Independent and additive association of prenatal famine exposure and intermediary life conditions with adult mortality between age 18-63 years.

OBJECTIVES: To quantify the relation between prenatal famine exposure and adult mortality, taking into account mediating effects of intermediary life conditions. DESIGN: Historical follow-up study. SETTING: The Dutch famine (Hunger Winter) of 1944-1945 which occurred towards the end of WWII in occupied Netherlands. STUDY POPULATION: From 408,015 Dutch male births born 1944-1947, examined for military service at age 18, we selected for follow-up all men born at the time of the famine in six affected cities in the Western Netherlands (n=25,283), and a sample of unexposed time (n=10,667) and place (n=9087) controls. These men were traced and followed for mortality through the national population and death record systems. OUTCOME MEASURE: All-cause mortality between ages 18 and 63 years using Cox proportional hazards models adjusted for intermediary life conditions. RESULTS: An increase in mortality was seen after famine exposure in early gestation (HR 1.12; 95% confidence interval (CI): 1.01-1.24) but not late gestation (HR 1.04; 95% CI: 0.96-1.13). Among intermediary life conditions at age 18 years, educational level was inversely associated with mortality and mortality was elevated in men with fathers with manual versus non-manual occupations (HR 1.08; CI: 1.02-1.16) and in men who were declared unfit for military service (HR 1.44; CI: 1.31-1.58). Associations of intermediate factors with mortality were independent of famine exposure in early life and associations between prenatal famine exposure and adult mortality were independent of social class and education at age 18. CONCLUSIONS: Timing of exposure in relation to the stage of pregnancy may be of critical importance for later health outcomes independent of intermediary life conditions.

The role of cultural and economic determinants in mortality decline in the Netherlands, 1875/1879-1920/1924: a regional analysis.

The objective of this study was to determine the relative importance of cultural and economic factors in mortality decline in the Netherlands in the periods 1875/1879-1895/1899 and 1895/1899-1920/1924. Mortality data by region, age, sex and cause of death as well as population data were derived from Statistics Netherlands for the years 1875/1879, 1885/1889, 1895/1899, 1910/1914, 1920/1924. Regional mortality declines were estimated on the basis of Poisson regression models. In a multivariate analysis the estimated declines were associated with economic (wealth tax) and cultural variables (% Roman Catholics and secularisation) corrected for confounders (soiltype, urbanisation). In the period from 1875/1879-1895/1899, %Roman Catholics was significantly associated with all-cause mortality decline and with mortality decline from diseases other than infectious diseases. Mortality declined less rapidly in areas with a high percentage of Roman Catholics. Secularisation was significantly associated with infectious-disease mortality decline. In areas with a high percentage population without a religious affiliation, mortality declined more rapidly. In the period from 1895/1899 to 1920/1924, wealth tax was significantly associated with all-cause and infectious-disease mortality decline. Mortality declined more rapidly in wealthy areas. Intermediary factors in the relationship between cultural factors and mortality decline were fertility decline, but more importantly, the number of medical doctors per 100,000 inhabitants. No intermediary factors were found for the association between the economic variable and mortality decline. Cultural and economic factors both played an important role in mortality decline in The Netherlands, albeit in different periods of time. The analysis of intermediary factors suggests that the acceptance of new ideas on hygiene and disease processes was an important factor in the association between culture and mortality decline in the late 19th century.

Long-term trends in marital status mortality differences in The Netherlands 1850-1970.

This article describes the long-term trends in marital status mortality differences in the Netherlands using a unique dataset relating to the period 1850-1970. Poisson regression analysis was applied to calculate relative mortality risks by marital status. For two periods, cause-of-death by marital status could be used. Clear differences in mortality by marital status were observed, with strongly increasing advantages for married men and women and a relative increase in the mortality of widowed compared with non-married people. Excess mortality among single and formerly married men and women was visible in many cause-of-death categories, and this became more widespread during the last decades of the nineteenth century. Hypotheses are formulated that might explain why married men and women underwent a stronger decrease in mortality up until the end of World War II.

Determinants of infant and early childhood mortality levels and their decline in the Netherlands in the late nineteenth century.

