Using data on biomarkers and siblings to study early-life economic determinants of type-2 diabetes.

We study the effect of economic conditions early in life on the occurrence of type-2 diabetes in adulthood using contextual economic indicators and within-sibling pair variation. We use data from Lifelines: a longitudinal cohort study and biobank including 51,270 siblings born in the Netherlands from 1950 onward. Sibling fixed-effects account for selective fertility. To identify type-2 diabetes we use biomarkers on the hemoglobin A1c concentration and fasting glucose in the blood. We find that adverse economic conditions around birth increase the probability of type-2 diabetes later in life both in males and in females. Inference based on self-reported diabetes leads to biased results, incorrectly suggesting the absence of an effect. The same applies to inference that does not account for selective fertility.

Cohort profile: The ENTWINE iCohort study, a multinational longitudinal web-based study of informal care.

Informal care is a key pillar of long-term care provision across Europe and will likely play an even greater role in the future. Thus, research that enhances our understanding of caregiving experiences becomes increasingly relevant. The ENTWINE iCohort Study examines the personal, psychological, social, economic, and geographic factors that shape caregiving experiences. Here, we present the baseline cohort of the study and describe its design, recruitment methods, data collection procedures, measures, and early baseline findings. The study was conducted in nine countries: Germany, Greece, Ireland, Israel, Italy, the Netherlands, Poland, Sweden, and the United Kingdom. The study comprised a web-based longitudinal survey (baseline + 6-month follow-up) and optional weekly diary assessments conducted separately with caregivers and care recipients. From 14 August 2020 to 31 August 2021, 1872 caregivers and 402 care recipients were enrolled at baseline. Participants were recruited via Facebook and, to a lesser extent, via the study website or caregiver/patient organisations. Caregiver participants were predominantly female (87%) and primary caregivers (82%), with a median age of 55 years. A large proportion (80%) held at least post-secondary education, and two-thirds were married/partnered. Over half of the caregivers were employed (53%) and caring for a person with multiple chronic conditions (56%), and nearly three-quarters were caring for either a parent (42%) or a spouse/partner (32%). About three-quarters of care recipient participants were female (77%), not employed (74%), and had at least post-secondary education (77%), with a median age of 55 years. Over half of the care recipients were married/partnered (59%), receiving care primarily from their spouses/partners (61%), and diagnosed with multiple chronic conditions (57%). This study examining numerous potential influences on caregiving experiences provides an opportunity to better understand the multidimensional nature of these experiences. Such data could have implications for developing caregiving services and policies, and for future informal care research.

The Economic Costs of Informal Care: Estimates from a National Cross-Sectional Survey in The Netherlands.

Faced with an unprecedented demand for long-term care, European health care systems are moving towards mixed care models, where the welfare state and informal caregivers share care responsibilities. While informal care is often viewed as a means of alleviating pressure on public care, it comes with significant economic costs for caregivers, their employers, and society at large. This study uses nationally representative data to estimate the total direct (informal care time and out-of-pocket costs) and indirect (productivity) economic costs of informal care in the Netherlands in 2019. Informal care time costs are estimated using the opportunity cost and the proxy good methods. Indirect costs are estimated using the human capital and friction cost approaches. Our results reveal the considerable annual societal cost of informal care in the Netherlands, ranging between €17.5 billion and €30.1 billion, depending on the valuation approach. These costs are equivalent to 2.15% and 3.71% of Dutch GDP in 2019, comparable to the public expenditure on long-term care in that year. Female caregivers account for slightly more than half (53%-57%) of the total costs. Around 57%-88% of these costs are in the form of informal care time. The main driver of indirect costs is the temporary cessation of work, which comprises 12%-17% of the total costs. Findings corroborate that substantial resources, yet thus far largely disregarded, are spent on informal care even in a country with a relatively generous public long-term care system.

Population health differences in cross-border regions within the European Union and Schengen area: a protocol for a scoping review.

