Selective mortality and fertility and long run health effects of prenatal wartime exposure.

Many previous studies have shown that prenatal exposure to adverse historical circumstances negatively affects long-run health. Most women who are pregnant during wars experience clearly adverse circumstances that are however not as harsh as the typically studied extreme episodes such as famines, combat and wide-scale destruction. We show that prenatal exposure to World War II (WWII) in five Western European countries did not lead to a population-wide poorer health among the elderly. We even find indications of a better than expected health. This is likely due to selective fertility and mortality. We attempt to quantify these selection effects and show that when taking them into account, the initially positively estimated health effects on almost all outcomes are substantially attenuated. Selective mortality and fertility likely occur in similar directions for many historical episodes of adversity. Our results therefore suggest that a part of the previous research on such exposures likely under estimated the true sizes of the long-run effects.

Is paternal height related to fertility outcomes? Evidence from the Netherlands during the secular growth trend.

Over the past two centuries, the Dutch experienced a tremendous secular trend in height, and ultimately became the tallest nation in the world. Improving environmental conditions likely played the largest role in explaining these developments. But it is not yet precisely clear what factor set the Dutch head and shoulders above other nations, who were also experiencing improving environmental conditions. Could fertility also have played a role? To understand this, we would first need to know whether height and fertility were related during the secular growth trend. In this study, we investigated whether this was the case. A sample of Dutch men, birth years 1850-1900 (n = 3396), was examined. We tested the extents to which height was associated with having a certain number of children, and with having a certain number of children survive infancy. Multinomial logistic regressions were used. In terms of findings, height's relationship to fertility outcomes was curvilinear: being shorter-than-average (0.75-0.5 standard deviations below the mean height) was associated with a higher probability of being married and having five to seven children, while being moderately tall (0.5 standard deviations above the mean height) was associated with the lowest probability of being unmarried. There was no relationship between paternal height and children surviving infancy in the sample overall, but taller height was associated with a decreased risk of being in a high-mortality family among men born between 1880 and 1900. If paternal fertility played a role in the secular growth trend, we would expect to see very tall men have the most children, and clearly have the most children surviving infancy. Given this study's findings, it is unlikely that this was the case.

A bit of salt, a trace of life: Gender norms and the impact of a salt iodization program on human capital formation of school aged children.

This paper evaluates the effect of a national salt iodization program on the cognition of school-aged children in China. We focus on the role of gender preferences. Linking pre-eradication iodine deficiency rates with household survey data, we find a strong positive impact of prenatal exposure to the program on cognition and schooling for girls. For boys, we find no effect. Child preferences play an important role in parental investment decisions and impact program effects. We find that parents invest more in girls with a high initial endowment. For boys, this is different. Parents invest in boys, irrespective of their initial endowment. The nationally implemented program may therefore primarily benefit low endowment girls. We then exploit village-level variation in gender attitudes and find that gender attitudes are related to parental investment behavior and that the program's impact is stronger for girls born to parents with strong preferences for boys.

The LifeCycle Project-EU Child Cohort Network: a federated analysis infrastructure and harmonized data of more than 250,000 children and parents.

Early life is an important window of opportunity to improve health across the full lifecycle. An accumulating body of evidence suggests that exposure to adverse stressors during early life leads to developmental adaptations, which subsequently affect disease risk in later life. Also, geographical, socio-economic, and ethnic differences are related to health inequalities from early life onwards. To address these important public health challenges, many European pregnancy and childhood cohorts have been established over the last 30 years. The enormous wealth of data of these cohorts has led to important new biological insights and important impact for health from early life onwards. The impact of these cohorts and their data could be further increased by combining data from different cohorts. Combining data will lead to the possibility of identifying smaller effect estimates, and the opportunity to better identify risk groups and risk factors leading to disease across the lifecycle across countries. Also, it enables research on better causal understanding and modelling of life course health trajectories. The EU Child Cohort Network, established by the Horizon2020-funded LifeCycle Project, brings together nineteen pregnancy and childhood cohorts, together including more than 250,000 children and their parents. A large set of variables has been harmonised and standardized across these cohorts. The harmonized data are kept within each institution and can be accessed by external researchers through a shared federated data analysis platform using the R-based platform DataSHIELD, which takes relevant national and international data regulations into account. The EU Child Cohort Network has an open character. All protocols for data harmonization and setting up the data analysis platform are available online. The EU Child Cohort Network creates great opportunities for researchers to use data from different cohorts, during and beyond the LifeCycle Project duration. It also provides a novel model for collaborative research in large research infrastructures with individual-level data. The LifeCycle Project will translate results from research using the EU Child Cohort Network into recommendations for targeted prevention strategies to improve health trajectories for current and future generations by optimizing their earliest phases of life.