OBJECTIVE: To study the relative importance of various determinants of total and cause-specific infant and early childhood mortality rates and their decline in The Netherlands in the period 1875-1879 to 1895-1899. DATA AND METHODS: Mortality and population data were derived from Statistics Netherlands for 16 towns and 11 rural areas. Mortality levels and their decline were estimated with a Poisson regression model. The associations of the estimated levels and declines, and determinants of infant and early childhood mortality were analysed using multivariate linear regression analysis. The causes of death studied were major contributors to infant mortality (convulsions, acute digestive disease, acute respiratory disease) and early childhood mortality (encephalitis/meningitis, acute respiratory disease, measles). RESULTS: Infant mortality rates were high in the south-western part of The Netherlands in 1875-1879. Due to a rapid decline in the western regions, this pattern changed to a north-south gradient in 1895-1899. Early childhood mortality showed an urban-rural gradient in 1875-1879 with mortality high in towns. This gradient had largely disappeared by 1895-1899, due to a rapid decline in mortality in towns. Roman Catholicism was significantly associated with infant mortality (particularly from diarrhoeal disease) in 1875-1879 and 1895-1899. The association with Roman Catholicism was stronger in 1895-1899 because mortality declines were less rapid in Roman Catholic areas in 1875-1879 to 1895-1899. Urbanization was significantly associated with early childhood mortality (particularly from respiratory disease) in 1875-1879 and 1895-1899. This association weakened over time, due to the rapid decline in mortality in towns. CONCLUSIONS: Different determinants of mortality (decline) were important in infant and early childhood mortality and they acted on different causes of death. Therefore, infant and childhood mortality should be studied separately. International comparison of the results showed that findings with respect to determinants of mortality (decline) for one country do not necessarily apply to other countries. The results for The Netherlands with respect to infant mortality differed from England and Wales.

The proper age to marry: social norms and behavior in nineteenth-century Netherlands.

"The article compares publicly discussed norms concerning the proper age at marriage for men and women in nineteenth-century Netherlands, and the actual trends present in the empirical evidence about marriage age. Medical professionals (the hygienists) expressed the belief that marriage at too young an age was damaging both to public hygiene and the family's health; other commentators stressed the connection between young marriages and poverty. Yet such norms were put forward vaguely, allowing other influences on marriage age to come into play. Consequently, data on marital behavior suggest considerable diversity in the population, with age at marriage varying strongly by class, sex, and region. Generally, age at marriage did not begin to fall until the period 1860-1870, and even after that decade class differences remained strong."

Mortality decline in The Netherlands in the period 1850-1992: a turning point analysis.

The aim of this paper is to give a detailed and fairly objective description of rapid mortality decline in The Netherlands between 1850 and 1992 with respect to the start, end, and phases of the decline. Turning points were estimated for the standardized mortality trend, and for age and sex-specific trends between 1850-1992. The technique used was derived from spline functions. The turning points divided the trends into phases with different paces of decline. Standardized mortality started to decline rapidly in The Netherlands around 1880. Four phases in the period of decline could be distinguished: 1880-1917 (1.2% annually), 1917-1955 (1.6%), 1955-1970 (0.4%), 1970-1992 (1.1%). For nearly all age groups, the most rapid decline occurred in a period comparable to 1917-1955. Causes of death which might have shaped the standardized mortality trend are, among others, respiratory tuberculosis (1917), heart disease (except ischemic) (1955), and ischemic heart disease (1970). Causes of death that shaped the mortality trend are related to trends of determinants of mortality decline. The technique used in this paper can also be applied to other trends e.g. fertility decline.

A longitudinal study of health selection in marital transitions.

We examined whether differences in health were associated with different probabilities of marital transitions in a longitudinal study, using Cox proportional hazard analysis. Data on approximately 10,000 Dutch persons of the GLOBE study, aged 15-74 years, were used for this purpose. The study started in 1991 and study subjects have been followed for 4.5 years. Of the four marital transitions studied (marriage among never married and divorced persons, and divorce and bereavement among married persons), only divorce among married persons was associated with health status: married persons who reported four or more subjective health complaints or two or more chronic conditions were, respectively, 1.5 and two times more likely to become divorced during follow-up than persons without these health problems. Since hardly any other studies have examined the role of health selection in marital transition with longitudinal data, more research is required before firm conclusions can be drawn. It can be concluded, however, that the frequently made assumption that health selection contributes only little to the explanation of health differences between marital status groups, seems, at least for the divorced, not justified.

The effects of water supply on infant and childhood mortality: a review of historical evidence.

The provision of clean water is mentioned as an important factor in many studies dealing with the decline of mortality in Europe during the late nineteenth and early twentieth centuries. In developing countries too, improved water supply is assumed to have a strong impact on mortality. When studying the effect of water supply on public health, researchers are confronted with many methodological problems. Most of these also apply to historical studies of the subject. We review the evidence from this historical research, taking into account the methodological problems observed in contemporary impact evaluation studies, and we use more refined data from the Dutch city of Tilburg, enabling us to overcome many of these shortcomings. Finally, we discuss some factors which may explain why we failed to discover an effect of the availability of piped water on the level of childhood mortality.

