Are dental care records in childhood associated with financial hardship in adulthood?

INTRODUCTION: Previous studies show that dental health is associated with educational and labour market outcomes, but it is unclear whether dental care records in childhood can serve as early markers of financial hardship risk in adulthood. METHODS: Data on sociodemographic variables and dental records of all children born in Finland and who lived their childhood in the city of Espoo were obtained from national registers (n=1867). Debt defaults at the age of 23 years were used as a measure of adulthood financial hardship. Caries recorded in dental check-ups and unnotified absence from dental appointments in childhood were derived from electronic health systems. Logistic regression models were fitted to investigate the extent to which these variables were associated with financial hardship in adulthood before and after adjusting for parental social assistance use. RESULTS: The odds of adulthood debt defaults were higher for people with caries before the age of 13 years (odds ratio 1.37, compared with people without) and for people with significant caries multiple times (odds ratio 2.07). Unnotified absences from dental checks were strongly associated with debt defaults. These associations were substantially reduced after adjusting the models for parental social assistance use. CONCLUSIONS: The association between childhood dental care records and adulthood financial hardship mainly reflects the fact that parental socioeconomic status links to dental records. Nevertheless, data from dental care could be used in targeting appropriate measures to prevent financial hardship later in life.

Effect of smoking on use of antibacterials: a 9-year follow-up study of 24 000 working-aged Finns.

BACKGROUND: Previous studies indicate an association between tobacco smoking and infectious diseases. However, large population-based follow-up studies including both accurate measurements of smoking behaviour and confounders and a reliable register-based follow-up of infections are lacking. OBJECTIVE: To examine the effect of smoking on use of antibacterials as an indicator of infections among working-aged population. METHODS: The participants of the population-based Health and Social Support Study (24,283 working-aged Finns) were followed up for 9 years. Information on smoking behaviour and confounders was obtained from a questionnaire in 1998. Number of antibacterial purchases was obtained from the National-Drug-Prescription-Register. The association between smoking and use of antibacterials was analysed using multinomial regression models. RESULTS: A graded association between lifetime smoking as measured by pack-years and use of antibacterials was found. Compared with never-smokers, the age-adjusted OR for multiple use of antibacterials among smokers with 12 or more pack-years was 2.32 (95% CI 1.91 to 2.82) in women and 1.45 (95% CI 1.23 to 1.71) in men. The associations remained after adjustment for the following confounding factors: use of alcohol, body mass index, physical activity, socioeconomic status, hard physical work, life satisfaction, disability pension and dyspnoea. CONCLUSIONS: Smoking is associated with increased use of antibacterials. Infectious periods experienced by patients should be used as an opportunity to encourage smoking cessation.

Health-related risk factors for disability pensions due to musculoskeletal diagnoses: a 30-year Finnish twin cohort study.

AIMS: There is a need to better understand work incapacity due to musculoskeletal disorders (MSD) and the factors that contribute to being granted disability pension (DP) with such disorders. A twin cohort study would serve a powerful tool responding to this knowledge gap by providing information on factors affecting DP when controlling for family background. The purpose was to investigate the incidence of and risk factors for DP due to any MSD (n=1,819) and specifically due to osteoarthritis (OA, n=677) in a twin cohort of 24,043 people over a 30-year follow-up. METHODS: Data on twin pairs from a mailed questionnaire during the baseline year of 1975 were followed up with register data regarding DP, emigration, old-age pension, and death. For statistical analysis, univariate and multivariate Cox proportional hazard ratios were estimated. RESULTS: Baseline musculoskeletal pain, frequency of use of analgesics, body mass index, and chronic diseases, as well as education and social class were significant risk factors for DP due to MSD at follow-up in both sexes. These factors were also the significant predictors of DP due to OA in men. In women, DP due to OA was best predicted by baseline musculoskeletal pain and lower social class. CONCLUSIONS: The risk of DP due to MSD and OA seemed to be influenced by comorbidities, educational level and social class. Analyses of twin pairs discordant for DP confirmed the results. Accumulated health problems and chronic conditions during the life course may lead to permanent work incapacity.

