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  • 1. Agardh, Emilie E.
    et al.
    Lundin, Andreas
    Lager, Anton
    Allebeck, Peter
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Andreasson, Sven
    Östenson, Claes-Göran
    Danielsson, Anna-Karin
    Alcohol and type 2 diabetes: The role of socioeconomic, lifestyle and psychosocial factors2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 4, p. 408-416Article in journal (Refereed)
    Abstract [en]

    AIMS: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.

    METHODS: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.

    RESULTS: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.

    CONCLUSIONS: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.

  • 2.
    Ahrén, Jennie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chiesa, F.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, C.
    Goodman, A.
    We are family - parents, siblings and eating disorders: Introducing the Stockholm Youth Cohort2012In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 27, no 1, p. P-251-Article in journal (Refereed)
    Abstract [en]

    Introduction: Eating disorders (ED) are among the leading causes of disease burden, especially in women.

    Objectives: The overall aim is to explore role of parental social characteristics and family composition in the development of ED in adolescent males and females.

    Aims: We investigated associations of parental socioeconomic position, family type, number of siblings and half-siblings and history of psychiatric disease in parents with the incidence of eating disorders at age 12–23 years.

    Methods: The Stockholm Youth Cohort (N = 589,114) is a database created by record-linkage for all children and adolescents, 0–17 years, resident in Stockholm County during the period 2001–2007, their parents and siblings. Hazard rations were calculated using Cox regression. Cases of ED were identified in outpatient care.

    Results: A total of 3251 cases of ED (2971 females and 280 males) were recorded among 249,884 study subjects. There was an increased risk of ED in both male and female offspring of parents who had a history of alcohol and drug abuse or psychiatric ill-health. Higher parental education was a risk factors in females. Increasing number of full siblings had a protective effect (fully adjusted HR 0.91, 95% CI 0.87–0.96, per sibling) while increasing number of half-siblings appeared to increase risk of eating disorders in females.

    Conclusions: Risk factors for ED seem to differ between females and males. While parental psychiatric health is related to risk of ED in both sexes, family socioeconomic position and relationships within family appear to be of more importance for influencing risk of ED in females.

  • 3.
    Ahrén, Jennie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chiesa, Flaminia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Psychosocial determinants and family background in anorexia nervosa: Results from the Stockholm Birth Cohort Study2012In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 45, no 3, p. 362-369Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to examine the associations between psychosocial factors and family background and incidence of anorexia nervosa (AN) in a Swedish cohort.

    Method: The Stockholm Birth Cohort, SBC (N = 14,294) contains information on social background and general health in males and females, born in Stockholm 1953. Hospitalizations for AN, based on diagnoses from the ICD-8 through ICD-10, were recorded from 1969 to 2002. Cox proportional hazard regression was used to measure the association between psychosocial characteristics and family background and the risk of AN.

    Results: Higher maternal education was associated with a higher risk for hospitalization for AN. An increased risk for AN was also found among females who stated that they “often compare their future prospects with others.”

    Discussion: Although the study is based on a low number of cases, it confirms earlier findings of higher maternal education among individuals with eating disorders in similar cohorts.

  • 4.
    Ahrén, Jennie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chiesa, Flaminia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, Cecilia
    Karolinska Institutet.
    Dalman, Christina
    Karolinska Institutet.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine.
    We are family - parents, siblings, and eating disorders in a prospective total-population study of 250,000 Swedish males and females2013In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 46, no 7, p. 693-700Article in journal (Refereed)
    Abstract [en]

    Objective: We examined how parental characteristics and other aspects of family background were associated with the development of eating disorders (ED) in males and females.

    Method: We used register data and record linkage to create the prospective, total-population study the Stockholm Youth Cohort. This cohort comprises all children and adolescents who were ever residents in Stockholm County between 2001 and 2007, plus their parents and siblings. Individuals born between 1984 and 1995 (N = 249, 884) were followed up for ED from age 12 to end of 2007. We used Cox regression modeling to investigate how ED incidence was associated with family socioeconomic position, parental age, and family composition.

    Results: In total, 3,251 cases of ED (2,971 females; 280 males) were recorded. Higher parental education independently predicted a higher rate of ED in females [e.g., adjusted hazard ratio (HR) 1.69 (95% CI: 1.42, 2.02) for degree-level vs. elementary-level maternal education], but not in males [HR 0.73 (95% CI: 0.42, 1.28), p < 0.001 for gender interaction]. In females, an increasing number of full-siblings was associated with lower rate of ED [e.g., fully adjusted HR 0.92 (95% CI: 0.88, 0.97) per sibling], whereas an increasing number of half-siblings was associated with a higher rate [HR 1.05 (95% CI: 1.01, 1.09) per sibling].