Ramadan exposure and birth outcomes: a population-based study from the Netherlands.

BACKGROUND: Ramadan, the Islamic month of daytime fasting, is observed by many pregnant Muslims. Although pregnant women are exempt, many prefer to fast. Previous research has shown long-term adverse effects on various health outcomes among the offspring, but evidence on effects on perinatal outcomes is mixed. This study investigates effects of Ramadan during pregnancy among Muslims in the Netherlands. METHODS: Data from the Perinatal Registry of the Netherlands (Perined) on all births between 2000 and 2010 to mothers recorded as Mediterranean (i.e. of Turkish/Moroccan descent, a proxy for Muslim) (n = 139,322) or as ethnically Dutch (n = 1,481,435) were used. Ramadan exposure was defined using an intention-to-treat approach as the occurrence of a Ramadan during gestation. Muslims with versus without a Ramadan occurring during gestation were compared using difference-in-differences analyses. In these multiple linear/logistic regressions, non-Muslims were additionally included in order to take out potentially remaining confounding through seasonal effects. RESULTS: The occurrence of a Ramadan during pregnancy among Muslims was not associated with altered birth weight, gestational length, newborn's sex, perinatal mortality, low Apgar, or mild congenital anomalies. Odds for severe congenital anomalies were higher among the exposed (odds ratio: 1.17; 95% confidence interval: 1.00, 1.37), but this association became non-significant when adjusting for multiple testing. CONCLUSIONS: Despite earlier research showing long-term adverse health effects of prenatal exposure to Ramadan, there seems to be little or no relation between exposure to Ramadan during pregnancy and birth outcomes.

Effects of Early Retirement Policy Changes on Working until Retirement: Natural Experiment.

Many European countries have implemented pension reforms to increase the statutory retirement age with the aim of increasing labor supply. However, not all older workers may be able or want to work to a very high age. Using a nation-wide register data of labor market transitions, we investigated in this natural experiment the effect of an unexpected change in the Dutch pension system on labor market behaviors of older workers. Specifically, we analyzed transitions in labor market positions over a 5-year period in two nation-wide Dutch cohorts of employees aged 60 years until they reached the retirement age (n = 23,703). We compared transitions between the group that was still entitled to receive early retirement benefits to a group that was no longer entitled to receive early retirement benefits. Results showed that the pension reform was effective in prolonging work participation until the statutory retirement age (82% vs. 61% at age 64), but also to a larger proportion of unemployment benefits in the 1950 cohort (2.0%-4.2%) compared to the 1949 cohort (1.4%-3.2%). Thus, while ambitious pension reforms can benefit labor supply, the adverse effects should be considered, especially because other studies have shown a link between unemployment and poor health.

Practice variation in long-term care access and use: The role of the ability to pay.

Practice variation in publicly financed long-term care (LTC) may be inefficient and inequitable, similarly to practice variation in the health care sector. Although most OECD countries spend an increasing share of their gross domestic product on LTC, it has received comparatively little attention to date compared with the health care sector. This paper contributes to the literature by assessing and comparing regional practice variation in both access to and use of institutional LTC and investigating its relation with income and out-of-pocket payment. For this, we have access to unique individual-level data covering the entire Dutch population. Even though we found practice variation in the use of LTC once access was granted, the variation between regions was still relatively small compared with international standards. In addition, we showed how a co-payment measure could be used to reduce practice variation across care office regions and income classes making the LTC system not only more efficient but also more equitable.

Health and prolonging working lives: an advisory report of the Health Council of The Netherlands.

