Quantifying self-rated age.

Chronological age, in conjunction with population life tables, is widely used for estimating future life expectancy. The aims of this study are to estimate a subjective ageing indicator, namely self-rated age, and to evaluate its concurrent validity in comparison with other age indicators: subjective survival probabilities, subjective age, and biological age. We use data from the Wave 6 of the Survey of Health, Ageing and Retirement in Europe, Wave 12 of the Health and Retirement Study in the United States, and life tables from the Human Mortality Database. For the statistical analysis we use multinomial regression models. Our results indicate that health status and frequency of physical activities imply similar patterns of self- rated age, subjective survival probabilities, subjective age, and biological age. However, the impact of cognitive function differs by geographical region. Self-rated age can be interpreted as a subjective adjustment that better reflects the ageing process.

Maternity migration and the recent normalization of the sex ratio at birth in Hong Kong.

Hong Kong is characterized by very low fertility. However, over a period from 2000 to 2015, both the total number of births and the sex ratio at birth (SRB) increased and then declined dramatically. We analysed the increases in a 2013 paper in this journal, where we largely ascribed them to a rapid growth in the number of 'transient' mothers from Mainland China disproportionately giving birth to boys in the territory. In 2012, policies were implemented to halt this 'maternity migration'. Here, we explore the impact of these policies, both on births and the SRB in Hong Kong. We conclude that the rises and falls in births and SRBs in Hong Kong can, indeed, be broadly ascribed to the reproductive behaviour of transient Mainland mothers. However, the role of the Hong Kong government's policy interventions is much less clearly defined.

CONTRASTING CONCURRENT AND CHILDHOOD SOCIOECONOMIC PREDICTORS OF SELF-RATED HEALTH AMONG OLDER EUROPEAN MEN AND WOMEN.

This study aimed to assess the relative importance of childhood and adulthood socioeconomic position (SEP) on the self-rated health (SRH) of men and women aged 50 or higher in Europe, controlling for a substantial number of mediators and health conditions. Data from Wave 2 (current data) and Wave 3 (retrospective material) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were combined (N=20,829) and logistic regression models applied; the analysis was carried out for males and females separately. The findings indicate that concurrent and past SEP, when considered separately, are both very significant predictors of SRH. When all factors were included in a comprehensive model most childhood and adult SEP variables retained their significance, implying that both types of socioeconomic circumstances have a strong and independent effect on SRH. However, the relative importance of several childhood indicators was reduced, signifying that their effect on SRH is mediated by adult SEP and, especially, educational attainment. Some childhood predictors, such as having experienced a period of hunger, remained very significant. Though these findings roughly hold for both sexes, the relative effects differentiate by sex. Current SEP is more important among women, with the exception of income and 'making ends meet in the household'. Childhood SEP indicators are more significant among men.

Very low, low and heavy weight births in Hong Kong SAR: how important is socioeconomic and migrant status?

Identification of modifiable factors and mediators linked to low and heavy birth weight is crucial in reducing infant mortality and health care expenditure. The present paper explores the associations of socio-demographic factors and immigrant status of parents with adverse pregnancy outcomes in Hong Kong. The analysis compares very low birth weight (VLBW: <1500 g), low birth weight (LBW: ≥ 1500 g and <2500 g) and heavy birth weight births (HBW: ≥ 4500 g) with births of normal weight (≥ 2500 g and <4500 g) using multinomial regression modelling of a large dataset of 828,975 births of singletons occurring between 1995 and 2009. The findings indicate the expected significant adverse associations between teenage and advanced age of the mother with compromised birth outcomes; teenage motherhood, however, has a protective effect against HBW births. A strong socioeconomic gradient is apparent, more marked among LBW births; low educational attainment of the father, low occupational class, public housing and single motherhood are strongly related to adverse pregnancy outcomes. Regarding immigrant status, women born in South and South-East Asia exhibit consistently higher odds of a compromised outcome. Women born in Hong Kong have significantly higher chances of LBW births while Mainland Chinese and parents from developed countries face higher odds of HBW births. The study identifies high-risk groups such as teenage, older and single mothers, South-East Asians and couples of low socioeconomic profile. Implementation of policies supporting these groups would be beneficial.

