaviors to Depression Risk Across Birth Cohorts.
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Gueltzow M, Bijlsma MJ, van Lenthe FJ, and Myrskylä M
- Subjects
- Adult, Cohort Studies, Female, Health Behavior, Humans, Male, Obesity epidemiology, United States epidemiology, Birth Cohort, Depression epidemiology
- Abstract
Background: More recent birth cohorts are at a higher depression risk than cohorts born in the early 20th century. We aimed to investigate to what extent changes in alcohol consumption, smoking, physical activity, and obesity contribute to these birth cohort variations., Methods: We analyzed panel data from US adults born 1916-1966 enrolled in the Health and Retirement Study (N = 163,760 person-years). We performed a counterfactual decomposition analysis by combining age-period-cohort models with g-computation. We thereby compared the predicted probability of elevated depressive symptoms (CES-D 8 score ≥3) in the natural course to a counterfactual scenario where all birth cohorts had the health behaviors of the 1945 birth cohort. We stratified analyses by sex and race-ethnicity., Results: We estimated that depression risk of the 1916-1949 and 1950-1966 birth cohort would be on average 2.0% (-2.3 to -1.7) and 0.5% (-0.9 to -0.1) higher with the alcohol consumption levels of the 1945 cohort. In the counterfactual with the 1945 BMI distribution, depression risk is on average 2.1% (1.8 to 2.4) higher for the 1916-1940 cohorts and 1.8% (-2.2 to -1.5) lower for the 1950-1966 cohorts. We find no cohort variations in depression risk for smoking and physical activity. The contribution of alcohol is more pronounced for Whites than for other race-ethnicity groups, and the contribution of BMI more pronounced for women than for men., Conclusion: Increased obesity levels were associated with exacerbated depression risk in recent birth cohorts in the United States, while drinking patterns only played a minor role., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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44. The gendered impacts of delayed parenthood: A dynamic analysis of young adulthood.
- Author
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Nisén J, Bijlsma MJ, Martikainen P, Wilson B, and Myrskylä M
- Subjects
- Male, Young Adult, Humans, Female, Adult, Educational Status, Salaries and Fringe Benefits, Mothers, Income
- Abstract
Young adulthood is a dynamic and demographically dense stage in the life course. This poses a challenge for research on the socioeconomic consequences of parenthood timing, which most often focuses on women. We chart the dynamics of delayed parenthood and its implications for educational and labor market trajectories for young adult women and men using a novel longitudinal analysis approach, the parametric g-formula. This method allows the estimation of both population-averaged effects (among all women and men) and average treatment effects (among mothers and fathers). Based on high-quality data from Finnish registers, we find that later parenthood exacerbates the educational advantage of women in comparison to men and attenuates the income advantage of men in comparison to women across young adult ages. Gender differences in the consequences of delayed parenthood on labor market trajectories are largely not explained by changes in educational trajectories. Moreover, at the time of entering parenthood, delayed parenthood improves the incomes of fathers more than those of mothers, thereby exacerbating existing gender differences. The results provide population-level evidence on how the delay of parenthood has contributed to the strengthening of women's educational position relative to that of men. Further, the findings on greater increases in fathers' than mothers' incomes at the time of entering parenthood, as followed by postponement, may help explain why progress in achieving gender equality in the division of paid and unpaid work in families has been slow., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2022
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45. An Introduction to the Supplemental Issue on Why Does Health in the US Continue to Lag Behind.
- Author
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Mehta NK and Myrskylä M
- Published
- 2022
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46. Cardiovascular Mortality Gap Between the United States and Other High Life Expectancy Countries in 2000-2016.