Objective This opinion paper summarizes the main findings and recommendations of an advisory report on health and prolonging working life, which was requested by the Dutch Minister of Social Affairs and Employment. Methods The advisory report was compiled by a multidisciplinary committee of ten scientists appointed by the Health Council of The Netherlands. The committee`s aims were to (i) describe the health of the ageing population, (ii) describe how prolonging working life influences health, (iii) describe determinants, besides health, for prolonging working lives, and (iv) review the literature on interventions aimed at retaining or improving employability of older workers. Results The report was presented to the Minister on 26 June 2018. As the likelihood of health problems increases with age, prolonging working life may be difficult. In general, life expectancy increases and gains in life years and health seem mainly attributable to people aged >75 years. Work is good for mental health. However, it may be beneficial for mental health to stop working around the retirement age. Besides health, financial factors, lifestyle, motivation to work, and working conditions play a role in prolonging working life. A systematic review of the evidence indicated that interventions such as worksite health promotion or career development workshops can support older workers in this matter. Conclusions The Health Council advised the Dutch Government to focus on worksite health promotion and career development interventions as well as the improvement of their implementation. This requires a tailored approach as there is a large diversity in health among older workers and particularly between low- and high-educated people. With this in mind, it was further recommended to explore whether flexible pension schemes might better suit this diversity.

Adult body height as a mediator between early-life conditions and socio-economic status: the case of the Dutch Potato Famine, 1846-1847.

Adult body height appears to be a relatively accurate summary variable of early-life exposures' influence on health, and may be a useful indicator of health in populations where more traditional health-related indicators are lacking. In particular, previous studies have shown a strong, positive relationship between environmental conditions in early life (particularly nutritional availability and the disease environment) and adult height. Research has also demonstrated positive associations between height and socioeconomic status. We therefore hypothesize that height mediates the relationship between early-life conditions and later-life socio-economic outcomes. We also hypothesize that the period of exposure in early life matters, and that conditions during pregnancy or the first years of life and/or the years during puberty have the largest effects on height and socio-economic status. To test these relationships, we use a sample of 1817 Dutch military conscripts who were exposed during early life to the Dutch Potato Famine (1846-1847). We conduct mediation analyses using structural equation modelling, and test seven different time periods in early-life. We use potato prices and real wages to proxy early-life environmental conditions, and occupational status (using the HISCAM scale) to proxy socioeconomic status. We find no evidence of mediation, partial or full, in any models. However, there are significant relationships between potato prices in adolescence, height and socio-economic status. To determine causality in these relationships, further research is needed.

Domains and determinants of retirement timing: A systematic review of longitudinal studies.

BACKGROUND: To date, determinants of retirement timing have been studied separately within various disciplines, such as occupational health and economics. This narrative literature review explores the determinants of retirement timing in countries, and relevant domains among older workers from both an economic and occupational health perspective. METHODS: A literature search was conducted using 11 databases. Longitudinal studies on determinants of retirement timing were included. Study inclusion criteria were as follows: full-text article written in English or Dutch, conducted in humans, main outcome was time until retirement (i.e. retirement date or retirement age), and longitudinal design. Next, the included articles were screened for hypotheses on retirement timing and these articles with hypotheses were subjected to a quality assessment. Determinants for retirement timing were classified into multiple domains by three researchers. RESULTS: The literature search identified 20 articles. The determinants of retirement timing were classified into eight domains: demographic factors, health factors, social factors, social participation, work characteristics, financial factors, retirement preferences, and macro effects. In total, we identified 49 determinants, ranging from one (social, and retirement preferences) to 21 determinants (work characteristics) per domain. CONCLUSIONS: The findings suggest that there is a wide range of determinants that influence retirement timing in modern industrialized countries and that these determinants differ between countries. We recommend that researchers include determinants from various domains when studying retirement timing, while taking into account a country's context.

Mortality and the business cycle: Evidence from individual and aggregated data.

There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality.

Predicting working beyond retirement in the Netherlands: an interdisciplinary approach involving occupational epidemiology and economics.

Objectives No study so far has combined register-based socioeconomic information with self-reported information on health, demographics, work characteristics, and the social environment. The aim of this study was to investigate whether socioeconomic, health, demographic, work characteristics and social environmental characteristics independently predict working beyond retirement. Methods Questionnaire data from the Study on Transitions in Employment, Ability and Motivation were linked to data from Statistics Netherlands. A prediction model was built consisting of the following blocks: socioeconomic, health, demographic, work characteristics and the social environment. First, univariate analyses were performed (P0<.15), followed by correlations and logistic multivariate regression analyses with backward selection per block (P0<.15). All remaining factors were combined into one final model (P0<.05). Results In the final model, only factors from the blocks health, work and social environmental characteristics remained. Better physical health, being intensively physically active for >2 days/week, higher body height, and working in healthcare predicted working beyond retirement. If respondents had a permanent contract or worked in handcraft, or had a partner that did not like them to work until the official retirement age, they were less likely to work beyond retirement. Conclusion Health, work characteristics and social environment predicted working beyond retirement, but register-based socioeconomic and demographic characteristics did not independently predict working beyond retirement. This study shows that working beyond retirement is multifactorial.