The effect of exposure to long working hours on alcohol consumption, risky drinking and alcohol use disorder: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing Joint Estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that exposure to long working hours may increase alcohol consumption and cause alcohol use disorder. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from alcohol consumption and alcohol use disorder that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption, risky drinking (three outcomes: prevalence, incidence and mortality) and alcohol use disorder (three outcomes: prevalence, incidence and mortality). DATA SOURCES: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trials Register, Ovid MEDLINE, PubMed, Embase, and CISDOC on 30 June 2018. Searches on PubMed were updated on 18 April 2020. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We considered for inclusion randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption (in g/week), risky drinking, and alcohol use disorder (prevalence, incidence or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from publications related to qualifying studies. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS: Fourteen cohort studies met the inclusion criteria, comprising a total of 104,599 participants (52,107 females) in six countries of three WHO regions (Americas, South-East Asia, and Europe). The exposure and outcome were assessed with self-reported measures in most studies. Across included studies, risk of bias was generally probably high, with risk judged high or probably high for detection bias and missing data for alcohol consumption and risky drinking. Compared to working 35-40 h/week, exposure to working 41-48 h/week increased alcohol consumption by 10.4 g/week (95% confidence interval (CI) 5.59-15.20; seven studies; 25,904 participants, I2 71%, low quality evidence). Exposure to working 49-54 h/week increased alcohol consumption by 17.69 g/week (95% confidence interval (CI) 9.16-26.22; seven studies, 19,158 participants, I2 82%, low quality evidence). Exposure to working ≥55 h/week increased alcohol consumption by 16.29 g/week (95% confidence interval (CI) 7.93-24.65; seven studies; 19,692 participants; I2 82%, low quality evidence). We are uncertain about the effect of exposure to working 41-48 h/week, compared with working 35-40 h/week on developing risky drinking (relative risk 1.08; 95% CI 0.86-1.36; 12 studies; I2 52%, low certainty evidence). Working 49-54 h/week did not increase the risk of developing risky drinking (relative risk 1.12; 95% CI 0.90-1.39; 12 studies; 3832 participants; I2 24%, moderate certainty evidence), nor working ≥55 h/week (relative risk 1.11; 95% CI 0.95-1.30; 12 studies; 4525 participants; I2 0%, moderate certainty evidence). Subgroup analyses indicated that age may influence the association between long working hours and both alcohol consumption and risky drinking. We did not identify studies for which we had access to results on alcohol use disorder. CONCLUSIONS: Overall, for alcohol consumption in g/week and for risky drinking, we judged this body of evidence to be of low certainty. Exposure to long working hours may have increased alcohol consumption, but we are uncertain about the effect on risky drinking. We found no eligible studies on the effect on alcohol use disorder. Producing estimates for the burden of alcohol use disorder attributable to exposure to long working hours appears to not be evidence-based at this time. PROTOCOL IDENTIFIER: https://doi.org/10.1016/j.envint.2018.07.025. PROSPERO REGISTRATION NUMBER: CRD42018084077.

Shift-work and cardiovascular disease: a population-based 22-year follow-up study.

Studies on the association between shift-work and cardiovascular disease (CVD), in particular coronary heart disease (CHD), have given conflicting results. In this prospective population-based study we assessed the association of shift-work with three endpoints: CHD mortality, disability retirement due to CVD, and incident hypertension. A cohort of 20,142 adults (the Finnish Twin Cohort) was followed from 1982 to 2003. Type of working time (daytime/nighttime/shift-work) was assessed by questionnaires in 1975 (response rate 89%) and in 1981 (84%). Causes of death, information on disability retirement and hypertension medication were obtained from nationwide official registers. Cox proportional hazard models were used to obtain hazard ratios (HR) for each endpoint by type of working time. Adjustments were made for 14 socio-demographic and lifestyle covariates. 76.9% were daytime workers and 9.5% shift-workers both in 1975 and in 1981. During the follow-up, 857 deaths due to CHD, 721 disability retirements due to CVD, and 2,642 new cases of medicated hypertension were observed. However, HRs for shift-work were not significant (mortality HR men 1.09 and women 1.22; retirement 1.15 and 0.96; hypertension 1.15 and 0.98, respectively). The results were essentially similar after full adjustments for all covariates. Within twin pairs, no association between shift work and outcome was observed. Our results do not support an association between shift-work and cardiovascular morbidity.

