The contribution of parental and grandparental childhood social disadvantage to circulatory disease diagnosis in young Swedish men☆
Introduction
In early twentieth century Sweden, children born out of wedlock (BOW) constituted a deprived group in many ways. From earlier research on individuals who were born at Uppsala University Hospital (UUH) between 1915 and 1929, we know that those born out of wedlock suffered disadvantages over the entire life-course in terms of suboptimal foetal growth (Vågerö, Koupilovà, Leon, & Lithell, 1999), reproductive success (Koupil, Vågerö, & Modin, 2005), marital career, achieved socio-economic status and relative risk of male ischaemic heart disease mortality (Modin, 2002, Modin, 2003). This study takes the question of childhood social disadvantage and its long-term health consequences one step further by examining the sons and grandsons of these men and women born to unmarried parents. The question posed is whether they are at a disadvantage vis-à-vis the corresponding descendants of individuals born inside wedlock (BIW) regarding circulatory disease at the time of military conscription. Women born outside marriage seem to have fared better than their male counterparts at least in terms of marital career, reproductive success and mortality risk over the life-course (Modin, 2002, Vågerö and Modin, 2002). In order to establish whether this also is the case among their male descendants, analysis is carried out separately for sons and grandsons of male versus female ancestors.
Section snippets
Illegitimacy as an indicator of childhood social disadvantage
As in most European countries, the illegitimacy ratio in Sweden escalated during the nineteenth century. Thus, from a level of 6.2% in 1811–1820, the share of illegitimate births climbed to 9% by 1851–1860, only to reach a level of 11% by the turn of the century (Brändström, 1996). At this time, however, illegitimacy was much more common in urban than in rural areas, often resulting in rates exceeding 20% in Swedish towns at the beginning of the twentieth century. Among the babies delivered at
Intergenerational pathways
There is abundant evidence of the transmission of health disadvantage from one generation to the next. The lasting impact of parents' socio-economic status on their children's social career (Björklund and Jännti, 1997, Erikson and Goldthorpe, 1992, Erikson and Jonsson, 1998) and health (Davey Smith et al., 2001, Kuh et al., 2004, Power et al., 2005) are well-established examples of such intergenerational transfers. Yet another example is the long-term health effects of birth size in relation to
Multigenerational transmission of health
Few studies into health have taken more than two generations into account. However, a recent study based on Danish men born in 1953 showed that the combination of never having been married at the age of 39, of one's mother having been single, divorced or widowed at the time of childbirth and maternal grandparental divorce was associated with a significantly increased mid-life mortality risk among these men in a dose-response fashion. This association remained significant even when mental health
Research questions
The purpose of this study is to empirically investigate the following questions. (i) Do the sons (UG2) and grandsons (UG3) of individuals born outside marriage at UUH in 1915–1929 (UG1) have an increased probability of circulatory disease diagnosis at the time of military conscription compared to the corresponding descendants of individuals born inside marriage?, (ii) Does any such finding differ according to whether the illegitimately born ancestor was a man or a woman?, and (iii) Can a
Data material
The material used is the UBCoS Multigenerational database, which was established by combining existing data on a cohort of all men and women born in Uppsala between 1915 and 1929 (the Uppsala Birth Cohort Study: UBCoS) with information on their descendants obtained through a linkage to routine data registers. The primary source of information was a linkage of personal identification numbers of UBCoS men and women who were alive and resident in Sweden in 1947, to the Swedish Multigeneration
Variables
Table 1 shows the distribution of the variables included in the analyses. Circulatory system disease (UG2 and UG3) was assessed by means of a medical examination at the time of military conscription (around 18 years of age). Up to six disease codes were recorded by a physician according to the International Classification of Disease, versions 8–10. Conscripts who were diagnosed with 390-459 (ICD 8 and 9) or I00-99 (ICD 10) were classified as having a circulatory system disease (3.5% of UG2s and
Statistical methods
The effect of UG1s legitimacy status at birth on their sons' and grandsons' risk of circulatory disease diagnosis at the time of conscription is analyzed by means of logistic regression. First, only birth year, parent's birth year and region of enlistment is adjusted for. Then, the question is further elaborated by adjusting for certain risk factors and testing for interactions. All analyses are carried out separately for sons and grandsons descending from male versus female UG1s. The
Results
Table 2 shows the odds ratios of being diagnosed with circulatory disease for the four combinations of young men with male or female ancestors in UG1. In the first model(s) we adjust for birth year, parent's birth year and region of enlistment whereas BMI and height at conscription as well as father's social class and UG1s circulatory disease history are adjusted for in the second model(s). It is quite evident that an increased probability of circulatory disease only exists among sons and
Limitations of the study
The period for which conscript data were available implies some limitations to the generalizability of the study that needs to be noted. Since conscript data are not available for men born before 1950, the analysis of the second generation is restricted to the right-hand side of their birth year distribution. This means that the analyzed UG2s, born in 1950 or later, are more likely to be later-borns with parents above the average age compared to UG2s born before 1950 (mean age of mothers: 31
Discussion
In another study carried out on UBCoS Multigen, clear disadvantages for a number of health related outcomes in young adulthood were found among the sons and grandsons of men and women who were born outside marriage (Modin et al., in press). The present study adds to these findings by showing that both sons and grandsons of illegitimately born men have higher odds of being diagnosed with circulatory disease at the time of conscription compared with the corresponding descendants of men born to
Acknowledgment
We would like to thank Kristiina Rajaleid (CHESS) for helpful advice during the progress of this paper.
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The Swedish Council for Working Life and Social Research financed this study.