Severe prenatal shocks and adolescent health: Evidence from the Dutch Hunger Winter.

This paper investigates health impacts at the end of adolescence of prenatal exposure to multiple shocks, by exploiting the unique natural experiment of the Dutch Hunger Winter. At the end of World War II, a famine occurred abruptly in the Western Netherlands (November 1944-May 1945), pushing the previously and subsequently well-nourished Dutch population to the brink of starvation. We link high-quality military recruits data with objective health measurements for the cohorts born in the years surrounding WWII with newly digitised historical records on calories and nutrient composition of the war rations, daily temperature, and warfare deaths. Using difference-in-differences and triple differences research designs, we first show that the cohorts exposed to the Dutch Hunger Winter since early gestation have a higher Body Mass Index and an increased probability of being obese at age 18. We then find that this effect is partly moderated by warfare exposure and a reduction in energy-adjusted protein intake. Lastly, we account for selective mortality using a copula-based approach and newly-digitised data on survival rates, and find evidence of both selection and scarring effects. These results emphasise the complexity of the mechanisms at play in studying the consequences of early conditions.

Infant and child mortality in the Netherlands 1935-47 and changes related to the Dutch famine of 1944-45: A population-based analysis.

Precise estimates of the impact of famine on infant and child mortality are rare due to lack of representative data. Using vital statistics reports on the Netherlands for 1935-47, we examine the impact of the Dutch famine (November 1944 to May 1945) on age-specific mortality risk and cause of death in four age groups (stillbirths, <1 year, 1-4, 5-14) in the three largest famine-affected cities and the remainder of the country. Mortality during the famine is compared with the pre-war period January 1935 to April 1940, the war period May 1940 to October 1944, and the post-war period June 1945 to December 1947. The famine's impact was most visible in infants because of the combined effects of a high absolute death rate and a threefold increase in proportional mortality, mostly from gastrointestinal conditions. These factors make infant mortality the most sensitive indicator of famine severity in this setting and a candidate marker for comparative use in future studies.

Overweight and obesity at age 19 after pre-natal famine exposure.

BACKGROUND: Weight for height has been used in the past as an indicator of obesity to report that prenatal exposure to the Dutch famine of 1944-1945 determined subsequent obesity. Further evaluation is needed as unresolved questions remain about the possible impact of social class differences in fertility decline during the famine and because being overweight is now defined by a Body Mass Index (BMI: kg/m2) from 25 to <30 and obesity by a BMI of 30 or more. METHODS: We studied heights and weights of 371,100 men in the Netherlands born between 1943 and 1947 and examined for military service at age 19. This group includes men with and without prenatal exposure to the Dutch famine. RESULTS: There was a 1.3-fold increase in the risk of being overweight or obese in young adults at age 19 after prenatal famine exposure in early gestation. The increase was only seen in sons of manual workers born in the large cities of Western Netherlands and not among those born in smaller cities or rural areas in the West. Social class differentials in fertility decline during the famine did not bias study results. CONCLUSIONS: The long-term adverse impact of prenatal famine on later life type 2 diabetes and mortality through age 63 is already showing at age 19 in this population as a significant increase in overweight risk.

War-related excess mortality in The Netherlands, 1944-45: New estimates of famine- and non-famine-related deaths from national death records.

Despite there being several estimates for famine-related deaths in the west of The Netherlands during the last stage of World War II, no such information exists for war-related excess mortality among the civilian population from other areas of the country. Previously unavailable data files from Statistics Netherlands allow researchers to estimate the number of war-related excess deaths during the last stage of the war in the whole country. This study uses a seasonal-adjusted mortality model combined with a difference-in-difference approach to estimate the number of excess deaths in the period between January 1944 and July 1945 at a total of close to 91,000 (75%) excess deaths. Almost half of all war-related excess mortality during the last year of the war occurred outside the west.

Gains in Life Expectancy Associated with Higher Education in Men.