PIP: The UN designation of the 1980s as the International Drinking Water Supply and Sanitation Decade has stimulated research into the effect of water supply on public health. This paper opens with a review of studies that have attempted to quantify the impact of improved water supply (improved quality and/or increased quantity) on infant and child mortality in 19th- and early 20th-century France, the Netherlands, Germany, Sweden, and the US. The next section reviews studies on the health effects of water supply on contemporary populations in the developing world. The paper continues by discussing some of the methodological problems contained in such research including the difficulty of predicting the sign of the correlation between waterworks and morality rates, the difficulty in choosing which dependent variable to use, data limitations, problems finding appropriate control groups, unequal conditions prevailing before adoption of a specific public health improvement, failure to analyze mortality by age, and failure to determine seasonal differences. Next, a study of the effect of water supply on the population in the Dutch city of Tilburg in the early 20th century is presented. This study answers some of these methodological problems because it uses available individual-level data on health indicators and water supply. Analysis of the data, including use of a hazard rate model with the independent variables of water supply, socioeconomic status, father's income level, age of mother at birth, birth order of child, interval to next child, season of birth, number of rooms in the house, and district of birth, was performed for three age groups from birth to five elapsed years. This study revealed no discernable effect of the availability of piped water on the level of childhood mortality. The paper ends by proposing various explanations for these findings.

Cause-specific mortality trends in The Netherlands, 1875-1992: a formal analysis of the epidemiologic transition.

BACKGROUND: The objective of this study is to produce a detailed yet robust description of the epidemiologic transition in The Netherlands. METHODS: National mortality data on sex, age, cause of death and calendar year (1875-1992) were extracted from official publications. For the entire period, 27 causes of death could be distinguished, while 65 causes (nested within the 27) could be studied from 1901 onwards. Cluster analysis was used to determine groups of causes of death with similar trend curves over a period of time with respect to age- and sex-standardized mortality rates. RESULTS: With respect to the 27 causes, three important clusters were found: (1) infectious diseases which declined rapidly in the late 19th century (e.g. typhoid fever), (2) infectious diseases which showed a less precipitous decline (e.g. respiratory tuberculosis), and (3) non-infectious diseases which showed an increasing trend during most of the period 1875-1992 (e.g. cancer). The 65 causes provided more detail. Seven important clusters were found: four consisted mainly of infectious diseases, including a new cluster that declined rapidly after the Second World War (WW2) (e.g. acute bronchitis/influenza) and a new cluster showing an increasing trend in the 1920s and 1930s before declining in the years thereafter (e.g. appendicitis). Three clusters mainly contained non-infectious diseases, including a new one that declined from 1900 onwards (e.g. cancer of the stomach) and a new one that increased until WW2 but declined thereafter (e.g. chronic rheumatic heart disease). CONCLUSIONS: The results suggest that the conventional interpretation of the epidemiologic transition, which assumes a uniform decline of infectious diseases and a uniform increase of non-infectious diseases, needs to be modified.

Family breakdown in nineteenth-century Netherlands: divorcing couples in The Hague.

This is an analysis of divorce trends in the Netherlands in the second half of the nineteenth century. "Use was made of a case-control research design in which the social characteristics of all marriages which ended in divorce were compared with those of a random sample from the marriages which ended in widowhood. The author analyzed a group of 2,300 marriages contracted in The Hague from their inception until their dissolution by death or divorce. All migrants were followed to their new place of residence. Multivariate (proportional hazards) analysis showed that the highest probability of divorce was found among persons who had already gone through a divorce before. Other factors related to divorce were high mobility, low ages at marriage, and large age and religious differences between spouses. Higher social classes had relatively high divorce risks."

Is fecundability associated with month of birth? An analysis of 19th and early 20th century family reconstitution data from The Netherlands.

The relationship between fecundability and month of birth was investigated in a cohort of 1526 women who married between 1802 and 1929, using only women whose first marriage occurred before the age of 35 years. On the basis of their time to pregnancy (TTP, calculated as time between wedding and first birth minus gestational length), women were categorized into two groups: fecunds (TTP up to 12 months or prenuptial conceptions, n = 1348) and subfecunds (TTP >18 months, n = 118). By use of logistic regression, cosinor functions with a period of 1 year or 6 months and variable shift and amplitude were fitted through the monthly odds of subfecunds versus fecunds. The best fitting curve was unimodal, with a zenith in September (P = 0.13 for H0: no differences). Exclusion of childless women (n = 36, minimum follow-up 5 years) from the subfecunds led to a similar curve (P < 0.01), while childless women, as compared with fecunds, showed a birth distribution that was best represented with a bimodal curve with zeniths in January and July (P = 0.06). This study provides evidence for the existence of differences in fecundability by month of birth. The cause of this relationship is unclear, but may lie in a melatonin-dependent circannual variability of the quality of the oocyte.

Reclassifying causes of death to study the epidemiological transition in the Netherlands,1875-1992.