INTRODUCTION: Along with European integration and the harmonisation of living conditions, improvements in health have been observed over the past decades. However, sociospatial inequalities within and across member states still exist today. While drivers of these health inequalities have been widely researched on a national and regional scale, cross-border regions remain understudied. The removal of border controls within the European Union (EU) member states has facilitated economic convergence and created new opportunities, including cross-border cooperation in the healthcare systems. However, whether and how these developments have influenced the population health in the respective cross-border regions is unclear. Hence, this scoping review aims to examine the empirical literature on the changes in health outcomes over time at the population level in EU cross-border areas. Additionally, we aim to identify the type of evidence and available data sources in those studies. Finally, we will determine the research gaps in the literature. METHODS AND ANALYSIS: We will follow the Joanna Briggs Institute methodology for this scoping review. The 'Population-Concept-Context' framework will be used to identify the eligibility criteria. A three-step search strategy will be conducted to find relevant studies in the databases of PubMed, Web of Science, Scopus and EBSCOhost (SocIndex). Additionally, we will search on websites of international governmental institutions for further reports and articles. The finalisation of the search is planned for August 2023. The extracted data from the scoping review will be presented in a tabular form. A narrative summary of the selected studies will accompany the tabulated results and describe how they answer the research questions. ETHICS AND DISSEMINATION: We will exclusively use secondary data from available studies for our analysis. Therefore, this review does not require ethical approval. We aim to publish our findings at (inter-)national conferences and as an open-access, peer-reviewed journal article.

Exposure in utero to adverse events and health late-in-life: Evidence from China.

This paper estimates the effect of in utero exposure to adverse events on late life diabetes, cardiovascular disease risks and cognition deficiency. We merge data on the regional violence during the Cultural Revolution and the excessive death rates during the Chinese Great Famine with data from the China Health and Retirement Longitudinal Study survey. Results show that female babies who were exposed in utero to the famine have higher diabetes risks, while male babies who were exposed to the Cultural Revolution are shown to have lower cognitive abilities.

The Long-Term Consequences of a Golden Nest: Socioeconomic Status in Childhood and the Age at Leaving Home.

The age at leaving the parental home has significant implications for social and economic outcomes across the life course, highlighting the importance of examining nest-leaving patterns. We study the role of childhood standard of living on the age at nest leaving. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we show empirically that individuals who grow up in families with a higher socioeconomic status-that is, in a golden nest-leave the parental home later than others. Given that better-off individuals tend to obtain more education, and that young adults generally leave the parental home after completing their education, we also find that a higher level of education delays nest leaving. Nonetheless, the positive relationship between socioeconomic status and nest-leaving age still holds for given education levels, across European countries characterized by different cultural traits, for both males and females, and among urban and rural residents. We use a three-period life cycle model to show that this behavior is consistent with standard assumptions about preferences and resources if earnings increase with age. Moreover, habit-forming preferences that assume that utility depends on the gap between current and past consumption reinforce the delaying effect of a golden nest on nest leaving.

A Multinational Longitudinal Study Incorporating Intensive Methods to Examine Caregiver Experiences in the Context of Chronic Health Conditions: Protocol of the ENTWINE-iCohort.

Informal caregivers are those who provide unpaid care to a relative or friend with a chronic illness, disability or other long-lasting health or care need. Providing informal care in the context of chronic health conditions presents a significant global challenge. Examination of the determinants of informal caregivers' behaviour, especially in terms of motivations and willingness to provide/receive care, is crucial to understanding the nature of caregiver and care recipient experiences. A large group of international researchers have co-operated to execute the ENTWINE iCohort-a multinational, transdisciplinary, longitudinal study incorporating intensive methods to examine caregiver experiences in the context of chronic health conditions. The aim of ENTWINE-iCohort is to investigate the broad spectrum of factors, i.e., cultural, personal, geographical, relational, psychological, and economic that may affect motivations, willingness to provide or receive care, among diverse groups of informal caregivers and their care recipients, in different countries that have different care systems. Study questionnaires will be disseminated on-line in nine countries: Germany, Greece, Ireland, Italy, Israel, the Netherlands, Poland, Sweden, and the UK. Cross-sectional and longitudinal multivariate analysis, including intensive longitudinal and dyadic data analysis will be applied to examine the relative contribution of the above factors to caregiver or care recipient wellbeing.

Physical and psychological health at adolescence and home care use later in life.