Modelling the effects of maternal socio-demographic characteristics on the preterm and term birth weight distributions in Greece using quantile regression.

The present study aims at modelling the effects of maternal socio-demographic characteristics on the birth weight distribution in Greece. The analysis is based on nationwide vital registration micro-data; 103,266 single live births recorded in 2006 are considered. Quantile regression models, allowing for the effects of covariates to vary across the conditional distribution of the dependent variable, birth weight, are applied to preterm and term births separately. The statistical analysis shows that the effects of most factors differentiate across the birth weight distributions. Ordinary Least Squares (OLS) coefficients, on the other hand, systematically underestimate effects at the lower tail and overestimate effects among heavier babies. Hence, quantile regression has a strong advantage over the OLS method. The findings also indicate that birth weight distributions of term and preterm infants are distinct and should be analysed separately. For both distributions female sex, primiparity, age of mother over 35 and prior history of stillbirths and child deaths are related to lower birth weight while higher educational attainment has a protective effect. Among term births, illegitimacy, living in big metropolitan areas and immigrant status of the mother are also significant predictors. For preterm births the impact of age of mother, parity and, in particular, prior stillbirths or deceased children is very pronounced.

'Maternity migration' and the increased sex ratio at birth in Hong Kong SAR.

The sex ratio at birth (SRB) in Hong Kong SAR (Special Administrative Region) has recently increased dramatically. Using a data set (N = 850,331) of all recorded births in Hong Kong between 1995 and 2009, we calculated SRBs by parity and immigrant status. The findings indicate a strong son preference among Mainland Chinese who have travelled to Hong Kong to give birth, especially at parity two or above. Logistic regression models show that this tendency is significantly greater among more affluent couples and remains strong even among Mainland Chinese women resident in Hong Kong for any length of time. The SRB of Hong Kong-born couples, though elevated at higher parities, is less skewed. Hong Kong has been serving as an outlet for 'elite' Mainland couples to circumvent family planning restrictions. The analysis also suggests the advantages of a wider set of immigrant variables over a binary construct.

Socioeconomic inequality and stillbirth rate disparities among native and foreign mothers: evidence from Greece.

We study, for the first time, stillbirth differentials among native and migrant populations in Greece using national vital registration microdata for the period of 2010-2014. We employ conventional demographic measures and propose a standardization procedure to delineate the effect of selected distributions of livebirths on the observed stillbirth rates. The stillbirth rate among immigrant mothers is 40% higher than among natives, an excess which persists throughout gestational intervals and age groups. Our findings also show a clear gradient of stillbirth rates by maternal education, favoring more educated women, and this finding applies to both native and immigrant mothers. Our standardization methodology shows that the distribution of births by maternal educational level and age play a role; this finding implies that elevated immigrant stillbirth rates may be attributed to a certain extent to the specific characteristics of this group, since immigrant women have, on average, a younger age structure and lower educational attainment. Supplementary Information: The online version contains supplementary material available at 10.1007/s43545-022-00410-y.

Demographic and socioeconomic determinants of low birth weight and preterm births among natives and immigrants in Greece: an analysis using nationwide vital registration micro-data.

The present study makes use of nationwide individual-level vital registration data on the single live births occurring in Greece in 2006 to explore associations of socio-demographic factors with adverse pregnancy outcomes, using multinomial logistic regression models. The findings indicate that important risk factors associated with low birth weight preterm and intra-uterine growth retarded births (IUGR) include female sex, primiparity, age of mother over 35, illegitimacy and prior history of stillbirths, infant and child deaths. These constitute risk factors for normal weight preterm births as well, though associations with sex and primiparity in this case point to the opposite direction. Residing in large metropolitan areas is related to a greater risk of an IUGR birth. Among Greek women, educational attainment has a protective effect while housewife status is linked to higher chances of an IUGR birth. For immigrant mothers however, the opposite holds. The study also shows that normal weight preterm births form a distinct group.

Economic crisis and stillbirth ratios: Evidence from Southern Europe.

