Cardiovascular disease in people born to unmarried mothers in two historical periods: the Helsinki Birth Cohort Study 1934-1944
Cardiovascular disease in people born to unmarried mothers in two historical periods: the Helsinki Birth Cohort Study 1934-1944
Aims: socio-economic conditions in early life are important contributors to cardiovascular disease – the leading cause of mortality globally – in later life. We studied coronary heart disease (CHD) and stroke in adulthood among people born out of wedlock in two historical periods: before and during World War II in Finland.
Methods: we compared offspring born out of wedlock before (1934–1939) and during (1940–1944) World War II with the offspring of married mothers in the Helsinki Birth Cohort Study. The war affected the position of unmarried mothers in society. We followed the study subjects from 1971 to 2014 and identified deaths and hospital admissions from CHD and stroke. Data were analysed using a Cox regression, adjusting for other childhood and adulthood socio-economic circumstances.
Results: the rate of out-of-wedlock births was 240/4052 (5.9%) before World War II and 397/9197 (4.3%) during World War II. Among those born before World War II, out-of-wedlock birth was associated with an increased risk of stroke (hazard ratio (HR)=1.44; 95% confidence interval (CI) 1.00–2.07) and CHD (HR=1.37; 95% CI 1.02–1.86). Among those born out of wedlock during World War II, the risks of stroke (HR=0.89; 95% CI 0.58–1.36) and CHD (HR=0.70; 95% CI 0.48=1.03) were similar to those observed for the offspring of married mothers. The p-values for interaction of unmarried×World War II were (p=0.015) for stroke and (p=0.003) for CHD.
Conclusions: in a society in which marriage is normative, being born out of wedlock is an important predictor of lifelong health disadvantage. However, this may change rapidly when societal circumstances change, such as during a war.
Finland, cardiovascular disease, childhood, coronary heart disease, life course, socio-economic, stroke, unmarried mother
Mikkonen, H.M
f93fa827-101b-4381-bc4e-0ab97f6dd9ec
Salonen, Minna K.
afeb1f26-cc79-4b5f-a5e5-6bc490150047
Hakkinen, Antti
391a6e7c-a9a2-4edc-9748-1ccf22e458ca
Osmond, Clive
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Eriksson, Johan G.
eb96b1c5-af07-4a52-8a73-7541451d32cd
Kajantie, Eero
c1db7428-b2c0-46f9-92c3-bcd8cdd452fd
31 May 2021
Mikkonen, H.M
f93fa827-101b-4381-bc4e-0ab97f6dd9ec
Salonen, Minna K.
afeb1f26-cc79-4b5f-a5e5-6bc490150047
Hakkinen, Antti
391a6e7c-a9a2-4edc-9748-1ccf22e458ca
Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
Eriksson, Johan G.
eb96b1c5-af07-4a52-8a73-7541451d32cd
Kajantie, Eero
c1db7428-b2c0-46f9-92c3-bcd8cdd452fd
Mikkonen, H.M, Salonen, Minna K., Hakkinen, Antti, Osmond, Clive, Eriksson, Johan G. and Kajantie, Eero
(2021)
Cardiovascular disease in people born to unmarried mothers in two historical periods: the Helsinki Birth Cohort Study 1934-1944.
Scandinavian Journal of Public Health.
(doi:10.1177/14034948211019792).
Abstract
Aims: socio-economic conditions in early life are important contributors to cardiovascular disease – the leading cause of mortality globally – in later life. We studied coronary heart disease (CHD) and stroke in adulthood among people born out of wedlock in two historical periods: before and during World War II in Finland.
Methods: we compared offspring born out of wedlock before (1934–1939) and during (1940–1944) World War II with the offspring of married mothers in the Helsinki Birth Cohort Study. The war affected the position of unmarried mothers in society. We followed the study subjects from 1971 to 2014 and identified deaths and hospital admissions from CHD and stroke. Data were analysed using a Cox regression, adjusting for other childhood and adulthood socio-economic circumstances.
Results: the rate of out-of-wedlock births was 240/4052 (5.9%) before World War II and 397/9197 (4.3%) during World War II. Among those born before World War II, out-of-wedlock birth was associated with an increased risk of stroke (hazard ratio (HR)=1.44; 95% confidence interval (CI) 1.00–2.07) and CHD (HR=1.37; 95% CI 1.02–1.86). Among those born out of wedlock during World War II, the risks of stroke (HR=0.89; 95% CI 0.58–1.36) and CHD (HR=0.70; 95% CI 0.48=1.03) were similar to those observed for the offspring of married mothers. The p-values for interaction of unmarried×World War II were (p=0.015) for stroke and (p=0.003) for CHD.
Conclusions: in a society in which marriage is normative, being born out of wedlock is an important predictor of lifelong health disadvantage. However, this may change rapidly when societal circumstances change, such as during a war.
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14034948211019792
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Accepted/In Press date: 27 April 2021
e-pub ahead of print date: 31 May 2021
Published date: 31 May 2021
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Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: Academy of Finland (274794, 315680 to E.K., 129369, 129907, 135072, 129255, 126775 to J.G.E.); The Diabetes Research Foundation (to J.G.E. and E.K.); Eemil Aaltonen Foundation (to H.M.M.); European Commission Horizon 2020 Framework Programme (733280 RECAP Research on Children and Adults Born Preterm to E.K., 633595 DynaHealth to J.G.E.); European Commission within the 7th Framework Programme (278603 DORIAN to J.G.E.); Finnish Cultural Foundation (to M.M.); Finnish Foundation for Cardiovascular Research (to J.G.E.); Finnish Foundation for Paediatric Research (to E.K.); Finnish Special Governmental Subsidy for Health Sciences (to J.G.E.); Finska Läkaresällskapet (to J.G.E.); Juho Vainio Foundation (to J.G.E., E.K. and H.M.M.); Liv och Hälsa (to J.G.E.); Ministry of Education and Culture Doctoral Programs for Public Health (to H.M.M.); Novo Nordisk Foundation (to E.K.); Samfundet Folkhälsan (to J.G.E.); Signe and Ane Gyllenberg Foundation (to J.G.E., E.K. and H.M.M.); Sigrid Jusélius Foundation (to E.K.); University of Helsinki Doctoral School in Health Sciences (to H.M.M.); Yrjö Jahnsson Foundation (to J.G.E., E.K. and H.M.M.).
Publisher Copyright:
© Author(s) 2021.
Keywords:
Finland, cardiovascular disease, childhood, coronary heart disease, life course, socio-economic, stroke, unmarried mother
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Local EPrints ID: 449897
URI: http://eprints.soton.ac.uk/id/eprint/449897
ISSN: 1403-4948
PURE UUID: 04ad9b89-ccbe-4369-a5cb-3faa9767372c
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Date deposited: 24 Jun 2021 16:31
Last modified: 17 Mar 2024 02:42
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Contributors
Author:
H.M Mikkonen
Author:
Minna K. Salonen
Author:
Antti Hakkinen
Author:
Johan G. Eriksson
Author:
Eero Kajantie
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