Sense of coherence and intentions to retire early among Finnish women and men.

BACKGROUND: Previous studies have shown that age, physical and mental health status and working circumstances, along with different socio-economic and psychosocial factors affect the retirement process. However, the role of psychological resources, such as sense of coherence (SOC), on the retirement process is still poorly understood. This study investigated the associations between SOC and intentions to retire early and whether these associations were explained by socio-economic, psychosocial and work and health related factors. METHODS: The data were derived from the Finnish Health and Social Support (HeSSup) Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow-up). The analyzed data consisted of 7409 women and 4866 men aged 30-54 at baseline. SOC and background factors including childhood circumstances, language, education, working circumstances, social support, health behaviour and somatic and mental health status were assessed at baseline. The intentions to retire early were assessed at follow-up using logistic regression analysis. RESULTS: SOC was associated with intentions to retire early among both genders. Socio-economic, psychosocial and work and health behaviour related factors did not influence the association between SOC and intentions to retire early among women and men reporting somatic or mental illness. Further, the association between SOC and intentions to retire early remained among (somatically and mentally) healthy men. Among healthy women the association was weaker and statistically non-significant. Among unhealthy women, the odds ratios of SOC was 0.97 (CI 95% 0.96-0.98) and 0.97 among ill men (CI 95% 0.96-0.98), i.e., each additional SOC score reduced the risk of intentions by 3% among both genders. CONCLUSION: Unhealthy employees with low SOC and low education were in the greatest risk to have reported intentions to retire early. SOC had an independent effect on intentions to retire early, and a strong SOC may have a potential to prevent early retirement in groups otherwise at risk. An important challenge would be to target the resources of SOC to the most vulnerable and design appropriate interventions in order to strengthen the level of SOC and hence prolong working years of the aging employees.

Childhood adversities predict strongly the use of psychotropic drugs in adulthood: a population-based cohort study of 24,284 Finns.

BACKGROUND: Exposure to adverse childhood experiences has been shown to be associated with negative health outcomes including mental health problems, but only a few studies with register-based data have used psychotropic drugs as an outcome variable. The purpose of this study is to examine whether adverse emotional childhood experiences, such as serious conflicts in the family and frequent fear of a family member, predict the use of psychotropic drugs in adulthood. In addition, the association of a child-parent relationship during childhood with the use of psychotropic drugs is studied. METHODS: The participants of the population-based Health and Social Support Study (24,284 working aged Finns) were followed up for 9 years. The information on childhood experiences and child-parent relationships was obtained from the questionnaires in 1998 and 2003. The number of psychotropic purchases (antipsychotics, drugs for bipolar disorder, antidepressants, anxiolytics, hypnotics and sedatives) was obtained from the National-Drug-Prescription-Register. Logistic and multinomial regression models were used. RESULTS: A graded association between childhood adversities and the use of psychotropic drugs was found, even after adjustments for occupational training, work status, recent life events and health behaviour. Frequent fear of a family member showed the strongest association: the OR for multiple use of antidepressants was 3.08 (95% CI 2.72 to 3.49) and 2.69 (2.27 to 3.20) for multiple use of anxiolytics. Use of psychotropic drugs was clearly increased among those with poor child-parent relationship and multiple childhood adversities. CONCLUSIONS: The results highlight the effect of environmental factors during childhood on mental health and the need for early recognition of families at risk.

Poor sleep predicts symptoms of depression and disability retirement due to depression.