In this paper we assess the impact of the recent European recession on stillbirth indices over the course of the 2000s and 2010s; the analysis focuses on four Southern European countries (Greece, Italy, Spain, Portugal), which were seriously affected by the sovereign debt crisis from around 2008 to 2017. We use national vital statistics and established economic indicators for the period 2000-2017; stillbirth ratios (stillbirths per 1000 livebirths) are the chosen response variable. For the purpose of the study, we employ correlation analysis and fit regression models. The overall impact of economic indicators on the stillbirth indices is sizeable and statistically robust. We find that a healthy economy is associated with low and declining levels of stillbirth measures. In contrast, economic recession appears to have an adverse effect (Greece, Italy and Spain), or an unclear impact (Portugal), on the stillbirth outcome. This study provides evidence of the adverse effect of the European sovereign debt crisis and ensuing period of austerity on a scarcely explored aspect of health.

Differentials in sex ratio at birth among natives and immigrants in Greece: an analysis employing nationwide micro-data.

This study uses micro-level information on the live births registered in Greece for 2006 to assess differentials in the propensity to have a male offspring between natives and immigrants. The sex ratio at birth for the whole population is 106.3 but it is considerably higher among immigrants (110.9) than among natives (105.4). Relatively high sex ratios at birth are observed for several migrant groups; differentials between natives, on the one hand, and Albanians (109.5) and Asians (129.0), on the other, are significant. The high sex ratio at birth for Albanians seems typical of that population. For Asians, the result is consistent with international findings though it may also be partly related to the small number of observations.

Increasingly heterogeneous ages at first birth by education in Southern European and Anglo-American family-policy regimes: A seven-country comparison by birth cohort.

According to the 'reproductive polarization' hypothesis, family-policy regimes unfavourable to the combination of employment with motherhood generate greater socio-economic differentials in fertility than other regimes. This hypothesis has been tested mainly for 'liberal' Anglo-American regimes. To investigate the effects elsewhere, we compared education differentials in age at first birth among native-born women of 1950s and 1960s birth cohorts in seven countries representing three regime types. Women with low educational attainment have continued to have first births early, not only in Britain and the USA but also in Greece, Italy, and Spain. Women at all other levels of education have experienced a shift towards later first births, a shift that has been largest in Southern Europe. Unlike the educationally heterogeneous changes in age pattern at first birth seen under the Southern European and Anglo-American family-policy regimes, the changes across birth cohorts in the study's two 'universalistic' countries, Norway and France, have been educationally homogeneous.

Childhood and adulthood circumstances predicting affective suffering and motivation among older adults: a comparative study of European welfare systems.

The aims of the study are, first, to examine the effect of childhood and adulthood predictors on affective suffering and motivational symptoms among older adults in Europe and, second, to assess differentials across European welfare systems. The mediating role of adulthood circumstances is also explored. Data are derived from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 2 (cross-sectional material) and 3 (retrospective information). The sample includes 23,050 respondents aged 50 +. The EUROD subscales were obtained using factor analysis; scores were transformed to binary constructs; logistic regression models were used to identify predictors; mediation was assessed employing a decomposition technique. Prevalence of both subscales is higher in Southern and Central/Eastern Europe and lower in Nordic countries, which are characterised by more equitable and generous welfare provisions. Though health, childhood socioeconomic status and childhood adversity are significant for both subscales, there are also differences; female gender, adulthood socioeconomic status and stress are associated with affective suffering, whereas age and educational attainment are of greater consequence for motivational symptoms. These findings are quite consistent across regions, indicating that the subscales represent different aspects of depression. By contrast, childhood circumstances are attenuated differentially by adulthood factors across Europe. Nevertheless, important mediating circumstances are stress for affective suffering and poor health for motivational symptoms. The importance of childhood circumstances in all aspects of later life mental health highlights the need for policy interventions across welfare systems, which should target vulnerable groups early in life.

The changing relationship between marriage and childbearing in Hong Kong.

