| Autor: |
Mikkonen HM; Finnish Institute for Health and Welfare, Finland.; Faculty of Medicine, University of Helsinki, Finland.; Economic and Social History, University of Helsinki, Finland., Salonen MK; Finnish Institute for Health and Welfare, Finland.; Folkhälsan Research Centre, Finland., Häkkinen A; Economic and Social History, University of Helsinki, Finland., Osmond C; MRC Lifecourse Epidemiology Unit, University of Southampton, UK., Eriksson JG; Folkhälsan Research Centre, Finland.; Department of General Practice and Primary Health Care, University of Helsinki, Finland.; Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore.; Department of Obstetrics and Gynaecology, and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Kajantie E; Finnish Institute for Health and Welfare, Finland.; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Finland.; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Finland.; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway. |
| Abstrakt: |
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. |