    Discussion: The effect of parental education on ED rate varies between males and females, whereas the effect of number of siblings varies according to whether they are full or half-siblings. A deeper understanding of these associations and their underlying mechanisms may provide etiological insights and inform the design of preventive interventions

  • 5.
    Ahrén-Moonga, Jennie
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mothers’ social background and risk of eating disorders in daughters [abstract]2008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no suppl. 1, p. 111-112Article in journal (Refereed)
  • 6.
    Ahrén-Moonga, Jennie
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Silverwood, Richard
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Association of Higher Parental and Grandparental Education and Higher School Grades With Risk of Hospitalization for Eating Disorders in Females: The Uppsala Birth Cohort Multigenerational Study2009In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 170, no 5, p. 566-575Article in journal (Refereed)
    Abstract [en]

    Eating disorders are a leading cause of disease burden amongyoung women. This study investigated associations of socialcharacteristics of parents and grandparents, sibling position,and school performance with incidence of eating disorders. Theauthors studied Swedish females born in 1952–1989 (n =13,376), third-generation descendants of a cohort born in Uppsalain 1915–1929. Data on grandparental and parental socialcharacteristics, sibling position, school grades, hospitalizations,emigrations, and deaths were obtained by register linkages.Associations with incidence of hospitalization for eating disorderswere studied with multivariable Cox regression, adjusted forage and study period. Overall incidence of hospitalization foreating disorders was 32.0/100,000 person-years. Women with morehighly educated parents and maternal grandparents were at higherrisk (hazard ratio for maternal grandmother with higher educationrelative to elementary education = 6.5, 95% confidence interval:2.2, 19.3, adjusted for parental education). Independent offamily social characteristics, women with the highest schoolgrades had a higher risk of eating disorders (hazard ratio =7.7, 95% confidence interval: 2.5, 24.1 for high compared withlow grades in Swedish, adjusted for parental education). Thus,higher parental and grandparental education and higher schoolgrades may increase risk of hospitalization for eating disordersin female offspring, possibly because of high internal and externaldemands.

  • 7. Blane, David
    et al.
    Akinwale, Bola
    Landy, Rebecca
    Matthews, Katey
    Wahrendorf, Morten
    Wahl, Hans-Werner
    Hayward, Mark D.
    Liefbroer, Aart C.
    Mishra, Gita D.
    Ferreira, Isabel
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    What can the life course approach contribute to an understanding of longevity risk?2016In: Longitudinal and life course studies, ISSN 1124-9064, E-ISSN 1757-9597, Vol. 7, no 2, p. 165-196Article in journal (Refereed)
    Abstract [en]

    Longevity risk means living longer than predicted. Attempts to understand longevity risk to date have concentrated on single diseases, usually coronary heart disease, and sought explanations in terms of risk factor change and medical innovation. In an opening paper, David Blane and colleagues point to evidence that suggests changes in positive health also should be considered; and that a life course approach can do so in a way that is socially and biologically plausible. Applying this approach to UK citizens currently aged 85 years suggests that life course research should give priority to trajectories across the whole life course and to the social and material contexts through which each cohort has passed. Testing these ideas will require inter-disciplinary and international comparative research. The opening paper is followed by commentaries from Hans-Werner Wahl, Mark Hayward, Aart Liefbroer and Gita Mishra. Finally Blane and colleagues respond to the points raised by the commentators.

  • 8. Bould, H.
    et al.
    Sovio, U.
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Dalman, C.
    Micali, N.
    Lewis, G.
    Magnusson, C.
    Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort2015In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 132, no 1, p. 51-59Article in journal (Refereed)
    Abstract [en]

    Objective: We investigated whether parental eating disorders (ED) predict ED in children, using a large multigeneration register-based sample.

    Method: We used a subset of the Stockholm Youth Cohort born 1984-1995 and resident in Stockholm County in 2001-2007 (N=286232), The exposure was a diagnosed eating disorder in a parent; the outcome was any eating disorder diagnosis in their offspring, given by a specialist clinician, or inferred from an appointment at a specialist eating disorder clinic. A final study sample of 158697 (55.4%) had data on these variables and confounding factors and contributed a total of 886241personyears to the analysis.

    Results: We found good evidence in support of the hypothesis that ED in either parent are independently associated with ED in their female children (HR 1.97 (95% CI: 1.17-3.33), P=0.01) and that ED in mothers are independently associated with ED in their female children (HR 2.35 (95% CI: 1.39-3.97) P=0.001). Numbers were too low to permit separate analysis of ED in parents and their male children.

    Conclusion: Eating disorders in parents were associated with ED in children. This study adds to our knowledge about the intergenerational transmission of ED, which will help identify high-risk groups and brings about the possibility of targeted prevention.