Births outside marriage (BoM) account for around 15% of all births globally. However, the distribution around the world is very uneven, as are cultural and political attitudes towards them. Studies from East Asia have shown that the percentage of such births is very low, with only modest increases in recent years. The orthodox demographic view holds that the maintenance of conservative views around the relationship between marriage and childbearing can play a role in keeping fertility low. Prenuptial pregnancies (PNP) (where births occur within eight months of marriage) have been identified as a growing phenomenon in Japan, possibly being an 'alternative' Asian pathway to family formation. As yet, no comprehensive statistical analysis of the trends of BoM or PNP has been performed for Hong Kong. Using a comprehensive microdata set of birth registration in Hong Kong from 1984-2015 (N = 1,680,831) we provide evidence of recent trends in such 'alternative pathways' to family formation and examine predictors through regression analysis. Our results indicate, in common with elsewhere in East Asia, low overall period rates of either BoM or PNP (although the latter has risen notably in recent years). While more recent birth cohorts exhibit higher prevalence of such births, their incomplete nature and higher expected propensity suggests that the figures are exaggerated. In our regression analysis, we find that lower educational attainment is a strong predictor of both BoM and PNP, suggesting that a bifurcation of experience may be occurring. This adds further evidence to the theory that the maintenance of traditional family formation systems in the context of revolutionised educational and work opportunities for women mean that the opportunity costs of the 'marriage package' become too high. Current disparities in rights and privileges between married and unmarried parents-and especially their children-means that targeted family planning services and support for vulnerable families are policy priorities.

Mortality by Cause of Death Among Immigrants and Natives in a South European Country: The Case of Greece, 2011.

The aim of the paper is to examine for the first time in Greece mortality by cause of death among immigrants. The analysis makes use of vital registration statistics for 2010-2012 and census data for 2011; standardised mortality ratios are estimated for four distinct groups: natives, migrants from EU-27 (excluding Greece), other Europeans (mainly Albanians) and those from all other countries (mainly Asia/Africa). All immigrants seem to experience favourable mortality from neoplasms but higher mortality from external causes in comparison to Greeks. The results regarding cardiovascular diseases are mixed. Persons originating in Asian/African regions exhibit higher mortality from infectious diseases and TB. The findings highlight the specificities of immigrant mortality which stem from pre-existing conditions in the country of origin as well as from the adverse socio-economic environment in the country of destination. As immigrants experience some excessive 'avoidable' mortality implementation of appropriate measures should be a social policy priority.

A Re-Interpretation of the 'Two-child Norm' in Post-Transitional Demographic Systems: Fertility Intentions in Taiwan.

Taiwan currently has one of the lowest fertility rates in the world, leading to projections of rapid population ageing and decline. In common with other territories in Pacific Asia, policies designed to support childbearing have recently been introduced. Some optimism for the future success of these policies has been drawn from the fact that the 'ideal' number of children stated in Taiwanese surveys is over two. In this way, Taiwan appears to fit the 'two-child norm' model identified for Europe and North America. Furthermore, this feature has led commentators to state that Taiwan is not in a 'low fertility trap'-where positive feedback mechanisms emanating from the normalisation of small families, slow economic growth and ageing/declining population mean attempts to increase fertility become ever less likely to succeed. Using a recent national representative survey, and arguing that 'intentions' are a more reliable guide to understanding the circumstances of family formation, this paper explores fertility intentions in Taiwan with a special focus on women at parity one and parity two. This will form the first full-length examination of fertility intentions in Taiwan published in English and one of the few studies of Pacific Asia that reports a micro-level analysis. We argue that using intentions should provide a better 'barometer' of attitudes towards childbearing in Taiwan, and that through micro-level analysis, we can better identify the predictors of intentions that could, in turn, provide useful clues both for projections as well as shaping policy responses. While we found some evidence for a 'two-child norm' among childless women, this could be an unrealistic ideal. This is supported by the fact that a majority of women with one child do not intend to have another.

Specific versus general self-reported health indicators predicting mortality among older adults in Europe: disparities by gender employing SHARE longitudinal data.