"This article describes a method for reclassifying causes of death in the Netherlands for the period 1875-1992....A method developed by Vallin and Mesle (1988), which involves ¿dual correspondence tables' and ¿fundamental associations', was used to create nosologically continuous categories. These categories were tested for statistical continuity during the transition years of one ICD-revision [International Classification of Diseases] to the next, using ordinary least squares regression analysis. The reclassification procedure resulted in a nested classification consisting of three levels of refinement of causes of death: 27 causes, 1875-1992; 65 causes, 1901-1992; and 92 causes, 1931-1992. On the basis of this classification, 43% of all deaths in 1875-79 and 98% of all deaths in 1992 could be allocated to either communicable diseases, non-communicable diseases or external causes." (SUMMARY IN FRE)

Trends and sex-differentials in Dutch mortality since 1850: insights from a cohort--and period--perspective.

"This paper makes use of a recently established comparative series of period and cohort life tables for the Netherlands for the period 1850-1991. Trends in period and cohort life expectancy at birth for males and females are discussed. A simple spline function is used to identify turning points in these trends. Trends in the contribution of specific age groups to the changes in life expectancy and to male excess mortality were studied using the Arriaga method. For this purpose, the results of period and cohort analysis were compared." (SUMMARY IN ITA AND FRE)

["The main cause of the differences is the crime": An attempt at explaining the excess mortality of illegitimate children in The Hague in the mid-nineteenth century]. / "La cause principale des différences c'est le crime": Essai d'explication de la surmortalité des enfants illégitimes à La Haye au milieu du XIXe siècle.

During the last quarter of the 19th century, illegitimate children had much higher infant mortality than legitimate children. To investigate which factors played a role in this, we collected information on the household situation and the life course of all illegitimate children, born in the Dutch city of The Hague in the years 1850-1852. Use was made of birth and death certificates and of the population registers of the city. We compared our information with data on a random sample of legitimate children,, born in the same city. After children had reached the age of one month, mortality among illegitimate children became very high, compared to that of our reference group. Proportional hazards analysis showed that this excess mortality was caused by a set of factors, the most important being the age of the mother at birth, regional background, and the socio-economic group to which the notifier of the birth belonged. Aside from those factors, legal status of the child as such had an effect on infant mortality. The unwed mothers most likely to lose their child in its first year of life lived alone with their child and were obliged to resume work to support themselves and their child. The opportunity to breastfeed may have played a key role in this.

The Dutch famine of 1944-45: mortality and morbidity in past and present generations.

During the last months of the Second World War the Western Netherlands was affected by an acute famine, known as the Hunger Winter. Food intake from all sources was reduced to extremely low levels. The effect on mortality at all ages was very large and immediate. By making use of unpublished data from the Dutch Central Bureau of Statistics, estimates could be made of the changes in mortality by cause of death and age for both sexes. Mortality due to hunger was most common in the very young and the very old whereas the effects in males were more pronounced than in females. Hunger was a contributing factor to the increased mortality due to infectious diseases and diseases of the digestive system. In several follow-up studies on selected populations, long-term consequences of the famine could be studied. They related to reproductive outcomes of women who gave birth during the Hunger Winter, to birth weight, malformations, and perinatal mortalitiy of the newborn who were exposed to the famine during gestation, and to the long-term effects of the famine on the medical and psychological situation of infants born during the famine. Several studies on reproductive outcomes in the subsequent generation are also discussed.

Differences in self-reported morbidity by marital status and by living arrangement.

It has frequently been shown that the never married, divorced and widowed have higher rates of self-reported morbidity than married people. The purpose of this study was to assess to what extent morbidity differences by marital status can be explained by differences in living arrangement (i.e. living with a partner or not). If living arrangement plays a major role, one expects to find that: 1. people who live with a partner have lower morbidity rates than those who live alone; 2. morbidity differences by marital status decrease substantially after controlling for living arrangement. Data from the GLOBE study, a large prospective cohort in the Netherlands, on 18,973 people from Eindhoven and its surroundings, aged 15-74, were used to test the hypotheses. The measures for morbidity were perceived general health, subjective health complaints, chronic conditions and work disability. Multiple logistic regression models were used to calculate odds ratios for morbidity by living arrangement (question 1) and for morbidity by marital status, firstly without control and subsequently with control for living arrangement (question 2). In all models we controlled for other sociodemographic variables (age, sex, educational level, degree of urbanization, religion and country of birth). Our analyses showed that people who live with a partner have lower morbidity rates than those who live alone. They further showed that the excess risks of the never married, widowed and divorced decreased by 40-70% for all health measures (except subjective health complaints) after controlling for living arrangement.(ABSTRACT TRUNCATED AT 250 WORDS)

Measuring the effect of changing legislation on the frequency of divorce: The Netherlands, 1830-1990.

This article discusses different procedures for measuring the effects of judicial changes on divorce rates. It presents an alternative model and applies it to a historical time series for the Netherlands. In this model, intervention variables were added to a statistical time-series (ARIMA) model. The conclusion of our analysis was that the effects of three judicial changes were only temporary.