  • 9. Bould, Helen
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Dalman, Christina
    De Stavola, Bianca
    Lewis, Glyn
    Magnusson, Cecilia
    Parental mental illness and eating disorders in offspring2015In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 48, no 4, p. 383-391Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate which parental mental illnesses are associated with eating disorders in their offspring.

    METHOD: We used data from a record-linkage cohort study of 158,679 children aged 12-24 years at the end of follow-up, resident in Stockholm County from 2001 to 2007, to investigate whether different parental mental illnesses are risk factors for eating disorders in their offspring. The outcome measure was diagnosis of any eating disorder, either from an ICD or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic.

    RESULTS: Mental illness in parents is a risk factor for eating disorders in female offspring (Adjusted Hazard Ratio (AHR) 1.57 (95% CI 1.42, 1.92), p < 0.0001). Risk of eating disorders is increased if there is a parental diagnosis of bipolar affective disorder (AHR 2.28 (95% CI 1.39, 3.72), p = 0.004), personality disorder (AHR 1.57 (95% CI 1.01, 2.44), p = 0.043) or anxiety/depression (AHR 1.57 (95% CI 1.32, 1.86), p < 0.0001). There is a lack of statistical evidence for an association with parental schizophrenia (AHR 1.41 (95% CI 0.96, 2.07), p = 0.08), and somatoform disorder (AHR 1.25 (95% CI 0.74, 2.13), p = 0.40). There is no support for a relationship between parental substance misuse and eating disorders in children (AHR 1.08 (95% CI 0.82, 1.43), p = 0.57).

    DISCUSSION: Parental mental illness, specifically parental anxiety, depression, bipolar affective disorder, and personality disorders, are risk factors for eating disorders in their offspring.

  • 10. Bureš, J.
    et al.
    Kopáčová, M.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Seifert, B.
    Škodová Fendrichová, M.
    Špirková, J.
    Voříšek, V.
    Rejchrt, S.
    Douda, T.
    Král, N.
    Tachecí, I.
    Significant decrease in prevalence of Helicobacter pylori in the Czech Republic2012In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 18, no 32, p. 4412-4418Article in journal (Refereed)
    Abstract [en]

    METHODS: A total of 22 centres entered the study. The catchment areas of these centres covered cities and towns with more than 20 000 inhabitants, smaller towns (<= 20 000 inhabitants) with surrounding villages and rural areas, and were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1 837 subjects (aged 5-98 years) took part in the study, randomly selected out of 38 147 people from the general population. H. pylori infection was investigated by means of a C-13-urea breath test. Breath samples in duplicates were analysed using isotope ratio mass spectrometry. The cut-off point was 3.5. Social and demographic characteristics were based on data from self-completed questionnaires. RESULTS: The overall prevalence of H. pylori infection was 23.5% (430/1826), and 4.8% (20/420) in children aged 15 or less. There was no statistically significant difference in prevalence between males (24.3%; 208/857) and females (22.9%, 222/969, P = 0.494). H. pylon infection was strongly associated with higher age, among subjects aged 55+ years, prevalence of H. pylori infection was 39.8% (252/633, P < 0.001). The highest prevalence of H. pylori infection was found among persons aged 55-64 years (43.9%, 97/221) and 75+ years (37.9%, 58/153). Among study subjects aged 15+ years, prevalence of H. pylori infection was significantly increased in those with lowest education (odds risk 3.19, 95% CI 1.87-5.47). Compared to never married (14.1%), the prevalence of H. pylori infection was statistically significantly higher among married (35.4%, 246/694, P < 0.001), divorced (36.8%, 49/133, P < 0.001) and widowed study subjects (40.2%, 45/112, P < 0.001), both in minimally and fully adjusted analysis. There was no significant difference in the prevalence of H. pylori infection between married and widowed subjects (35.4%, 246/694 vs 40.2%, 45/112, P = 0.389). There was little variation in smoking prevalence across categories of smoking and there was no evidence of an increased risk of H. pylon infection among current or past smokers in our data (odds risk 1.04 with 95% CI 0.78-1.40 for current smokers; odds ratio 0.83 with 95% CI 0.60-1.16 for former smokers). The current prevalence of H. pylori in 2011 was significantly lower compared to the prevalence reported from identical geographical areas in 2001 (23.5% vs 41.7%, P < 0.001). CONCLUSION: The overall prevalence of H. pylon infection in the general population has fallen substantially in the Czech Republic over the past 10 years.