OBJECTIVES: To examine the relation between physical and psychological health indicators at adolescence (age 18) and household, personal, and nursing home care use later in life at ages 57-69 years. METHODS: Using medical examinations on men born in 1944-1947 who were evaluated for military service at age 18 in the Netherlands, we link physical and psychological health assessments to national administrative microdata on the use of home care services at ages 57-69 years. We postulate a panel probit model for home care use over these years. In the analyses, we account for selective survival through correlated panel probit models. RESULTS: Poor mental health and being overweight at age 18 are important predictors of later life home care use. Home care use at ages 57-69 years is also highly related to and interacts with father's socioeconomic status and recruits' education at age 18. DISCUSSION: Specific health characteristics identified at age 18 are highly related to the later utilization of home-care at age 57-69 years. Some characteristics may be amenable to early life health interventions to decrease the future costs of long-term home care.

Lifelines COVID-19 cohort: investigating COVID-19 infection and its health and societal impacts in a Dutch population-based cohort.

PURPOSE: The Lifelines COVID-19 cohort was set up to assess the psychological and societal impacts of the COVID-19 pandemic and investigate potential risk factors for COVID-19 within the Lifelines prospective population cohort. PARTICIPANTS: Participants were recruited from the 140 000 eligible participants of Lifelines and the Lifelines NEXT birth cohort, who are all residents of the three northern provinces of the Netherlands. Participants filled out detailed questionnaires about their physical and mental health and experiences on a weekly basis starting in late March 2020, and the cohort consists of everyone who filled in at least one questionnaire in the first 8 weeks of the project. FINDINGS TO DATE: >71 000 unique participants responded to the questionnaires at least once during the first 8 weeks, with >22 000 participants responding to seven questionnaires. Compiled questionnaire results are continuously updated and shared with the public through the Corona Barometer website. Early results included a clear signal that younger people living alone were experiencing greater levels of loneliness due to lockdown, and subsequent results showed the easing of anxiety as lockdown was eased in June 2020. FUTURE PLANS: Questionnaires were sent on a (bi)weekly basis starting in March 2020 and on a monthly basis starting July 2020, with plans for new questionnaire rounds to continue through 2020 and early 2021. Questionnaire frequency can be increased again for subsequent waves of infections. Cohort data will be used to address how the COVID-19 pandemic developed in the northern provinces of the Netherlands, which environmental and genetic risk factors predict disease susceptibility and severity and the psychological and societal impacts of the crisis. Cohort data are linked to the extensive health, lifestyle and sociodemographic data held for these participants by Lifelines, a 30-year project that started in 2006, and to data about participants held in national databases.

Moral hazard and selection for voluntary deductibles.

This paper investigates whether the voluntary deductible in the Dutch health insurance system reduces moral hazard or acts only as a cost reduction tool for low-risk individuals. We use a sample of 14,089 observations, comprising 2,939 individuals over seven waves from the Longitudinal Internet Studies for the Social sciences panel for the analysis. We employ bivariate models that jointly model the choice of a deductible and health care utilization and supplement the identification with an instrumental variable strategy. The results show that the voluntary deductible reduces moral hazard, especially in the decision to visit a doctor (extensive margin) compared with the number of visits (intensive margin). In addition, a robustness test shows that selection on moral hazard is not present in this context.

Economic conditions at birth and cardiovascular disease risk in adulthood: Evidence from post-1950 cohorts.

Much of the literature that studies long-run effects of early-life economic conditions on health outcomes is based on pre-1940 birth cohorts. Early in these individuals' lives, public social safety nets were at best rudimentary, and female labor force participation was relatively low. We complement the evidence by studying the effects of regional business cycle variations in the post-1950 Netherlands on cardiovascular disease risk in adulthood. We use data from Lifelines, a large cohort study that covers socio-economic, biological and health information from over 75,000 individuals aged between 20 and 63. Cardiovascular risk index is constructed from an extensive set of biomarkers. The results show that for women a 1 percentage point increase in the provincial unemployment level leads to a 0.02 percentage point increase in the risk of a fatal cardiovascular event in the coming 10 years while the effect in men is not significant. We conclude that women born in adverse economic conditions experience higher cardiovascular risk.

Childhood Socioeconomic Status and Late-Adulthood Mental Health: Results From the Survey on Health, Ageing and Retirement in Europe.

