Neurological conditions and subsequent divorce risk in the Nordic countries: the importance of gender and both spouses' education.

BACKGROUND: Prior studies suggest that poor physical health, accompanied by functional disability, is associated with increased divorce risk. However, this association may depend on gender, the socioeconomic resources of the couple, as well as the social policy and social (in)equality context in which the illness is experienced. This study focuses on neurological conditions, which often have substantial functional consequences. METHODS: We used longitudinal population-wide register data from the years 2007-2016 (Denmark, Sweden) or 2008-2017 (Finland, Norway) to follow 2 809 209 married couples aged 30-64 for neurological conditions, identified using information on specialised healthcare for diseases of the nervous system and subsequent divorce. Cox regression models were estimated in each country, and meta-analysis used to calculate across-country estimates. RESULTS: During the 10-year follow-up period, 22.2% of couples experienced neurological conditions and 12.0% of marriages ended in divorce. In all countries, divorce risk was elevated among couples where at least one spouse had a neurological condition, and especially so if both spouses were ill. The divorce risk was either larger or similar for husband's illness, compared with wife's illness, in all educational categories. For the countries pooled, the weighted average HR was 1.21 (95% CI 1.20 to 1.23) for wives' illness, 1.27 (95% CI 1.25 to 1.29) for husbands' illness and 1.38 (95% CI 1.34 to 1.42) for couples where both spouses were ill. CONCLUSIONS: Despite some variation by educational resources and country context, the results suggest that the social consequences of illness are noticeable even in Nordic welfare states, with the husband's illness being at least as important as the wife's.

Survival of children with rare structural congenital anomalies: a multi-registry cohort study.

BACKGROUND: Congenital anomalies are the leading cause of perinatal, neonatal and infant mortality in developed countries. Large long-term follow-up studies investigating survival beyond the first year of life in children with rare congenital anomalies are costly and sufficiently large standardized cohorts are difficult to obtain due to the rarity of some anomalies. This study aimed to investigate the survival up to 10 years of age of children born with a rare structural congenital anomaly in the period 1995-2014 in Western Europe. METHODS: Live births from thirteen EUROCAT (European network for the epidemiological surveillance of congenital anomalies) population-based registries were linked to mortality records. Survival for 12,685 live births with one of the 31 investigated rare structural congenital anomalies (CAs) was estimated at 1 week, 4 weeks and 1, 5 and 10 years of age within each registry and combined across Europe using random effects meta-analyses. Differences between registries were evaluated for the eight rare CAs with at least 500 live births. RESULTS: Amongst the investigated CAs, arhinencephaly/holoprosencephaly had the lowest survival at all ages (58.1%, 95% Confidence Interval (CI): 44.3-76.2% at 1 week; 47.4%, CI: 36.4-61.6% at 1 year; 35.6%, CI: 22.2-56.9% at 10 years). Overall, children with rare CAs of the digestive system had the highest survival (> 95% at 1 week, > 84% at 10 years). Most deaths occurred within the first four weeks of life, resulting in a 10-year survival conditional on surviving 4 weeks of over 95% for 17 out of 31 rare CAs. A moderate variability in survival between participating registries was observed for the eight selected rare CAs. CONCLUSIONS: Pooling standardised data across 13 European CA registries and the linkage to mortality data enabled reliable survival estimates to be obtained at five ages up to ten years. Such estimates are useful for clinical practice and parental counselling.

Living arrangements after parental separation have minimal impact on mental health at age 7 years.

AIM: This study compared mental health after parental separation in 7-year-old children living in joint physical custody with sole physical custody family arrangements. METHODS: The study population included 39 661 children from the Danish National Birth Cohort, living in a nuclear family at age 6 months. Child mental health was measured at age 7 years with maternal reports of the Strength and Difficulties Questionnaire (SDQ) operationalised as a high total score. Associations between living arrangements and mental health were analysed using logistic regression models, taking into account early childhood indicators of family relations, parental mental health and socioeconomic conditions. RESULTS: There were no statistically significant differences between the living arrangements after parental separation with joint physical custody having an odds ratio (OR) of 1.37 (95% CI 1.10-1.70), sole physical custody without a new partner OR 1.33 (95% CI 1.19-1.47) and OR 1.55 (95% CI 1.30-1.84) for sole physical custody with new partner, with children in a nuclear family as reference. CONCLUSION: This study indicates that living arrangements after parental separation have a minimal influence on child mental health at age 7 years.

Early childhood social determinants and family relationships predict parental separation and living arrangements thereafter.

AIM: Parental separation has been associated with poor mental health in children with better outcomes in children living in joint physical custody compared with those living with one parent after the separation. In this study, we investigated socioeconomic and relational predictors in early childhood of later parental separation and family arrangements thereafter. METHODS: This study included 34 768 children from the Danish National Birth Cohort, who were living with both parents at the 6 months' data collection and followed up in 2010-2014 at age 11 years. Questionnaire data from the two data collections were linked with population registers in Statistics Denmark about parental income, education and psychiatric care and analysed in logistic regression models. RESULTS: Socioeconomic indicators of the family and parental psychiatric disorders before birth of the child and family relationships in infancy predicted parental separation at age 11 year. For children with separated parents, a high family income and a high parental educational level were the main predictors of living in joint physical custody at the 11-year follow-up. CONCLUSION: Socioeconomic living conditions predict parental separation as well as living arrangements thereafter. Studies of consequences of living arrangements after parental separation should account for family factors preceding the separation.

Primary school achievement and socioeconomic attainment in individuals affected by parental cancer in childhood or adolescence: a Danish nationwide register-based study.

BACKGROUND: Children who experience parental cancer are at increased risk of developing emotional, social, cognitive and behavioural problems. Our aim was to investigate how experience of parental cancer in childhood or adolescence is associated with primary school achievement, educational attainment and income in early adult life. METHODS: This is a register-linkage, prospective study of children born in Denmark from 1978 through 1999 and their parents. Parental cancer experience before the ages of 15 and 18 was identified in the Danish National Patient Registry. Final grade point average (GPA) in ninth grade, educational attainment and disposable personal income at the age of 30 were identified in Statistics Denmark registers. General linear models and multinomial logistic regression were used to estimate beta estimates of GPA, and relative risk ratios (RRR) for lower educational and income levels compared with children without parental cancer, taking parental educational status into account. RESULTS: Children who had experienced parental cancer achieved a slightly lower final GPA in ninth grade and had a higher risk of low educational attainment (RRR: 1.20; 95% CI 1.14 to 1.25) and attenuated income at the age of 30 (RRR: 1.11; 95% CI 1.06 to 1.16). For all outcomes, analyses suggested substantial deterioration in achievements in subgroups of children whose parent had a severe cancer type (RRRLow education: 1.52; 95% CI 1.39 to 1.66) or if the parent died of cancer (RRRLow education: 1.61; 95% CI 1.49 to 1.75). CONCLUSION: Educational and socioeconomic attainments in early adulthood were affected negatively in individuals who had experienced parental cancer as children or adolescents. The associations appeared stronger the more severe the cancer was.