Safe Linkage of Cohort and Population-Based Register Data in a Genomewide Association Study on Health Care Expenditure.

There are research questions whose answers require record linkage of multiple databases that may be characterized by limited options for full data sharing. For this purpose, the Open Data Infrastructure for Social Science and Economic Innovations (ODISSEI) consortium has supported the development of the ODISSEI Secure Supercomputer (OSSC) platform that allows researchers to link cohort data to data from Statistics Netherlands and run large-scale analyses in a high-performance computing (HPC) environment. Here, we report a successful record linkage genomewide association (GWA) study on expenditure for total health, mental health, primary and hospital care, and medication. Record linkage for genotype data from 16,726 participants from the Netherlands Twin Register (NTR) with data from Statistics Netherlands was accomplished in the secure OSSC platform, followed by gene-based tests and estimation of total and single nucleotide polymorphism (SNP)-based heritability. The total heritability of expenditure ranged between 29.4% (SE 0.8) and 37.5% (SE 0.8), but GWA analyses did not identify SNPs or genes that were genomewide significantly associated with health care expenditure. SNP-based heritability was between 0.0% (SE 3.5) and 5.4% (SE 4.0) and was different from zero for mental health care and primary care expenditure. We conclude that successfully linking genotype data to administrative health care expenditure data from Statistics Netherlands is feasible and demonstrates a series of analyses on health care expenditure. The OSSC platform offers secure possibilities for analyzing linked data in large scale and realizing sample sizes required for GWA studies, providing invaluable opportunities to answer many new research questions.

[Symposium The future of informal care]. / Symposium De toekomst van de informele zorg.

Due to the reform of long term care in 2015, there is growing concern about whether groups at risk receive the care they need. People in need of care have to rely more on help from their social network. The increased need for informal care requires resilience and organizational skills of families, but also of volunteers, professionals and employers. What does this mean for the provision of informal care in the next decennia? The symposium 'The future of informal care', organized on January 26 2017 by the National Institute for Social Research and the Institute for Societal Resilience of the Vrije Universiteit, addressed possible answers to this question. In her inaugural speech Alice de Boer discussed social inequality as possible determinant and outcome of informal care. Some conclusions:Until 2050 the absolute number of 75-plus doubled to about 3 million persons, but the number of informal caregivers will decrease. In addition to the importance of social and economic resources (the 'have & have-nots'), the ability to arrange care (the 'can & can-nots') gains importance.Almost half of the older employers provides informal care just before retirement. Flexibility in working hours and work location facilitates combining work and care, but about half of the employers indicates that partial retirement and working at home are no options.Informal caregivers and professionals often provide care from comparable perspectives and identities. Addressing similarities rather than differences improves their chances for collaboration.The number of adult children providing household care to older parents increased between 2002 and 2014. This suggests an increase in family solidarity, but current reform policies may increase the gender inequality in caregiving families.Spouses and children remain primary caregivers in the future, preferably supported by many different types of caregivers. Not everybody has the capabilities to organize and direct such a large care network.Providing informal care increases the risk for overburden and absence at work or education. Informal caregivers at risk remain, also in the future, women, spouses, migrants, and younger carers.

Parity and men's mortality risks.

BACKGROUND: Most studies on associations between parity and mortality focus on women, and find a negative correlation or U-shaped pattern. If and why having children is associated with mortality among men is less clear. Our objective was to improve understanding of the association between men's parity and mortality, and to investigate mechanisms potentially underlying this association. METHODS: Analysis of baseline data (1991) from a prospective cohort study (the GLOBE study) with almost 17 years mortality follow-up among 4965 men, aged ≥45 years. Cox proportional hazard hierarchical regression models were used to link parity to mortality and to explore the role of socio-economic position (SEP), health behaviours and partner status. RESULTS: Fathers of two or three children [hazard rate ratio (HR) 0.85; 95% confidence interval (95% CI) 0.74-0.99] and especially fathers of four or more children (HR 0.81; 95% CI 0.69-0.95) had lower mortality risks compared with childless men. However, this association attenuated to non-significance after adding SEP, health behaviours and partner status to the model. CONCLUSIONS: Our findings suggest that childless men have higher mortality risks in comparison with men who have fathered two or more children.

Cross-national differences in older adult loneliness.