- Author
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Acosta E, Mehta N, Myrskylä M, and Ebeling M
- Subjects
- Humans, Life Expectancy, Obesity, Risk Factors, United States epidemiology, Cardiovascular Diseases, Stroke
- Abstract
Objectives: Reductions in U.S. cardiovascular disease (CVD) mortality have stagnated. While other high life expectancy countries (HLCs) have also recently experienced a stall, the stagnation in CVD mortality in the United States appeared earlier and has been more pronounced. The reasons for the stall are unknown. We analyze cross-national variations in mortality trends to quantify the U.S. exceptionality and provide insight into its underlying causes., Methods: Data are from the World Health Organization (2000-2016). We quantified differences in levels and trends of CVD mortality between the United States and 17 other HLCs. We decomposed differences to identify the individual contributions of major CVD subclassifications (ischemic heart disease [IHD], stroke, other heart diseases). To identify potential behavioral explanations, we compared trends in CVD mortality with trends in other causes of death related to obesity, smoking, alcohol, and drugs., Results: Our study has four central findings: (a) U.S. CVD mortality is consistently higher than the average of other HLCs; (b) the U.S.-HLC gap declined until around 2008 and increased thereafter; (c) the shift from convergence to divergence was mainly driven by slowing IHD and stroke mortality reductions and increasing mortality from other CVD causes; (d) among the potential risk factors, only obesity- and alcohol-related mortality showed age-specific temporal changes that are similar to those observed for cardiovascular mortality., Discussion: The exceptional changes in U.S. CVD mortality are driven by a distinct pattern of slowing reductions in IHD and stroke mortality and deteriorating mortality from other CVD causes. Obesity and alcohol abuse appear to be interrelated factors., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America.)
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- 2022
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47. Imprisonment, community sanctions and mortality by cause of death among patients with substance use disorder - a 28-year follow-up using Finnish register data.
- Author
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Laine R, Myrskylä M, Kaskela T, and Pitkänen T
- Subjects
- Cause of Death, Finland epidemiology, Follow-Up Studies, Humans, Prisoners, Substance-Related Disorders therapy
- Abstract
Background: The first few weeks' post-imprisonment are associated with high mortality, particularly among individuals with a history of substance use. Excess risk may vary by societal context due to a range of penal systems and substance use patterns. Using data on Finnish individuals who had sought treatment for substance use, we studied the association between criminal sanctions with cause-specific mortality., Methods: The database contained 10887 individuals who had sought treatment between 1990 and 2009. Their treatment data were combined with register data on imprisonments and community sanctions and weekly mortality between 1992 and 2015. Mortality was analysed using discrete-time survival models. We controlled for age and sociodemographic factors, and analysed whether education, type of substance used and the type of latest sentence modified the associations., Findings: Mortality was high in the first two weeks after sanctions (all-cause odds ratio [OR] 2.61, 95% confidence interval [CI] 1.67-4.07; drug-related deaths OR 8.52, 95% CI 4.64-15.7). Excess risk declined over time (OR after 12 weeks: 1.19, 95% CI 1.07-1.31). Most of the excess risk was attributable to external causes. Mortality was low during imprisonment, but not during community sanctions. The patterns were similar by level of education, substance use and the type of latest sentence., Conclusions: Community sanctions were not associated with mortality among people with substance use disorders. Mortality was low during imprisonment, but high post-release. Criminal sanctions should be better utilised as intervention touchpoints and follow-up resources should target prisoners with substance use treatment history to reduce post-release mortality., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2022
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48. Less Partnering, Less Children, or Both? Analysis of the Drivers of First Birth Decline in Finland Since 2010.
- Author
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Hellstrand J, Nisén J, and Myrskylä M
- Abstract
In the 2010s, fertility has declined in the Nordic countries, most strikingly in Finland, and first births drive the decline. It remains unclear whether this decline results from decreased fertility within unions, changing union dynamics, or both. Thus, we investigated changes in the union-first birth dynamics from 2000 through 2018 in Finland using full-coverage population register data and an incidence-based multistate model. To do so, we calculated the yearly age-specific transition probabilities across states of single, cohabitation, marriage, and first births among 15- to 45-year-old childless men and women. We found lower fertility rates in unions after 2010, increasing dissolution rates amongst cohabiting couples, and long-term declines in the transition to marriage. Counterfactual simulations showed that, for the decline in first births since 2010, fertility within unions matters more (three-quarters) than union dynamics (one-quarter): that is, lower fertility in cohabitating and married individuals explained 42% and 13% of the decline, respectively, and decreasing fertility rates among couples entering cohabitation explained a further 17%. Decreasing marriage (19%) and cohabitation rates (2-4%) as well as higher union dissolution rates (6%) explained a smaller share of the first birth decline. The decline in first births was somewhat sharper among the lower social strata, but across strata the decreasing first birth transitions in unions explained most of the decline. To conclude, while changing union dynamics provide a partial explanation, postponing or foregoing fertility within unions represents the primary reason for the fertility decline., Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09605-8., Competing Interests: Conflicts of interestThe authors declare that there is no conflict of interest., (© The Author(s) 2022.)
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- 2022
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49. Medically Assisted Reproduction Treatment Types and Birth Outcomes: A Between-Family and Within-Family Analysis.