  • 11. Byberg, Liisa
    et al.
    Michaëlsson, Karl
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
    Zethelius, Björn
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth Weight is not Associated with Risk of Fracture: Results From Two Swedish Cohort Studies2014In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 29, no 10, p. 2152-2160Article in journal (Refereed)
    Abstract [en]

    Development and growth in utero has been suggested to influence bone health. However, the relationship with risk of fracture in old age is largely unknown. Using Cox proportional hazards regression, we studied the association between birth weight and fractures at ages 50-94 among 10,893 men and women (48% women) from the Uppsala Birth Cohort Study (UBCoS, born 1915-29) and 1,334 men from the Uppsala Longitudinal Study of Adult Men (ULSAM, born 1920-24). Measured birth weight was collected from hospital or midwives' records and fractures from the Swedish National Patient Register. We observed 2,796 fractures (717 of these were hip fractures) in UBCoS and 335 fractures (102 hip fractures) in ULSAM. In UBCoS, the hazard ratio (HR) per 1 kg increase in birth weight, adjusted for sex and socioeconomic status at birth, was 1.01 (95% confidence interval [CI], 0.94-1.09) for any fracture and 1.06 (95% CI, 0.91-1.23) for hip fracture. Estimates in ULSAM were similar. We did not observe a differential association of birth weight with fractures occurring before age 70 or after age 70 years. Neither birth weight standardized for gestational age nor gestational duration was associated with fracture rate. In linear regression, birth weight was not associated with bone mineral density among 303 82-year-old men in ULSAM but showed positive associations with total body bone mineral content (β per kg increase in birth weight, adjusted for social class and age, 133; 95% CI, 30-227). This association was attenuated after further adjustment for body mass index and height (β, 41; 95% CI, -43 to 126). We conclude that birth weight is associated with bone mineral content but this association does not translate into an association with risk of fracture in men and women aged 50-94 years.

  • 12.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    De Luna, Xavier
    Haggstrom, Jenny
    Ivarsson, Anneli
    Lindgren, Urban
    Nilsson, Karina
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Childhood family structure and women's adult overweight risk: A longitudinal study2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 5, p. 511-519Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. Methods: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/ obesity (body mass index (BMI) >= 25 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. Results: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. Conclusions: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

  • 13. Chaparro, M. Pia
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Byberg, Liisa
    Maternal pre-pregnancy BMI and offspring body composition in young adulthood: the modifying role of offspring sex and birth order2017In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 20, no 17, p. 3084-3089Article in journal (Refereed)
    Abstract [en]

    To investigate if the association between maternal pre-pregnancy BMI and offspring’s body composition in late adolescence and young adulthood varies by offspring birth order and sex.

    Family cohort study, with data from registers, questionnaires and physical examinations. The main outcome under study was offspring body composition (percentage fat mass (%FM), percentage lean mass (%LM)) measured by dual-energy X-ray absorptiometry.

    Uppsala, Sweden.

    Two hundred and twenty-six siblings (first-born v. second-born; average age 19 and 21 years) and their mothers.

    In multivariable linear regression models, maternal pre-pregnancy BMI was positively associated with daughter’s %FM, with stronger estimates for first-born (β=0·97, 95 % CI 0·14, 1·80) v. second-born daughters (β=0·64, 95 % CI 0·08, 1·20). Mother’s BMI before her first pregnancy was associated with her second-born daughter’s body composition (β=1·05, 95 % CI 0·31, 1·79 (%FM)) Similar results albeit in the opposite direction were observed for %LM. No significant associations were found between pre-pregnancy BMI and %FM (β=0·59, 95 % CI−0·27, 1·44 first-born; β=−0·13, 95 % CI−0·77, 0·52 second-born) or %LM (β=−0·54, 95 % CI−1·37, 0·28 first-born; β=0·11, 95 % CI−0·52, 0·74 second-born) for sons.

    A higher pre-pregnancy BMI was associated with higher offspring %FM and lower offspring %LM in late adolescence and young adulthood, with stronger associations for first-born daughters. Preventing obesity at the start of women’s reproductive life might reduce the risk of obesity in her offspring, particularly for daughters.

  • 14.
    Chaparro, Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The impact of parental educational trajectories on their adult offspring's overweight/obesity status: a study of three generations of Swedish men and women2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 120, p. 199-207Article in journal (Refereed)
  • 15.
    Chiesa, Flaminia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Effect of parental social class on alcohol related mortality in adulthood and old age.2009In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 24, no Suppl1, p. 36-Article in journal (Refereed)
  • 16. Danziger, P. D.
    et al.
    Silverwood, R.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fetal growth, early life circumstances, and risk of suicide in late adulthood2011In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 26, no 7, p. 571-581Article in journal (Refereed)
    Abstract [en]

