Elsevier

Social Science & Medicine

Volume 66, Issue 4, February 2008, Pages 822-834
Social Science & Medicine

The contribution of parental and grandparental childhood social disadvantage to circulatory disease diagnosis in young Swedish men

https://doi.org/10.1016/j.socscimed.2007.11.001Get rights and content

Abstract

Men born out of wedlock in early twentieth century Sweden who never married have previously been shown to have a doubled mortality risk from ischaemic heart disease compared to the corresponding group of men born to married parents. This study further explores the question of childhood social disadvantage and its long-term consequences for cardiovascular health by examining the two subsequent generations. The question posed is whether the sons and grandsons of men and women born out of wedlock in early twentieth century Sweden have an increased risk of circulatory disease compared with the corresponding descendants of those born inside marriage. We examined this by use of military conscription data. The material used is the Uppsala Birth Cohort Multigenerational database consisting of individuals born at Uppsala University Hospital between 1915 and 1929 (UG1), their children (UG2) and grandchildren (UG3). Conscription data were available for UG2s born between 1950 and 1982 (n = 5,231) and UG3s born between 1953 and 1985 (n = 10,074) corresponding to 72.1% and 73.6%, respectively, of all males born in each time-period. Logistic regression showed that significant excess risk of circulatory disease diagnoses was present only among descendants of men born outside marriage, with sons and grandsons demonstrating odds ratios of 1.64 and 1.83, respectively, when BMI and height at the time of conscription, father's social class in mid-life and father's or grandfather's history of circulatory disease had been adjusted for. Separate analyses showed that the effect of the maternal and paternal grandfather was of approximately the same magnitude. Further analyses revealed an interaction between the father's social class and the grandfather's legitimacy status at birth on UG3-men's likelihood of having a circulatory disease, with elevated odds only among those whose fathers were either manual workers or self-employed. The results of this study suggest that social disadvantage in one generation can be linked to health disadvantage in the subsequent two generations.

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.

References (50)

  • D.J.P. Barker et al.

    Size at birth and resilience to effects of poor living conditions in adult life: longitudinal study

    British Medical Journal

    (2001)
  • A. Björklund et al.

    Intergenerational income mobility in Sweden compared to the United States

    American Economic Review

    (1997)
  • L.O. Bygren et al.

    Longevity determined by paternal ancestors' nutrition during their slow growth period

    Acta Biotheoretica

    (2001)
  • M. Cherniak et al.

    Vibration exposure, smoking, and vascular dysfunction

    Occupational and Environmental Medicine

    (2000)
  • B. Claussen et al.

    Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study

    Journal of Epidemiology and Community Health

    (2003)
  • G. Davey Smith et al.

    Social circumstances in childhood and cardiovascular disease mortality: prospective observational study of Glasgow university students

    Journal of Epidemiology and Community Health

    (2001)
  • Engwall, K., 1998. Gör barn till medborgare! Om barn och demokrati under 1900-talet [Turn children into citizens. On...
  • R. Erikson et al.

    The constant flux: A study of class mobility in industrial societies

    (1992)
  • R. Erikson et al.

    Qualifications and the allocation process of young men and women in the Swedish labour market

  • L. Fraenkel et al.

    Different factors influencing the expression of Raynaud's phenomenon in men and women

    Arthritis and Rheumatism

    (1999)
  • B. Galobardes et al.

    Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood

    Annals of Epidemiology

    (2005)
  • G. Hu et al.

    Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women

    European Heart Journal

    (2004)
  • A.V. James et al.

    Fertility patterns in a bastardy-prone sub-society

    Journal of Quantitative Anthropology

    (1990)
  • G. Kaati et al.

    Cardiovascular and diabetes mortality determined by nutrition during parents' and grandparents' slow growth period

    European Journal of Human Genetics

    (2002)
  • S. Kinra et al.

    Is maternal transmission of coronary heart disease risk stronger than paternal transmission?

    Heart

    (2003)
  • Cited by (15)

    • From Epigenetic Associations to Biological and Psychosocial Explanations in Mental Health

      2018, Progress in Molecular Biology and Translational Science
      Citation Excerpt :

      As described by Frances Champagne and in the beginning of this chapter, decades of longitudinal, preclinical and clinical based studies have highlighted the relationship between the social environment and behavioral/health outcomes.126 There are several epidemiological registry-based studies also pointing in the same direction.127–131 Continuous similar studies are coming from the Stockholm Public Health Cohorts,132 as well as other study cohorts such as a prospective military cohorts.133

    • Grandparental education, parental education and adolescent blood pressure

      2016, Preventive Medicine
      Citation Excerpt :

      Only one small (n = 88) Canadian study, using convenience sampling, suggested grandparental education was associated with lower adolescent blood pressure (Schreier and Chen, 2010). Whether grandparental socioeconomic experience plays a specific role in cardiovascular health, as suggested by the association of maternal or paternal grandfather's childhood social disadvantage, indicated by illegitimate birth, with cardiovascular disease risk in Swedish military conscripts, (Modin et al., 2008) remains to be elucidated. We examined prospectively the associations of parental (maternal and paternal) and grandparental education with adolescent blood pressure using a population-representative birth cohort from Hong Kong.

    • The impact of parental educational trajectories on their adult offspring's overweight/obesity status: A study of three generations of swedish men and women

      2014, Social Science and Medicine
      Citation Excerpt :

      Since these are likely to vary both over calendar time and across social contexts, the actual importance of intergenerational social mobility for OWOB still remains to be addressed more comprehensively. The importance of grandparents' circumstances on their grandchildren's health status has been highlighted previously (Modin et al., 2008; Osler et al., 2005), with a few studies linking grandparental characteristic specifically to BMI and obesity. In a recent study based on a representative U.S. sample, grandparental educational attainment was negatively associated with their grandchildren's obesity status among Whites, and this association was independent of parental and own educational attainment (Le-Scherban et al., 2014).

    • The impact of early twentieth century illegitimacy across three generations. Longevity and intergenerational health correlates

      2009, Social Science and Medicine
      Citation Excerpt :

      However, in a recent study we showed that both sons and grandsons of men born outside marriage in 1915–1929 were significantly worse off vis-à-vis the corresponding descendants of men born inside marriage regarding circulatory disease diagnosis at the time of conscription. These results held true also when body mass index and height at the time of conscription as well as the father's social class and father's/grandfather's history of circulatory disease were adjusted for (Modin et al., 2008). Another study, based on Danish men born in 1953, showed that the accumulation of being never married at the age of 39, of one's mother having been single-, divorced- or widowhood 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.

    View all citing articles on Scopus

    The Swedish Council for Working Life and Social Research financed this study.

    View full text