Objectives: A growing literature acknowledges the association between childhood socioeconomic status (SES) and health in late adulthood (i.e., 50+). Less, however, is known about the association with mental health outcomes, such as depression. We use the Survey on Health, Ageing, and Retirement in Europe (SHARE) to analyze overall and gender-specific associations between childhood SES and late-adulthood depression. Methods: Using life history and contemporaneous data from 21,989 SHARE respondents in combination with principal component analysis we construct indices of childhood SES. We measure late-adulthood depression using the EURO-D scale. Contemporaneous SES is operationalized as the logarithm of household equivalized income. We estimate associations using linear regression models. Results: We document a positive association between childhood SES and the late-adulthood EURO-D score. The association persists even when allowing for contemporaneous SES. Zooming in on gender-specific associations reveals that the association for mental health is particularly pronounced for women. Discussion: Our findings reveal the long-term association between childhood socioeconomic conditions and depression later in life, which persists even after taking into account current socioeconomic conditions and are stronger for women than for men. These results imply that boosting childhood socioeconomic conditions can potentially have effects lasting well beyond the childhood phase.

Economic downturns and infant health.

We study the gender-specific impact of macroeconomic conditions around birth on infant health. We use a sample of over 50,000 respondents born between 1950 and 1994 from Lifelines-a cohort and biobank from the northern Netherlands. Our results show that high provincial unemployment rates decrease fertility and lead to a lower birthweight in boys. The negative impact of high unemployment on birthweight is particularly strong for boys born to older mothers and for babies born to smoking mothers.

Diabetes-Associated Factors as Predictors of Nursing Home Admission and Costs in the Elderly Across Europe.

OBJECTIVE: To identify the main factors associated with the use of nursing home facilities and to calculate their costs among older people with diabetes in Europe. METHODS: The sample included 48,464 individuals aged 50 years and older in 12 European countries participating in the Survey of Health, Aging, and Retirement in Europe study from 2004 to 2010. Cost data were obtained from the Organization for Economic Cooperation and Development and the World Bank. Logit regressions were used to assess the impact of diabetes, comorbidities, and functional status on the frequency of nursing home admission. Etiologic fractions were calculated to obtain the nursing home costs attributable to diabetes and its clinical and functional complications. RESULTS: Diabetes is a predictor for institutionalization. When adjusted for clinical and functional complications, impairment of physical function [mild: odds ratio (OR) 3.27; 95% confidence interval (CI) 2.60-4.19; moderate: OR 8.48, 95% CI 6.02-13.09; severe: OR 12.53, 95% CI 8.03-19.98] and cognition (OR 2.00, 95% CI 1.60-2.68), as well as stroke (OR 2.08, 95% CI 1.61-2.80) showed the strongest association with increased risk of institutionalization. Moreover, this relationship between diabetes, function, and cost was age-dependent, increasing as people get older. Total average nursing home costs incurred by patients with diabetes reached nearly US $13/capita, ranging between countries from US $61 to $0.5. Diabetes-related complications accounted for one-third of these costs (US $4) and, of these, 78% resulted from functional impairment. CONCLUSIONS: Diabetes is associated with higher risk of institutionalization even after adjusting for complications. Among them, functional impairment explains the major part of the association between diabetes and nursing home admission and leads to increasing costs.

Associations between Childhood Parental Mental Health Difficulties and Depressive Symptoms in Late Adulthood: The Influence of Life-Course Socioeconomic, Health and Lifestyle Factors.

BACKGROUND: Depression among older adults (i.e., the 50+) is a major health concern. The objective of this study is to investigate whether growing up with a parent suffering from mental health problems is associated with depressive symptoms in late-adulthood and how this association is influenced by life-course socio-economic, health and lifestyle factors in childhood and late adulthood. METHODS: We used life-history data from the SHARE survey, consisting of 21,127 participants living in 13 European countries. Symptoms of depression were assessed using the EURO-D scale. Parental mental health was assessed by asking respondents to report whether any of their parents had mental health problems during the respondents' childhood. Logistic regression models were used to assess the association between parental mental health status and depression. Variables on childhood and late-life socio-economic, health and lifestyle factors were sequentially added to the model to assess the extent to which this association is influenced by life-course circumstances. RESULTS: Individuals who were exposed during childhood to a parent with mental health problems suffered from depressive symptoms more often in late adulthood than those who were not (OR 1.76, 95% CI: 1.43-2.17). Adjustment for life-course socio-economic, health and lifestyle factors in childhood and late adulthood diminished this association to an OR of 1.54 (95% CI: 1.24-1.90) and OR of 1.45 (95% CI: 1.16-1.82), respectively. CONCLUSION: Our results indicate a substantial association between parental mental health problems in childhood and depression in late adulthood and that this association is partly explained by childhood as well as late adulthood socio-economic, health and lifestyle factors.