    Recent studies in Sweden and Scotland have found early life conditions to be associated with increased risk of attempted and completed suicide in adolescence and young adulthood. It is not known, however, whether early life conditions affect suicide risk throughout the life course, from adulthood into old age. We examined the effects of early life conditions, including markers of fetal growth, and social and economic characteristics in adulthood, on risk of suicide by violent and non-violent methods in women and men aged 31–87 years using Cox regression. 11,650 women and men born at the Uppsala University Hospital in Sweden between 1915 and 1929 were followed from 1960 until 2002 using linked records from obstetric archives, Census, population and mortality registries. During 435,039 person-years of follow-up 161 completed suicides (104 in males, 57 in females) were observed. An inverse association was found between lower birthweight-for-gestational age and risk of violent suicide in females, although the association did not reach the conventional level of statistical significance (minimally adjusted HR 2.02, 95% CI (0.88–4.63); Table 4). Being male, unmarried, and in the “other or unknown” social class category in adulthood were independently associated with increased rates of suicide. There was a weak association between higher maternal parity and suicide rates. Our findings suggest differences in effects of fetal growth patterns and perinatal circumstances on suicide risk later in life, and suggest that suicide in adults and in the elderly may be influenced by a different combination of factors than those that influence suicide in adolescence and young adulthood.

  • 17. De Stavola, B. L.
    et al.
    Leon, D. A.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Intergenerational correlations in size at birth and the contribution of environmental factors: The Uppsala Birth Cohort Multigenerational Study, Sweden, 1915-20022011In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 174, no 1, p. 52-62Article in journal (Refereed)
    Abstract [en]

    Data indicate an inverse association between dietary calcium and magnesium intakes and blood pressure (BP); however, much less is known about associations between urinary calcium and magnesium excretion and BP in general populations. The authors assessed the relation of BP to 24-hour excretion of calcium and magnesium in 2 cross-sectional studies. The International Study of Macro- and Micro-Nutrients and Blood Pressure (INTERMAP) comprised 4,679 persons aged 40–59 years from 17 population samples in China, Japan, the United Kingdom, and the United States, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) comprised 10,067 persons aged 20–59 years from 52 samples around the world. Timed 24-hour urine collections, BP measurements, and nutrient data from four 24-hour dietary recalls (INTERMAP) were collected. In multiple linear regression analyses, urinary calcium excretion was directly associated with BP. After adjustment for multiple confounders (including weight, height, alcohol intake, calcium intake, urinary sodium level, and urinary potassium intake), systolic BP was 1.9 mm Hg higher per each 4.1 mmol per 24 hours (2 standard deviations) of higher urinary calcium excretion (associations were smaller for diastolic BP) in INTERMAP. Qualitatively similar associations were observed in INTERSALT analyses. Associations between magnesium excretion and BP were small and nonsignificant for most of the models examined. The present data suggest that altered calcium homoeostasis, as exhibited by increased calcium excretion, is associated with higher BP levels.

  • 18. Dekhtyar, Serhiy
    et al.
    Wang, Hui-Xin
    Scott, Kirk
    Goodman, Anna
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Herlitz, Agneta
    A life-course study of cognitive reserve in dementia from childhood to old age2015In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 23, no 9, p. 885-896Article in journal (Refereed)
    Abstract [en]

    Objective: To test a life-course model of cognitive reserve in dementia and examine if school grades around age 10 years, formal educational attainment, and lifetime occupational complexity affect the risk of dementia in old age. Methods: 7,574 men and women from the Uppsala Birth Cohort Multigenerational Study were followed for 21 years. Information on school performance, formal education, and occupational attainment was collected prospectively from elementary school archives and population censuses. Dementia diagnosis was extracted from the two Swedish registers. Discrete-time Cox proportional hazard models were estimated. Results: Dementia was diagnosed in 950 individuals (12.5%). Dementia risk was lower among individuals with higher childhood school grades (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.68 to 0.93) and was lower among individuals in data-complex occupations (HR: 0.77; 95% CI: 0.64 to 0.92). Professional/university education predicted lower risk of dementia in minimally adjusted models (HR: 0.74; 95% CI: 0.60 to 0.91), although the effect faded with adjustment for occupational complexity. Lowest risk was found in the group with both higher childhood school performance and high occupational complexity with data (HR: 0.61; 95% CI: 0.50 to 0.75). Importantly, high occupational complexity could not compensate for the effect of low childhood grades. In contrast, dementia risk was reduced in those with higher school grades, irrespective of occupational complexity. Conclusion: Higher childhood school performance is protective of dementia risk, particularly when preserved through complex work environments in adulthood, although it will remain protective even in the absence of later-life educational or occupational stimulation.