BACKGROUND: Disturbed sleep is associated with mood disorders. Both depression and insomnia may increase the risk of disability retirement. The longitudinal links among insomnia, depression and work incapacity are poorly known. METHODS: We examined association of self-reported sleep quality with incident symptoms of depression and disability retirement due to depressive disorders in a longitudinal population-based sample of twins (n=12,063 individuals). These adults were categorized by their sleep quality in 1975 and 1981, excluding individuals with depressed mood in 1975/1981. The outcomes were the Beck Depression Inventory (BDItot) and its subscale Negative Attitudes Towards Self (BDINATS) in 1990 as dichotomized measures, and the incidence of disability retirement due to depressive disorder during 1991-2004. RESULTS: Onset of poor sleep between 1975 and 1981 predicted incident depression (BDItot OR=4.5, 95% CI: 2.7-7.4, BDINATS OR=2.0, 95% CI: 1.4-2.7), while persistent poor sleep showed somewhat weaker effects (BDItot; OR=2.5, 95% CI: 1.0-6.0, BDINATS OR=1.9, 95% CI: 1.1-3.3). Among those with few recent stressful life events, onset of poor sleep predicted strongly depression (BDINATS OR=9.5, 95% CI: 3.7-24.2). Likewise onset of poor sleep by 1981 increased the risk of disability retirement due to depression (OR=2.9, 95% CI: 1.8-4.9) with a similar risk among those with persistent poor sleep (OR=2.7, 95% CI: 1.3-5.7). LIMITATIONS: Lack of baseline diagnostic interviews; sleep quality based on self-report. CONCLUSIONS: Poor sleep is of importance in etiology of depression and disability retirement due to depression. This emphasizes the importance of early detection and treatment of sleep disturbances.

Disability pension due to musculoskeletal diagnoses: importance of work-related factors in a prospective cohort study of Finnish twins.

OBJECTIVES: The aim of this study was to investigate the impact of work-related risk factors for future disability pension (DP) due to musculoskeletal diagnoses and for a subgroup of these, namely, DP due to osteoarthritis. METHODS: For this prospective study of 16,028 Finnish twins born in 1911-1957 and employed at baseline, a postal questionnaire collected information in 1975 on work-related factors; follow-up data on DP was gathered through register linkages up to 2004. A series of proportional hazards (Cox) regression models were used to analyze the associations between work-related factors and the incidence of DP. RESULTS: During the 30-year follow-up, 1297 participants (8%) were granted DP due to musculoskeletal diagnoses, 376 of which were due to osteoarthritis. High stress of daily activities, monotonous work, physical workload (namely work including lifting and carrying or physically heavy work), several workplace changes, and unemployment displayed a strong association with DP due to musculoskeletal diagnoses that was not affected by familial factors, including genetics and shared environment. Additionally, standing work increased the risk for DP due to osteoarthritis. CONCLUSIONS: Uninfluenced by family background or other confounding factors, several work-related factors were identified as being strong and direct risk factors for DP due to musculoskeletal diagnoses.

Effects of work and lifestyle on risk for future disability pension due to low back diagnoses: a 30-year prospective study of Finnish twins.

OBJECTIVE: To investigate work and lifestyle factors as predictors for disability pension (DP) due to low back diagnoses (LBDs) during a 30-year follow-up. METHODS: Baseline survey data were obtained in 1975 for 16,028 working-age twins followed with register data on DP, emigration, old-age pension, and death until end of 2004; analyzed by Cox proportional hazards regression. RESULTS: Among those at work at baseline, 470 DPs due to LBDs were granted during the follow-up. Monotonous work, lifting and carrying at work or physically heavy work, and unemployment at least once before baseline were significant predictors for DP. A healthy lifestyle was a protective factor for DP. Family background played a role in all these associations. CONCLUSION: The factors shared by family members seemed to influence both work and lifestyle factors, which then influenced the incidence of DP due to LBDs.

Personality traits and life dissatisfaction as risk factors for disability pension due to low back diagnoses: a 30-year longitudinal cohort study of Finnish twins.

OBJECTIVE: Little is known about the association of mild symptoms and mental well-being with risk of disability pension (DP) due to somatic diagnoses, even less for DP due to low back diagnoses (LBD). Moderate genetic influences on personality traits, life dissatisfaction and DP exist suggesting that shared genetic influences may underlie these associations. One can control for familial confounding (genetics and family environment) by examining twins. This twin study aimed to investigate personality traits and life dissatisfaction as predictors for DP due to LBD accounting for familial confounding. METHODS: Data on 24043 twins aged 18-65year in a baseline survey in 1975 was followed up from national DP register data until 2004. Personality traits were assessed using the short version of the Eysenck Personality Inventory and life dissatisfaction was measured with a four item scale on levels of interest, happiness, easiness, and loneliness of life. Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: DP due to LBD was granted to 537 individuals during the follow-up. Each one unit increase in life dissatisfaction (HR 1.06; 95%CI 1.03, 1.10) and neuroticism (1.07; 1.03, 1.10) but not extroversion was significantly associated with an elevated risk for DP due to LBD. These associations with life dissatisfaction and neuroticism remained when socioeconomic status, education, and marital status were taken into account, and demonstrated an independence from familial confounding. CONCLUSION: Life dissatisfaction and neuroticism seems to be early, perhaps causal risk factors for DP due to LBD.

Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study.

OBJECTIVE: To examine difference in mortality between postal survey non-respondents and respondents. DESIGN: A prospective cohort study with baseline survey in 1998 and comprehensive linkage to national mortality registers until 2005, the Health and Social Support study. SETTING: A population-based postal survey of the working-aged population in Finland in 1998. PARTICIPANTS: The original random sample comprised 64 797 working-aged individuals in Finland (20-24, 30-34, 40-44, 50-54 years of age; 32 059 women and 32 716 men), yielding 25 898 (40.0%) responses in the baseline postal survey in 1998. PRIMARY OUTCOME MEASURE: Registry-based primary causes of death encoded with the International Classification of Diseases (ICD-10). RESULTS: In women, HR for total mortality was 1.75 (95% CI 1.40 to 2.19) times higher among the non-respondents compared with the respondents. In men, non-response was associated with a 1.41-fold (1.21-1.65) excess risk of total mortality. Non-response associated in certain age groups with deaths due to diseases in women and with deaths due to external causes in men. The most prominent excess mortality was seen for total mortality for both genders and for mortality due to external causes among men. CONCLUSIONS: Postal surveys result in slight underestimation of illness prevalence.

Health-related and sociodemographic risk factors for disability pension due to low back disorders: a 30-year prospective Finnish Twin Cohort Study.

OBJECTIVES: To investigate health-related and sociodemographic risk factors for disability pensions (DP) due to low back disorders (LBD). METHODS: Questionnaire data in 1975 of the Finnish Twin Cohort Study with record linkage to information on DP due to LBD from the official pension registers during follow-up 1975 to 2004 was analyzed with Cox proportional hazard models. RESULTS: Musculoskeletal pain (Hazards Ratio [HR] = 2.36 to 2.39; 95% CI 1.97 to 2.88), smoking (HR = 1.82; 1.49 to 2.22), frequent analgesics use (HR = 1.67; 1.38 to 2.02), and presence of other chronic disease (HR = 1.44; 1.22 to 1.70) increased the risk for DP due to LBD. Years of education decreased the risk (HR = 0.81; 0.77 to 0.85). Associations remained significant when adjusted for familial background. CONCLUSIONS: Health-related and sociodemographic risk factors for DP due to LBD can be identified early in life, and they seem independent from familial effects.

The burden of symptoms predicts early retirement: a twin cohort study on fibromyalgia-associated symptoms.

OBJECTIVE: To assess whether symptoms of fibromyalgia (FM) predict disability retirement or mortality. METHODS: All Finnish Twin Cohort members and diagnosed FM-patients who had answered the same health questionnaire in 1990-1992 were studied. A sample of 10,608 working aged individuals of the cohort was classified in homogenous groups based on symptom profile with latent class analysis, using a battery of questions addressing FM-associated symptoms validated between FM-patients and twins. This resulted in three classes: no or few symptoms (LC1), some symptoms (LC2), and high load of FM-symptoms (LC3). In a 14-year follow-up, 1990-2004, information on disability retirement was obtained from official pension registers. Further linkage with Population Register Centre data for 1990-2009 yielded information on the vital status of the cohort subjects. Those with malignancies or inflammatory rheumatic diseases were excluded. RESULTS: Cumulative incidence of early disability retirement was 9.5% among all 8448 individuals (after exclusions), and 26% in LC3. Adjusted hrs for early retirement were 1.0 (reference class) in LC1, 1.5 (95%CI 1.2-1.7) in LC2, and 2.9 (2.4-3.6) in LC3 for all causes and 1.8 (1.4-2.5) in LC2 and 5.0 (3.6-6.9) in LC3 for musculoskeletal disorders. In 173,675 person-years, the high symptom class (LC3) had a 43% (95% CI 17-75%) increased overall mortality risk, which was fully accounted for by adjustment for lifestyle factors, mainly smoking. CONCLUSION: Symptoms associated with FM strongly correlate with early disability retirement. Lifestyle problems associated with high symptom load need prompt management to avoid increased risk of mortality.