The role of life-course socioeconomic and lifestyle factors in the intergenerational transmission of the metabolic syndrome: results from the LifeLines Cohort Study.

BACKGROUND: The risk of metabolic syndrome is associated between parents and offspring, but studies are inconsistent on differences by sex of parents and offspring. Our aim is to investigate to what extent metabolic syndrome present in fathers and mothers is associated with risk of metabolic syndrome in sons and daughters. Furthermore, we investigate to what extent these associations are explained by socioeconomic factors and health behaviours. METHODS: We used data from the LifeLines Cohort Study (N = 7239). Metabolic syndrome was defined according to the NCEP-ATPIII criteria. Logistic regression analyses were performed to investigate associations of metabolic syndrome present in parents with the risk of metabolic syndrome in offspring. Analyses were sequentially adjusted for: age and sex; childhood factors (socioeconomic position and parental smoking); and adult factors (education, income, smoking, physical activity, alcohol intake, and dietary factors). RESULTS: Multivariate regression analysis adjusted for age and sex showed associations of the metabolic syndrome between father-son: odds ratio (OR) [95% confidence interval (CI)] 2.41 (1.93-3.00), father-daughter: OR (95% CI) 1.80 (1.39-2.33)), mother-son: OR (95% CI) 1.82 (1.44-2.29) and mother-daughter: OR (95% CI) 1.97 (1.52-2.55). Furthermore, each individual factor underlying the metabolic syndrome in parents was associated with metabolic syndrome in offspring, but not for all parent-offspring combinations. None of the parent-offspring associations was attenuated when adjusting for socioeconomic factors and health behaviours. CONCLUSIONS: High risk of metabolic syndrome is transmitted from fathers and mothers to sons and daughters. Our results suggest that this transmission is irrespective of the socioeconomic position and health behaviours of the offspring.

Born at the right time? Childhood health and the business cycle.

We analyze the relationship between the state of the business cycle at birth and childhood health. We use a retrospective survey on self-reported childhood health for ten Western European countries and combine it with historically and internationally comparable data on the Gross Domestic Product. We validate the self-reported data by comparing them to realized illness spells. We find a positive relationship between being born in a recession and childhood health. This relationship is not driven by selection effects due to heightened infant mortality during recessions. Placebo regressions indicate that the observed effect is not spurious.

Home-ownership in Europe: How did it happen?

We use data from the third wave of the Survey of Health, Ageing and Retirement in Europe (SHARELIFE)(1) to document the different ways individuals first became home-owners across countries and over cohorts over the second half of the 20th century. Focusing on first-time home owners we find that younger cohorts became home-owners earlier and were more likely to do it through credit, less likely to inherit their home directly. Having higher human capital, being employed, married, having children and living in an urban area, all make it more likely to purchase a home with a mortgage. The persistence of family help in accessing home-ownership in many countries demonstrates the interrelation between family, market and the state in most of continental Europe.

Age, Health and Life Satisfaction Among Older Europeans.

In this paper we investigate how age affects the self-reported level of life satisfaction among the elderly in Europe. By using a vignette approach, we find evidence that age influences life satisfaction through two counterbalancing channels. On the one hand, controlling for the effects of all other variables, the own perceived level of life satisfaction increases with age. On the other hand, given the same true level of life satisfaction, older respondents are more likely to rank themselves as "dissatisfied" with their life than younger individuals. Detrimental health conditions and physical limitations play a crucial role in explaining scale biases in the reporting style of older individuals.

Cross-Country Differentials in Work Disability Reporting Among Older Europeans.

Descriptive evidence shows that there is large cross-country variation in self-reported work disability rates of the elderly in Europe. In this paper we analyse whether these differences are genuine or they just reflect heterogeneity in reporting styles. To shed light on the determinants of work-disability differentials across countries, we combine a wide set of individuals' socioeconomic and health status characteristics with macro-economic indicators describing the institutional background of the country of residence.