Article Text

Download PDFPDF
Early-life exposure to economic stress and metabolic risks in young adulthood: the children of the reunification in East Germany
  1. Lara Bister1,
  2. Fanny Janssen1,2,
  3. Tobias Vogt1,3
  1. 1 Population Research Centre, University of Groningen, Groningen, The Netherlands
  2. 2 Netherlands Interdisciplinary Demographic Institute – KNAW / University of Groningen, The Hague, The Netherlands
  3. 3 Prasanna School of Public Health, Manipal Academy for Higher Education, Manipal, India
  1. Correspondence to Lara Bister, Population Research Centre, University of Groningen, Groningen, The Netherlands; l.bister{at}


Background Research on the long-term health consequences of early-life exposure to economic crises is scarce. We examine for the first time the long-term effects of early-life exposure to an economic crisis on metabolic health risks. We study objective health measures, and exploit the quasi-experimental situation of the postreunification economic crisis in East Germany.

Methods Data were drawn from two waves of the longitudinal German Health Interview and Examination Survey for Children and Adolescents (2003–2006, 2014–2017). We compared 392 East Germans who were exposed to the economic crisis in utero and at ages 0–5 with 1123 of their West German counterparts using propensity score matching on individual and family characteristics. We assessed blood pressure, cholesterol, blood fat and body mass index (BMI); both combined as above-average metabolic health risks and individually at ages 19–30.

Results Early-life exposure to the economic crisis significantly increased the number of above-average metabolic health risks in young adulthood by 0.1482 (95% CI 0.0169 to 0.2796), which was 5.8% higher compared with no exposure. Among individuals exposed in utero, only females showed significant effects. Early-life exposure to the economic crisis was associated with increased systolic (0.9969, 95% CI −0.2806 to 2.2743) and diastolic blood pressure (0.6786, 95% CI −0.0802 to 1.4373), and with increased BMI (0.0245, 95% CI −0.6516 to 0.7001).

Conclusion The increased metabolic health risks found for women exposed to the postreunification economic crisis in-utero are likely attributable to increased economic stress. While the observed differences are small, they may foreshadow the emergence of greater health disparities in older age.

  • cohort studies
  • environmental health
  • life course epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data may be obtained from a third party and are not publicly available.

View Full Text


  • Twitter @LaraBister

  • Contributors LB: guarantor, conceptualisation, methodology, software, formal analysis, investigation, validation, data curation, writing—original draft, writing—review and editing, visualisation, project administration. FJ: conceptualisation, investigation, writing—review and editing, supervision. TV: conceptualisation, investigation, writing—review and editing, supervision, project administration.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.