Cohort Studies

April 4, 2014
Dora Costa of the University of California, Los Angeles, Organizer

Ilona Koupil, Stockholm University

Socioeconomic Inequalities in Health among Swedish Men and Women Born 1915-2010: Life Course and Intergenerational Effects across the Twentieth Century

Socioeconomic inequalities in health have been observed worldwide, including in welfare states like Sweden. The research goal of the Uppsala Birth Cohort Multigenerational Study (UBCoS Multigen) is to explore how the socioeconomic environment interacts with health, growth, and development in order to predict health and social outcomes across the life course and across generations. The study started with a representative cohort of 14,192 males and females born in Uppsala University Hospital from 1915–29 and the first results were published in the 1990s. Since 2003, the study has been led by Ilona Koupil and the original cohort was combined with social and health data on all their descendants obtained from routine registers and additional data collected from church parish records, school archives, obstetric records, and the 1930 census. Today, this multigenerational study comprises more than 150,000 individuals followed until the end of 2009/2010 and further data collection in the archives continues. Multiple UBCoS studies demonstrate associations between social and health characteristics across more than two generations. These studies also highlight that early life predictors of social outcomes show both important similarities and important differences between men and women and between generations. Based on data from the UBCoS Multigen, Koupil and her team demonstrate that early life biological and social disadvantage in the original cohort members predicts lower school achievement, educational continuation, and income in later life, and that this in turn predicts lower socioeconomic position (SEP) in their children and lower school achievement and SEP in their grandchildren. Several UBCoS Multigen analyses indicate the presence of multigenerational effects on social outcomes and suggest that these may operate via the social mobility of intervening generations. The uniqueness of UBCoS Multigen stems from a combination of routine registry data (available in Sweden since 1960) with manually collected social and health data going back to the early 1900s. Understanding intergenerational determinants of health and health inequality can not only clarify disease etiologies at the individual level, but also generate evidence for effective policy interventions.

Alissa Goodman, University of London; Elaine Kelly, Institute for Fiscal Studies; and James Smith, RAND Corporation

Childhood Health in the United States and United Kingdom: A Cross-Cohort, Cross-National Comparison

Goodman, Kelly, and Smith highlight long-term economic costs of childhood psychological health and determinants of poor childhood mental health, all done in an international comparative context using data from the United Kingdom and the United States. The data consist of three British Cohort Studies: NCDS, the 1958 Birth Cohort; BCS, the 1970 Birth Cohort; and the MCS, the 2000-1 Millennium Cohort and the American Panel Study of Income Dynamics (PSID). The authors find in previous work using these data that there are large associations between poor childhood mental health and a variety of key socioeconomic status (SES) adult outcomes including wages, the probability of working, the stability of partnerships and marriage, and family income. In this work, they extend this research to examine two highly related issues. The first concerns the determinants of four dimensions of mental health issues in children as summarized by four Rutter components: conduct, hyperactivity, emotional problems, and peer problems. The determinants they examine include measures of family SES, mental health issues of parents, and early indicators of developmental problems. The second part of the research estimates models that relate these Rutter score components to later life adult outcomes including education, work, wages, family income, and partnership stability.

Robert Levenson, University of California at Berkeley

Emotional Diversity: Sources and Consequences

Emotions are brief biobehavioral events that occur in response to life's significant challenges and opportunities. Increasingly we are learning that emotions profoundly influence the ways we see the world and the choices and decisions we make. Evolutionary views of emotion often emphasize their more universal aspects. However, there are also sizeable and important differences among individuals in the ways that emotions are generated, regulated, and recognized. In this talk, Levenson describes several sources of these individual differences, focusing on normal aging, neurodegenerative diseases of late life, and genes. He also discusses some of the long-term consequences that these individual differences in emotional functioning have for health and well-being.

Lambert Lumey, Columbia University

Early Life Determinants of Health and Socioeconomic Outcomes over the Lifecourse: Findings from the Dutch Famine 1944-5

Studies of men and women exposed to the Dutch famine of 1944-5 (also known as the Dutch "hunger winter") during different periods of life are important because they provide an opportunity to look at long-term effects of disturbances in the early life environment. For ethical and practical reasons, such studies could not otherwise be carried out in humans. In the Dutch famine, civilian starvation was caused by conditions of war and the impact of extreme changes in nutrition not normally seen in human populations. Lumey presents an overview of studies conducted on the Dutch famine using military examination records, psychiatric hospital records, population surveys, and famine birth cohorts followed to the present day for medical examinations and DNA analysis. Of all reported outcomes, associations between prenatal famine and adult body size, diabetes, and schizophrenia show the most consistent pattern. For other outcomes the pattern is more variable and inconsistent. There are also associations between prenatal famine and long-lasting epigenetic changes in DNA regulation. These need replication but could provide a potential mechanism to explain other observations. Studies of the Dutch famine are well suited to testing hypotheses of "fetal programming" and the biology of human adaptations in response to changes in the environment. They can contribute significantly to a better understanding of human biology.

Jonas Hjort, Columbia University; Mikkel Sølvsten, University California, Berkeley; and Miriam Wüst, Aarhus University

Long-Run Returns to Universal Investments in Infant Health: Evidence from Denmark's Home Visiting Program

Hjort, Sølvsten, and Wüst provide some of the first estimates of the long-run causal effects of a universal infant health intervention. Specifically, exploiting variation in the timing of program implementation across municipalities, they examine the impact of the 1937 Danish home visiting program that targeted all infants. They use population outcome data from administrative registers to show that home visits significantly affected adult health of treated individuals. Individuals exposed to the program in infancy are 5 to 8 percent less likely to die between the ages of 45 and 57, and 2 to 4 percent less likely to be diagnosed with cardiovascular disease. These estimates for long-run health effects are remarkably stable across different specifications accounting for municipal level trends and pre-treatment municipal characteristics. Thus, universal home visiting had long-run positive effects for population health in middle age, most likely through improvement of nutrition and disease environment for treated infants. Examining educational and labor market outcomes, the authors find somewhat weaker results. Heterogeneity in the effects of the program across different types of municipalities (such as those with different levels of pre-treatment infant mortality) highlights the important interplay of early childhood intervention and other contemporary factors that impact child development.

Randy Jirtle, University of Wisconsin


Gabriella Conti, University College London and NBER

Beyond Birth Weight: The Origins of Health Capital

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