Does the Size of the Effect of Adverse Events at High Ages on Daily-Life Physical Functioning Depend on the Economic Conditions Around Birth?

This paper considers determinants of physical functional limitations in daily-life activities at high ages. Specifically, we quantify the extent to which the impact of adverse life events on this outcome is larger in case of exposure to adverse economic conditions early in life. Adverse life events include bereavement, severe illness in the family, and the onset of chronic diseases. We use a longitudinal data set of individuals born in the first decades of the 20th century. The business cycle around birth is used as an indicator of economic conditions early in life. We find that the extent to which functional limitations suffer from the onset of chronic diseases is larger if the individual was born in a recession. The long-run effect of economic conditions early in life on functional limitations at high ages runs primarily via this life event. Copyright © 2015 John Wiley & Sons, Ltd.

Babies of the War: The Effect of War Exposure Early in Life on Mortality Throughout Life.

There is increasing evidence that circumstances very early in our lives, and particularly during pregnancy, can affect our health for the remainder of life. Studies that have looked at this relationship have often used extreme situations, such as famines that occurred during wartime. Here we investigate whether less extreme situations during World War II also affected later-life mortality for cohorts born in Belgium, France, The Netherlands, and Norway. We argue that these occupied countries experienced a considerable deterioration in daily life situations and show that this resulted in strongly increased mortality rates and lower probabilities of survival until age 55 among civilian populations who had been prenatally exposed to wartime circumstances. However, this mortality effect among the prenatally exposed is entirely concentrated in the first years of life, particularly infanthood. Once we condition on having survived the first years of life, those who had been prenatally exposed do not have higher mortality rates. This suggests that "culling" is important and that effects found in earlier studies may have been biased downward substantially.

Long-run effects of gestation during the Dutch Hunger Winter famine on labor market and hospitalization outcomes.

The Dutch Hunger Winter (1944/45) is the most-studied famine in the literature on long-run effects of malnutrition in utero. Its temporal and spatial demarcations are clear, it was severe, it was not anticipated, and nutritional conditions in society were favorable and stable before and after the famine. This is the first study to analyze effects of in utero exposure on labor market outcomes and hospitalization late in life, and the first to use register data covering the full Dutch population to examine long-run effects of this famine. We provide results of famine exposure by sub-interval of gestation. We find a significantly negative effect of exposure during the first trimester of gestation on employment outcomes 53 or more years after birth. Hospitalization rates in the years before retirement are higher after middle or late gestational exposure.

The effect of retirement on cognitive functioning.

Cognitive impairment has emerged as a major driver of disability in old age, with profound effects on individual well-being and decision making at older ages. In the light of policies aimed at postponing retirement ages, an important question is whether continued labour supply helps to maintain high levels of cognition at older ages. We use data of older men from the US Health and Retirement Study to estimate the effect of continued labour market participation at older ages on later-life cognition. As retirement itself is likely to depend on cognitive functioning and may thus be endogenous, we use offers of early retirement windows as instruments for retirement in econometric models for later-life cognitive functioning. These offers of early retirement are legally required to be nondiscriminatory and thus, inter alia, unrelated to cognitive functioning. At the same time, these offers of early retirement options are significant predictors of retirement. Although the simple ordinary least squares estimates show a negative relationship between retirement duration and various measures of cognitive functioning, instrumental variable estimates suggest that these associations may not be causal effects. Specifically, we find no clear relationship between retirement duration and later-life cognition for white-collar workers and, if anything, a positive relationship for blue-collar workers.

Slipping Anchor? Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity.

We propose tests of the two assumptions under which anchoring vignettes identify heterogeneity in reporting of categorical evaluations. Systematic variation in the perceived difference between any two vignette states is sufficient to reject vignette equivalence. Response consistency - the respondent uses the same response scale to evaluate the vignette and herself - is testable given sufficiently comprehensive objective indicators that independently identify response scales. Both assumptions are rejected for reporting of cognitive and physical functioning in a sample of older English individuals, although a weaker test resting on less stringent assumptions does not reject response consistency for cognition.

Education-related inequity in healthcare with heterogeneous reporting of health.

Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in healthcare utilization. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity that is identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of visits to a doctor in the direction of inequality favouring the better educated. There is a further, and typically larger, shift in the same direction when correction is made for the tendency of the better educated to rate their health more negatively.