  • 19. DeStavola, Bianca
    et al.
    Leon, Dave
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Contribution of environmental factors to intergenerational correlations in size at birth (abstract)2010In: Longitudinal and Life Course Studies, Vol. 1, no 3 Supplement, p. 259-Article in journal (Refereed)
  • 20. Donrovich, Robyn
    et al.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet.
    Early life conditions, partnership histories, and mortality risk for Swedish men and women born 1915-19292014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 108, p. 60-67Article in journal (Refereed)
    Abstract [en]

    This paper investigates the relationship between early life biological and social factors, partnership history, and mortality risk. Mortality risks for Swedish men and women over age 50 in the Uppsala Birth Cohort born 1915-1929 were estimated using survival analysis. Relative mortality risk was evaluated through nested multiplicative Gompertz models for 4348 men and 3331 women, followed from age 50 to the end of 2010. Being born to an unmarried mother was associated with higher mortality risk in later life for men and women, and relative to married individuals, being unmarried after age 50 was associated with elevated mortality risk. Single women and divorced men were the highest risk groups, and women were negatively impacted by a previous divorce or widowhood, while men were not. Both genders showed direct effects of early life variables on later life mortality and were vulnerable if unmarried in later life. However, in this study, previous marital disruptions appeared to have more (negative) meaning in the long-term for women.

  • 21. dos Santos Silva, Isabel
    et al.
    De Stavola, Bianca
    McCormack, Valerie
    Collaborative Group on Pre-Natal Risk Factors and Subsequent Risk of Breast Cancer,
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth Size and Breast Cancer Risk: Re-analysis of Individual Participant Data from 32 Studies2008In: PLoS Medicine, Vol. 5, no 9, p. e193-Article in journal (Refereed)
  • 22. Falkstedt, Daniel
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hemmingsson, Tomas
    Blood pressure in late adolescence and early incidence of coronary heart disease and stroke in the Swedish 1969 conscription cohort2008In: Journal of Hypertension, Vol. 26, p. 1313-1320Article in journal (Refereed)
  • 23.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Socioeconomic inequalities in circulatory and all-cause mortality after retirement: the impact of mid-life income and old-age pension. Evidence from the Uppsala Birth Cohort Study2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 7, p. e16-Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore the impact of mid-life income and old-age pensions on the risk of mortality in later life. Furthermore, the study explored whether income inequalities in old-age mortality can be explained by differences in early childhood development, social class during childhood, education or marital status.

    Methods: The study sample comprises all individuals born at Uppsala Academic Hospital during the period 1915–1924 who had retired but not died or emigrated by 1991 (n=4156). Information on social and biological conditions was retrieved from national registries.

    Results: The results show that income during mid-life and income during retirement were associated with old-age mortality. However, mutually adjusted models showed that income in mid-life was more important for women's late-life mortality and that income during retirement was more important for men's late-life mortality. Furthermore, differences in education and marital status seemed to explain a substantial part of income inequalities in late-life mortality.

    Conclusions: It is unlikely that egalitarian social policies aimed at older populations can eradicate health inequalities accumulated over the life course. However, retirement income appears to have an effect on late-life mortality that is independent of the effect of income in mid-life, suggesting that egalitarian pension schemes could affect health inequalities in later life or, at the very least, slow down further accumulation of inequalities.

  • 24. Gao, M.
    et al.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    Mishra, G.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Associations of birth characteristics with perimenopausal disorders: a prospective cohort study2019In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 10, no 2, p. 246-252Article in journal (Refereed)
    Abstract [en]

    Perimenopausal disorders (PDs) are prevalent and importantly affect quality of life among middle-aged women. Yet, very little is known about the developmental origins of these disorders. The objective of this study was to investigate the associations of birth characteristics with PDs. This cohort study is based on archived birth records for birth weight and gestational age, and followed prospectively in Swedish inpatient and outpatient registers for 8 years (n=3212). The main outcomes were menopausal and climacteric states (e.g. flushing, sleeplessness), perimenopausal bleeding and other PDs (e.g. atrophic vaginitis). Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for three subtypes of PDs separately. During the follow-up, 218 women had PDs, among whom 125 had menopausal and climacteric states, 61 had perimenopausal bleeding and 58 had other PDs as first recorded disorder. Birth weight was linearly associated with incidence rate of menopausal and climacteric states [HR=1.66 per 1 kg increase, 95% confidence interval (95% CI)=1.14-2.41]. Gestational age (rather than birth weight) was associated with incidence rate of other PDs (HR=0.87 per 1 week increase, 95% CI=0.79-0.95). Neither birth weight nor gestational age was associated with perimenopausal bleeding. Similar results were found after adjustment for other early-life and adult socio-demographic characteristics. This observational study provides, for the first time, evidence regarding the developmental origins of PDs. Future research is required to investigate the underlying causal mechanisms, which may shed further light on the etiology of this class of disorders.

  • 25. Gao, M.
    et al.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, Gita
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Developmental origins of perimenopausal disorders: evidence from a Swedish cohort2017In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 8, no Suppl. 1Article in journal (Refereed)
  • 26. Gao, Menghan
    et al.
    Allebeck, Peter
    Mishra, Gita D.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Developmental origins of endometriosis: a Swedish cohort study2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 4, p. 353-359Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Endometriosis is a chronic condition affecting women of reproductive age and is associated with multiple health burdens. Yet, findings regarding its 'developmental origins' are inconsistent. We aimed to investigate the associations of birth characteristics with endometriosis. We also explored potential mediation by adult social and reproductive factors.