Loneliness concerns the subjective evaluation that the number of relationships is smaller than the individual considers desirable or that the intimacy that the individual wishes for has not been realized. The aim of this study was to assess variations in levels of late-life loneliness and its determinants across Europe. Data came from the SHARE surveys, Wave 2 (Borsch-Supan et al., 2008), encompassing adults aged 50 years and over in Austria, Belgium, the Czech Republic, Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland (N = 12,248). Loneliness was measured by a single item derived from the CES-D (depression) scale. Using logistic models, the present authors tested several types of explanations for country differences: differences in demographic characteristics, wealth and health, and social networks. Older adults in the southern and central European countries were generally lonelier than their peers in the northern and western European countries. In the southern and central European countries, loneliness was largely attributable to not being married, economic deprivation, and poor health. Frequent contacts with parents and adult children, social participation, and providing support to family members were important in preventing and alleviating loneliness in almost all countries. To combat loneliness among older adults, the findings suggest both (a) generic approaches aimed at improving social embeddedness and (b) country-tailored approaches aimed at improving health and wealth.

Understanding the effects of Covid-19 through a life course lens.

The Covid-19 pandemic is shaking fundamental assumptions about the human life course in societies around the world. In this essay, we draw on our collective expertise to illustrate how a life course perspective can make critical contributions to understanding the pandemic's effects on individuals, families, and populations. We explore the pandemic's implications for the organization and experience of life transitions and trajectories within and across central domains: health, personal control and planning, social relationships and family, education, work and careers, and migration and mobility. We consider both the life course implications of being infected by the Covid-19 virus or attached to someone who has; and being affected by the pandemic's social, economic, cultural, and psychological consequences. It is our goal to offer some programmatic observations on which life course research and policies can build as the pandemic's short- and long-term consequences unfold.

Is Living Alone "Aging Alone"? Solitary Living, Network Types, and Well-Being.

OBJECTIVES: When identifying older adults who may be at risk of being without necessary supports, policy makers and scholars tend to focus on those living alone, neglecting differences within that group. We examine how their social networks contribute to subjective well-being, why some of them fare better and compare their well-being to older adults coresiding with others. METHOD: Data are from the fourth wave of the Survey of Health and Retirement in Europe (N = 53,383). A network typology for older people living alone (N = 10,047) is constructed using a latent class analysis. Using ordinary least squares (OLS) regressions, we examined differences in subjective well-being (life satisfaction, satisfaction with social network, depression) by network type, adding adults coresiding with others (N = 43,336) as comparison group. RESULTS: We find four social network types among older adults living alone. The likelihood of having "restricted" and "child-based" networks is greater in Eastern and Southern European countries, whereas the likelihood of having "friend-oriented" networks is greater in Western and Northern European countries. Across countries, only those with "restricted" networks tend to have the poorest well-being. Those with "diverse" networks have even better well-being than coresiding older adults. DISCUSSION: Our study shows the importance of drawing distinctions within the group of older adults living alone. Most (two thirds) are not vulnerable and at risk, but fare just as well or even better than peers who coreside with others. Country-level factors shape the opportunities to build satisfactory networks, but subjective well-being depends more strongly on individual resources, including social networks, than country-level factors.

Pathways into childlessness: evidence of gendered life course dynamics.

Using data from the first wave of the Netherlands Kinship Panel Study (NKPS) for 2867 women and 2195 men aged 40 to 79, this study examines to what extent educational, employment and marital pathways shape the likelihood of remaining childless, and whether these pathways are gendered. The findings indicate that women and men have distinctive pathways into childlessness. Educational attainment increases the likelihood of remaining childless among women only. A stable career increases the likelihood of remaining childless among women, but it increases the likelihood of entering fatherhood. Years without a partner is positively associated with childlessness among both women and men. Not having had a partnership and having had multiple partnerships are strong determinants of childlessness, especially among men.

Cross-national Differences in Intergenerational Family Relations: The Influence of Public Policy Arrangements.

Focusing mostly on Europe, this overview reveals how the research on cross-national differences in intergenerational family relations has moved from basic descriptions to a focus on understanding how support exchanges are shaped by macro-level processes. A key issue concerns generational interdependence, the extent to which public policy arrangements impose reliance on older and younger family members or enable individual autonomy. Real theoretical progress is visible in three areas of research. The first pertains to analyses at the micro level of how family members actually respond to the incentives that different macro contexts provide. The generosity or restrictedness of public provisions variably releases or necessitates normative obligations in interdependent family relationships. The second area of progress involves analyses of the implications of specific policies rather than policy packages for gender and socioeconomic inequality. The third area of progress is a more nuanced view on the familialism-individualism divide. These three areas provide inspiring examples for future investigations.

Care Ideals in the Netherlands: Shifts between 2002 and 2011.

