Independent and additive association of prenatal famine exposure and intermediary life conditions with adult mortality between age 18-63 years

P. Ekamper, F.W.A. van Poppel, A.D. Stein, L.H. Lumey

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Abstract

Objectives
To quantify the relation between prenatal famine exposure and adult mortality, taking into account mediating effects of intermediary life conditions.
Design
Historical follow-up study.
Setting
The Dutch famine (Hunger Winter) of 1944–1945 which occurred towards the end of WWII in occupied Netherlands.
Study population
From 408,015 Dutch male births born 1944–1947, examined for military service at age 18, we selected for follow-up all men born at the time of the famine in six affected cities in the Western Netherlands (n = 25,283), and a sample of unexposed time (n = 10,667) and place (n = 9087) controls. These men were traced and followed for mortality through the national population and death record systems.
Outcome measure
All-cause mortality between ages 18 and 63 years using Cox proportional hazards models adjusted for intermediary life conditions.
Results
An increase in mortality was seen after famine exposure in early gestation (HR 1.12; 95% confidence interval (CI): 1.01–1.24) but not late gestation (HR 1.04; 95% CI: 0.96–1.13). Among intermediary life conditions at age 18 years, educational level was inversely associated with mortality and mortality was elevated in men with fathers with manual versus non-manual occupations (HR 1.08; CI: 1.02–1.16) and in men who were declared unfit for military service (HR 1.44; CI: 1.31–1.58). Associations of intermediate factors with mortality were independent of famine exposure in early life and associations between prenatal famine exposure and adult mortality were independent of social class and education at age 18.
Conclusions
Timing of exposure in relation to the stage of pregnancy may be of critical importance for later health outcomes independent of intermediary life conditions.
Original languageEnglish
Pages (from-to)232-239
JournalSocial Science & Medicine
Volume119
Issue numberOctober
DOIs
Publication statusPublished - 2014

Keywords

  • nutrition
  • famine
  • mortality
  • prenatal exposure
  • delayed effects
  • Netherlands
  • World War II
  • SSCI

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