    METHODS: This cohort study consisted of 3406 women born in Uppsala, Sweden, between 1933 and 1972. We used data from archived birth records and endometriosis diagnoses at ages 15-50 recorded in the national patient registers. Socioeconomic and reproductive characteristics were obtained from routine registers. HRs were estimated from Cox regression.

    RESULTS: During the follow-up, 111 women have been diagnosed with endometriosis, and most cases are external endometriosis (ie, outside the uterus, n=91). Lower standardised birth weight for gestational age was associated with increased rate of endometriosis (HR 1.35 per standard deviation decrease; 95% CI 1.08 to 1.67). This increased rate was also detected among women with fewer number of live births (HR 2.38; 95% CI 1.40 to 4.07 for one child vs ≥2 children; HR 6.09; 95% CI 3.88 to 9.57 for no child vs ≥2 children) and diagnosed infertility problem (HR 2.00; 95% CI 1.10 to 3.61) prior to endometriosis diagnosis. All the observed associations were stronger for external endometriosis. However, no evidence was found that number of births was the mediator of the inverse association between standardised birth weight and endometriosis.

    CONCLUSION: This study supports the developmental origins theory and suggests that exposure to growth restriction during the fetal period is associated with increased risk of endometriosis during reproductive years.

  • 27.
    Gisselmann, Marit
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    De Stavola, B. L.
    The combined influence of parental education and preterm birth on school performance2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 9, p. 764-769Article in journal (Refereed)
    Abstract [en]

    Background Social background and birth characteristics are generally found to be independently associated with school achievements but the underlying mechanisms are not fully understood. This study aimed to explore how parental education and shorter gestational age jointly influence school performance in a cohort of Swedish children.

    Methods 10 835 children born between 1973 and 1981 were studied, the third generation of the register-based Uppsala Multigenerational Birth Cohort. Ordinal logistic regression models were fitted to estimate OR of achieving middle and high grades in Swedish language at age 16 years, relative to low grade, by parental education and own gestational age, adjusting for potential confounders.

    Results In children from families with lower parental education, the adjusted OR of receiving a higher grade was 0.54 (95% CI 0.41 to 0.71) for preterm (<37 completed weeks) compared with full-term births. This estimate did not change when adjusted for several potential confounders (0.59; CI 0.44 to 0.79). When different cut-points were selected to define preterm birth, the estimated OR for those with low parental education decreased linearly from 0.83 (CI 0.72 to 0.96) using less than 39 weeks as the cut-point, to 0.52 (CI 0.30 to 0.90) using less than 35 weeks. There was no evidence of significant effects of shorter gestational age for children with parents from other educational groups.

    Conclusions The disadvantage of shorter gestational age on the chance of achieving higher grades in Swedish language was confined to children from families in which none of the parents had higher education. This suggests that the detrimental influence of shorter gestational age on school performance in language may be avoidable.

  • 28.
    Goodman, A.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Gisselmann, Marit
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth outcomes and early-life social characteristics predict unequal educational outcomes across the life course and across generation: Data from a Swedish cohort born 1915-1929 and their grandchildren born 1973-19802011In: IEA World Congress of Epidemiology, 7–11 August 2011, Edinburgh International Conference Centre, Edinburgh, Scotland. Programme and abstracts: Programme and abstracts, 2011, Vol. 65Conference paper (Refereed)
    Abstract [en]

    Educational inequalities are a major contributor to health and social inequalities. We investigated the effects of adverse birth characteristics and social disadvantage upon educational outcomes over the lifecourse and across generations. Our subjects were 12 674 Swedish infants born 1915–1929 and 9706 of their grandchildren born 1973–1980. Within both cohorts, better school achievement (schoolmarks in elementary school) was predicted by: heavier birthweight, lower birth order, older mother, married mother and higher family social class. These effects persisted after mutual-adjustment, and birth characteristics and family composition played little role in explaining social class effects. There were no independent effects of preterm or twin status, but weak evidence that postterm infants were disadvantaged. The predictors of education continuation (secondary school attendance and entrance to tertiary education) were very similar, with family composition and social class effects persisting even after adjusting for school achievement. Across generations, better grandchild educational outcomes were predicted by heavier birthweight, lower birth order and higher social class in the grandparents. These associations became non-significant and/or substantially attenuated after adjusting for grandchild socio-economic position in childhood, suggesting this was the major mechanism for this effect. We conclude that multiple early-life characteristics predict educational outcomes across the lifecourse and across generations, including birth outcome and family composition effects which typically receive little attention. Most effects were remarkably stable, suggesting their relevance for understanding educational inequalities in other populations. Such understanding would, in turn, clarify a major mechanism whereby health inequalities emerge across the lifecourse and are recreated across generations.