BACKGROUND: Many studies show large differences in life expectancy across the range of education, intelligence, and socio-economic status. As educational attainment, intelligence, and socio-economic status are highly interrelated, appropriate methods are required to disentangle their separate effects. The aim of this paper is to present a novel method to estimate gains in life expectancy specifically associated with increased education. Our analysis is based on a structural model in which education level, IQ at age 18 and mortality all depend on (latent) intelligence. The model allows for (selective) educational choices based on observed factors and on an unobserved factor capturing intelligence. Our estimates are based on information from health examinations of military conscripts born in 1944-1947 in The Netherlands and their vital status through age 66 (n = 39,798). RESULTS: Our empirical results show that men with higher education have lower mortality. Using structural models to account for education choice, the estimated gain in life expectancy for men moving up one educational level ranges from 0.3 to 2 years. The estimated gain in months alive over the observational period ranges from -1.2 to 5.7 months. The selection effect is positive and amounts to a gain of one to two months. Decomposition of the selection effect shows that the gain from selection on (latent) intelligence is larger than the gain from selection on observed factors and amounts to 1.0 to 1.7 additional months alive. CONCLUSION: Our findings confirm the strong selection into education based on socio-economic status and intelligence. They also show significant higher life expectancy among individuals with higher education after the selectivity of education choice has been taken into account. Based on these estimates, it is plausible therefore that increases in education could lead to increases in life expectancy.

Prenatal famine exposure and adult mortality from cancer, cardiovascular disease, and other causes through age 63 years.

Nutritional conditions in early life may affect adult health, but prior studies of mortality have been limited to small samples. We evaluated the relationship between pre-/perinatal famine exposure during the Dutch Hunger Winter of 1944-1945 and mortality through age 63 years among 41,096 men born in 1944-1947 and examined at age 18 years for universal military service in the Netherlands. Of these men, 22,952 had been born around the time of the Dutch famine in 6 affected cities; the remainder served as unexposed controls. Cox proportional hazards models were used to estimate hazard ratios for death from cancer, heart disease, other natural causes, and external causes. After 1,853,023 person-years of follow-up, we recorded 1,938 deaths from cancer, 1,040 from heart disease, 1,418 from other natural causes, and 523 from external causes. We found no increase in mortality from cancer or cardiovascular disease after prenatal famine exposure. However, there were increases in mortality from other natural causes (hazard ratio = 1.24, 95% confidence interval: 1.03, 1.49) and external causes (hazard ratio = 1.46, 95% confidence interval: 1.09, 1.97) after famine exposure in the first trimester of gestation. Further follow-up of the cohort is needed to provide more accurate risk estimates of mortality from specific causes of death after nutritional disturbances during gestation and very early life.

Historical trends in the correlation of sibling deaths in infancy in the Netherlands.

In this article, we study temporal, regional, and social variation in infant and childhood death clustering in The Netherlands, using data from three provinces. The data relate to children born in 90,000 marriages contracted between the beginning and the last quarter of the nineteenth century. Descriptive indicators show that death clustering was more frequent in the province of Zeeland and more common in the lower classes, and that it increased in two provinces over time. Shared frailty hazard models make it clear that the number of children who died before the birth of an index child had a negative effect on the mortality of index children, whereas earlier stillbirths and the number of children who died when the index child was at a young age had an increasing effect on the mortality of index children.

Future trends in health and marital status: effects on the structure of living arrangements of older Europeans in 2030.

This article presents the results of projections of older people's living arrangements in 2030 in nine European countries. It analyses expected changes due to future trends in health and marital status. Future changes in the marital status of the older people will result in a higher proportion living in their own homes: women in each age group will more often grow old living with their partner, and this will also apply, to a lesser extent, to men aged 85 and over. Both men and women will be less likely to live alone, with people other than a partner, or in institutions. But for men aged 74-84 the likelihood of choosing one or another type of living arrangement will remain remarkably stable in the future. Further, an improvement in health will lead to older people living alone slightly more often, and they will also more often do so in good health. A comparison of two health scenarios shows that changes in marital status have a major impact on overall trends in living arrangements whereas an improvement in health-which is not certain to occur-will affect them only marginally.