Childhood adversities and quality of sleep in adulthood: A population-based study of 26,000 Finns.

OBJECTIVE: To find out if childhood adversities predict poor sleep quality in working age. METHODS: Survey data from the Health and Social Support (HeSSup) study was used (N=25,605, 59% women). Negative childhood adversities and quality of sleep in adulthood were assessed by the questionnaire in 1998. Multinomial regression models were used. RESULTS: A graded association between childhood adversities and the quality of sleep in adulthood was found. Odds ratio (OR) of poor quality of sleep for those with multiple childhood adversities (3-6) was 3.64 (95% CI 2.94-4.50). The association between childhood adversities and the quality of sleep remained significant after adjustments for work status, use of psychotropic drugs, health behaviours, recent life events and child-parent relationships. Poor quality of sleep was clearly increased among those with both poor child-mother (OR 10.4, 95% CI 6.73-16.07) or poor child-father (OR 5.4, 95% CI 3.89-7.50) relationships and multiple childhood adversities. In the analyses of specific childhood adversities, frequent fear of a family member and serious conflicts in the family showed the strongest associations. CONCLUSIONS: The strong association between childhood adversities and the quality of sleep in adulthood highlights the importance of early life circumstances on adult health. Early stage recognition, prevention and supportive measures against childhood adversities and serious family conflicts should be promoted.

Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease.

BACKGROUND: Studies suggest that childhood adversities are important determinants of various types of later illnesses as well as poor health behaviour. However, few large-scale prospective studies have examined the associations between childhood adversities and cardiovascular disease. OBJECTIVE: To investigate whether childhood adversities are associated with increased risk of incident cardiovascular disease. DESIGN AND SETTING: Participants were 23 916 men and women in four age groups (20-24, 30-34, 40-44, and 50-54 years) from the Health and Social Support study, a longitudinal study on a random sample representative of the Finnish population. Data from national health registers on coronary heart disease and cerebrovascular disease during a mean follow-up of 6.9 years were linked to survey responses on childhood adversities. Cox proportional hazard models were adjusted for age group and potential mediators (education, health risk behaviours, diabetes and depression). RESULTS: There was a significant linear trend between the number of childhood adversities and disease end points in women. The risk of incident cardiovascular disease was threefold among women exposed concurrently to three types of childhood adversities (financial difficulties, interpersonal conflicts and longstanding illness of a family member). Among men, increased risk was observed only among those with longstanding illness of a family member (HR=1.44; 95% CI 1.06 to 1.96). CONCLUSIONS: In this prospective population-based sample, childhood adversities were associated with a significantly increased risk of objectively verified cardiovascular disease, especially among women but to a lesser extent among men. More studies with prospective settings are needed to confirm the association and possible mechanisms.

Childhood adversities, adulthood life events and depression.

BACKGROUND: The role of childhood adversities in predicting adulthood depression has been suggested to be complex and in need of additional comprehensive studies. AIMS: This investigation set out to examine whether increased exposure to life events (LEs) in adulthood mediates the association between childhood adversities and adulthood depression. METHODS: This study is based on a random health survey sample from the Finnish working-aged population (n=16,877) with a follow-up of up to 7 years. Depression was identified by Beck Depression Inventory, records of antidepressant prescriptions and hospitalization due to depression obtained from national health registers. RESULTS: Childhood adversities were associated with an increased likelihood of experiencing a high number of LEs in adulthood and their perceived burdensomeness. The mean number of new LEs correlated significantly (P<0.001) in a dose-response relationship with the number of childhood adversities. Reporting childhood adversities was associated with a 1.28-2.70-fold increase in the odds of depression as indicated by BDI score, a 1.29-1.94-fold increase in the rate of antidepressant prescriptions and a 1.17-4.04-fold increase in the risk of hospitalization due to depression. Adjustment for new LE attenuated these associations by 21-24%, but did not render them insignificant. CONCLUSIONS: Increased exposure to adult negative life events proximal to adult depression may partially explain the association between childhood adversities and adult depression.