Our study's premise was that normative care beliefs can inform the current care policy debate. We conducted latent class regression analyses on two waves of Netherlands Kinship Panel Study data (n = 4,163) to distinguish care ideals that captured multiple dimensions of normative care beliefs simultaneously. We also assessed how these care ideals have shifted in the early twenty-first century. We distinguished four care ideals: warm-modern (family and state jointly responsible for caring, egalitarian gender roles), cold-modern (large state responsibility, restricted family responsibility, egalitarian gender roles), traditional (restricted state responsibility, large family responsibility, moderately traditional gender roles), and cold-traditional (large state responsibility, restricted family responsibility, traditional gender roles). Between 2002 and 2011, there has been a shift away from warm-modern care ideals and towards cold-modern care ideals. This is remarkable, because Dutch policy makers have increasingly encouraged family members to take on an active role in caring for dependent relatives.

Gender and marital-history differences in emotional and social loneliness among Dutch older adults.

In this study, Weiss's (1973) theorizing about the sources of emotional and social loneliness is elaborated--with notions about the asymmetric gratifications derived from marriage, about the conflicting loyalties that result from remarriage, and about selection into marriage--in order to reach an understanding of gender differences in loneliness, both in and outside of marriage. First and subsequent marriages are considered, as well as marital disruptions and never marrying. The data (N = 3737) are from the 1992 Dutch survey on older adults' living arrangements and social networks (NESTOR-LSN). Marital-history differences emerge, not only for emotional loneliness, but also (and contrary to Weiss's theoretical conceptualizations) for social loneliness. The marital-history differences in emotional and social loneliness are greater among men than women. For men, the marriage bond appears not only to be more central to emotional well-being than is the case for women but also to play a pivotal role in their involvement with others. Marital history offers the best explanation for differences in emotional loneliness among men, but social embeddedness characteristics also account for differences in emotional loneliness among women. Apparently, whereas men are more likely to find an intimate attachment in marriage, women also find protection from emotional loneliness in other close ties. The marital-history differences in social loneliness are largely mediated by social embeddedness characteristics, partly in different ways for men and women. Involvement in activities outside the home serves as the context for sociability for men, whereas parenthood plays a more important role in women's social engagements.

The transition to parenthood and well-being: the impact of partner status and work hour transitions.

Using data from the first two waves of the Netherlands Kinship Panel Study for 338 women and 262 men, we examine the consequences of making the transition to parenthood for life satisfaction, loneliness, positive affect, negative affect, and partnership satisfaction. We extend previous work by taking transitions in partner status and work hours into account. Results show a moderate impact of becoming a parent on well-being. In so far as effects of making the transition to parenthood emerge, they are attributable to changes in partner status and work hours. First, the decrease in negative affect upon making the transition to motherhood is attributable to the group of women who increase their working hours. Second, the detrimental impact of making the transition to motherhood on partnership satisfaction is attributable to the group of new mothers who quit their job. Third, the detrimental impact of making the transition to fatherhood on loneliness is attributable to the group of new fathers who become married. There is one exception to this pattern of partner status and work hours as mechanisms for changes in well-being. Men who become fathers remain less satisfied with their partnership, even when transitions in partner status and work hours have been taken into account. In the discussion-section, we consider the possible underestimation of negative effects because of the focus on the continuously partnered. We also reflect on our results in the light of the high incidence of part-time work in the Netherlands and Dutch policies aimed at supporting new parents.

Older adult loneliness: myths and realities.

The focus in this paper is on the social domain of quality of life, and more particularly loneliness. The empirical literature on older adult loneliness is reviewed, thereby challenging three often-held assumptions that figure prominently in public debates on loneliness. The first assumption that loneliness is a problem specifically for older people finds only partial support. Loneliness is common only among the very old. The second assumption is that people in individualistic societies are most lonely. Contrary to this belief, findings show that older adults in northern European countries tend to be less lonely than those in the more familialistic southern European countries. The scarce data on Central and Eastern Europe suggest a high prevalence of older adult loneliness in those countries. The third assumption that loneliness has increased over the past decades finds no support. Loneliness levels have decreased, albeit slightly. The review notes the persistence of ageist attitudes, and underscores the importance of considering people's frame of reference and normative orientation in analyses of loneliness.

Intergenerational contact beyond the dyad: the role of the sibling network.

In this paper we aim to reach beyond the dyadic perspective on intergenerational contact and examine the influence of the sibling network on parent-child contact. We include aggregate sibling network characteristics as well as the adult child's position in the network vis-à-vis siblings, and use data from the Netherlands Kinship Panel Study (2002-2004 NKPS; N = 4,601 dyads). Regarding aggregate network characteristics results show that having sisters, having stepsiblings, increasing geographical distance between siblings, and decreasing levels of network cohesion are associated with less contact per parent-child dyad. Regarding the position of the adult child vis-à-vis his or her siblings, results show that having geographically or emotionally closer siblings has a negative effect on parent-child contact. The impact of differences in emotional distance among siblings is stronger when the analyses are limited to parents in poor health. Suggestions for future research are made.