- Author
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Pelikh A, Smith KR, Myrskylä M, and Goisis A
- Subjects
- Adult, Cross-Sectional Studies, Female, Humans, Infant, Newborn, Infant, Premature, Infant, Small for Gestational Age, Male, Pregnancy, Pregnancy Complications etiology, Reproductive Techniques, Assisted adverse effects, Utah epidemiology, Young Adult, Pregnancy Complications epidemiology, Reproductive Techniques, Assisted statistics & numerical data
- Abstract
Objective: To compare risks of adverse birth outcomes among pregnancies conceived with and without medically assisted reproduction treatments., Methods: Birth certificates were used to study birth outcomes of all neonates born in Utah from 2009 through 2017. Of the 469,919 deliveries, 52.8% (N=248,013) were included in the sample, with 5.2% of the neonates conceived through medically assisted reproduction. The outcome measures included birth weight, gestational age, low birth weight (LBW, less than 2,500 g), preterm birth (less than 37 weeks of gestation), and small for gestational age (SGA, birth weight less than the 10th percentile). Linear models were estimated for the continuous outcomes (birth weight, gestational age), and linear probability models were used for the binary outcomes (LBW, preterm birth, SGA). First, we compared the birth outcomes of neonates born after medically assisted reproduction and natural conception in the overall sample (between-family analyses), before and after adjustment for parental background and neonatal characteristics. Second, we employed family fixed effect models to investigate whether the birth outcomes of neonates conceived through medically assisted reproduction differed from those of their naturally conceived siblings (within-family comparisons)., Results: Neonates conceived through medically assisted reproduction weighed less, were born earlier, and were more likely to be LBW, preterm, and SGA than neonates conceived naturally. More invasive treatments (assisted reproductive technology [ART] and artificial insemination [AI] or intrauterine insemination) were associated with worse birth outcomes; for example, the proportion of LBW and preterm birth was 6.1% and 7.9% among neonates conceived naturally and 25.5% and 29.8% among neonates conceived through ART, respectively. After adjustments for various neonatal and parental characteristics, the differences in birth outcomes between neonates conceived through medically assisted reproduction and naturally were attenuated yet remained statistically significant; for example, neonates conceived through ART were at 3.2 percentage points higher risk for LBW (95% CI 2.4-4.1) and 4.8 percentage points higher risk for preterm birth (95% CI 3.9-5.7). Among siblings, the differences in the frequency of adverse outcomes between neonates conceived through medically assisted reproduction and neonates conceived naturally were small and statistically insignificant for all types of treatments., Conclusion: Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments itself., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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50. The growing rural-urban divide in US life expectancy: contribution of cardiovascular disease and other major causes of death.
- Author
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Abrams LR, Myrskylä M, and Mehta NK
- Subjects
- Aged, Cause of Death, Female, Humans, Life Expectancy, Male, Rural Population, Urban Population, Cardiovascular Diseases
- Abstract
Background: The US rural disadvantage in life expectancy (LE) relative to urban areas has grown over time. We measured the contribution of cardiovascular disease (CVD), drug-overdose deaths (DODs) and other major causes of death to LE trends in rural and urban counties and the rural-urban LE gap., Methods: Counterfactual life tables and cause-of-death decompositions were constructed using data on all US deaths in 1999-2019 (N = 51 998 560) from the Centers for Disease Control and Prevention., Results: During 1999-2009, rural and urban counties experienced robust LE gains, but urban LE increased by 1.19 years more in women and 0.86 years more in men compared with rural LE. During 2010-2019, rural counties experienced absolute declines in LE (women -0.20, men -0.30 years), whereas urban counties experienced modest increases (women 0.55, men 0.29 years). Counterfactual analysis showed that slowed CVD-mortality declines, particularly in ages 65+ years, were the main reason why rural LE stopped increasing after 2010. However, slow progress in CVD-mortality influenced LE trends more in urban areas. If CVD-mortality had continued to decline at its pre-2010 pace, the rural-urban LE gap would have grown even more post 2010. DODs and other causes of death also contributed to the LE trends and differences in each period, but their impact in comparison to that of CVD was relatively small., Conclusions: Rural disadvantage in LE continues to grow, but at a slower pace than pre 2010. This slowdown is more attributable to adverse trends in CVD and DOD mortality in urban areas than improvements in rural areas., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association.)
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- 2022
- Full Text
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