OBJECTIVES: The study aims at assessing the relative importance of specific versus general self-reported indicators of health and disability in predicting mortality among older adults and at exploring the potential value of the global activity limitation indicator (GALI), a recently validated general measure of activity restrictions, as predictor of death. METHODS: Longitudinal data from two waves (2004 and 2006-2007) of the Survey of Health, Ageing and Retirement in Europe were employed. The sample comprises 17,941 persons aged 50+ at baseline, representing 11 countries. Associations were estimated by sex using Cox's proportional hazards regression models. RESULTS: Most specific and general indicators of health and disability are strong and independent predictors. There are disparities by sex; among general measures, controlling for all indicators under consideration, self-rated health (SRH) only remains significantly associated with mortality among males and GALI among females. CONCLUSIONS: A combination of specific and general measures is more efficient in predicting mortality than either of these alone. SRH and GALI seem to share some traits, adding health and disability dimensions over specific measures, representing though different aspects by gender.

Determinants of change in self-rated health among older adults in Europe: a longitudinal perspective based on SHARE data.

The present study aims at detecting factors which may predict a decline or an improvement in self-rated health (SRH) of older adults (persons aged 50 or higher) among socio-demographic characteristics, physical and mental health indicators and risky health behaviours. In the analysis, multinomial logistic regression models are applied to data from waves 1 and 2 of the Survey of Health Ageing and Retirement in Europe (carried out about 3 years apart); persons who report a decline or an improvement in SRH at wave 2 are compared to those who report no change while controlling for SRH at baseline and country of residence. The analysis was carried out for the whole sample and two subgroups, persons aged 50-64 and 65 or higher. The results indicate that female sex and higher educational attainment have a strong protective effect against decline in SRH. Worse health at baseline is an important predictor of subsequent decline but changes occurring between the waves have a more pronounced effect, implying that SRH is influenced more by recent developments. The findings also indicate that improvement in SRH is a more complex concept than decline and is strongly affected by factors other than health. Among behavioural risk factors, low levels of physical activity and a decrease in the levels of activity between the waves are significantly related to decline while frequent drinking seems associated with improvement. Differentiations by age are modest and probably suggest that advancing age is related to a milder view of one's health.

Key elements composing self-rated health in older adults: a comparative study of 11 European countries.

Self-rated health (SRH) is a multidimensional measure, predictive of morbidity and mortality. Comparative studies of determinants, however, are rare due to a lack of comparable cross-national data. This paper contributes towards filling in this gap, using data for persons aged 50 or higher in 11 European countries from the SHARE study (2004). The analysis aims at identifying key elements composing SRH using multinomial logistic regression models. In addition, the homogeneity of associations across populations is assessed. The findings indicate that education, depression, chronic conditions, mobility difficulties, somatic symptoms and levels of physical activity constitute important components of SRH; ADLs and obesity, on the other hand, are not significant and IADLs are important only in a few countries. All these associations point to the expected direction and are homogeneous across countries. However, demographic factors, age and gender, though significant in many countries have divergent associations. Effects of smoking also differentiate between southern and northern Europe.

Socio-demographic and health-related factors affecting depression of the Greek population in later life: an analysis using SHARE data.

Depression in later life is one of the most prevalent conditions forecasted to rise to the second most burdensome health condition worldwide by 2020. Using data from the 2004 Study of Health Ageing and Retirement in Europe (SHARE: release 1) on 857 Greek males and 1,032 females aged 50 or higher this study explores, firstly, associations of socio-demographic and health related indicators with depressive symptoms (EURO-D) and, secondly, attempts to identify patterns and structures among them. To achieve the first objective, the 12-item summated EURO-D scale is used in binary form with a cut-off point clinically validated by the EURODEP. Use of logistic regression pinpoints strong associations with gender, years of education, co-morbidity, disability, cognitive function and past depression. Women, less educated persons, those with poor physical health, declining cognitive function and a history of depression are significantly more at risk of scoring higher than three at the EURO-D scale. The role of age is not as clear. To achieve the second objective, multiple correspondence analysis is used in the first instance and factor analysis for binary data subsequently; two components are identified within EURO-D and continuous factor scores are produced. These factors are called "affective suffering" and "motivation". Linear regression models reveal that the first component is responsible for the gender while the second for the age differentials in EURO-D; additionally we find that, apart from physical health indicators which are strongly related to both factors, other associations differ. Further exploration of this differentiation seems of interest, particularly as there is an indication that "motivation" may be an affectively neutral condition.