  • 29. Goodman, Anna
    et al.
    Gisselmann, Marit
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth characteristics and early-life social characteristics predict unequal educational outcomes: consistency across Swedish cohorts born 1915-1929 and 1973-1981 (abstract)2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no Suppl 1, p. Abstract ref 027-Article in journal (Refereed)
  • 30. Goodman, Anna
    et al.
    Gisselmann, Marit
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Birth outcomes and early-life social characteristics predict unequal educational outcomes: consistency across Swedish cohorts born 1915-1929 and 1973-19802010In: Longitudinal and Life Course Studies, Vol. 1, no 4, p. 317-338Article in journal (Refereed)
  • 31. Goodman, Anna
    et al.
    Gisselmann, Marit
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Size at birth and early life social characteristics predict educational outcomes: consistency across Swedish cohorts born 1915-1929 and 1973-1980 (abstract)2010In: Longitudinal and Life Course Studies, Vol. 1, no 3 Supplemebt, p. 210-Article in journal (Refereed)
  • 32.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Heshmati, Amy Frances
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Family history of education predicts eating disorders across multiple generations among 2 million Swedish males and females2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, PloS one, ISSN 1932-6203, Vol. 9, no 8, p. e106475-Article in journal (Refereed)
    Abstract [en]

    Purpose To investigate which facets of parent and grandparent socio-economic position (SEP) are associated with eating disorders (ED), and how this varies by ED subtype and over time.

    Methods Total-population cohort study of 1,040,165 females and 1,098,188 males born 1973-1998 in Sweden, and followed for inpatient or outpatient ED diagnoses until 2010. Proportional hazards models estimated associations with parental education, income and social class, and with grandparental education and income.

    Results 15,747 females and 1051 males in our sample received an ED diagnosis, with rates increasing in both sexes over time. ED incidence in females was independently predicted by greater educational level among the father, mother and maternal grandparents, but parent social class and parental income showed little or no independent effect. The associations with education were equally strong for anorexia nervosa, bulimia nervosa and ED not-otherwise-specified, and had increased over time. Among males, an apparently similar pattern was seen with respect to anorexia nervosa, but non-anorexia ED showed no association with parental education and an inverse association with parental income.

    Conclusions Family history of education predicts ED in gender- and disorder-specific ways, and in females the effect is observed across multiple generations. Particularly given that these effects may have grown stronger in more recent cohorts, these findings highlight the need for further research to clarify the underlying mechanisms and identify promising targets for prevention. Speculatively, one such mechanism may involve greater internal and external demands for academic success in highly educated families.

  • 33.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Heshmati, Amy Frances
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, N
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Associations between birth characteristics and eating disorders across the life course: findings from 2 million Swedish males and females born 1975-19982013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no Supplement 1, p. 108-109Article in journal (Refereed)
  • 34.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
    Heshmati, Amy
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Family history of education predicts eating disorders across multiple generations: a study of one million Swedish females born 1973-19982013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, p. 108-108Article in journal (Other academic)
  • 35.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of London, England.
    Heshmati, Amy
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, Ninoa
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Associations between birth characteristics and eating disorders across the life course: findings from 2 million males and females born in Sweden, 1975–19982014In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, no 7, p. 852-863Article in journal (Refereed)
    Abstract [en]

    Birth characteristics predict a range of major physical and mental disorders, but findings regarding eating disorders are inconsistent and inconclusive. This total-population Swedish cohort study identified 2,015,862 individuals born in 1975–1998 and followed them for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified until the end of 2010. We examined associations with multiple family and birth characteristics and conducted within-family analyses to test for maternal-level confounding. In total, 1,019 males and 15,395 females received an eating disorder diagnosis. Anorexia nervosa was independently predicted by multiple birth (adjusted hazard ratio = 1.33, 95% confidence interval: 1.15, 1.53) for twins or triplets vs. singletons) and lower gestational age (adjusted hazard ratio = 0.96, 95% confidence interval: 0.95, 0.98) per extra week of gestation, with a clear dose-response pattern. Within-family analyses provided no evidence of residual maternal-level confounding. Higher birth weight for gestational age showed a strong, positive dose-response association with bulimia nervosa (adjusted hazard ratio = 1.15, 95% confidence interval: 1.09, 1.22, per each standard-deviation increase), again with no evidence of residual maternal-level confounding. We conclude that some perinatal characteristics may play causal, disease-specific roles in the development of eating disorders, including via perinatal variation within the normal range. Further research into the underlying mechanisms is warranted. Finally, several large population-based studies of anorexia nervosa have been conducted in twins; it is possible that these studies considerably overestimate prevalence.

  • 36.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine.
    Heshmati, Amy
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, Ninoa
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    PL03 Associations between Birth Characteristics and Eating Disorders Across the Life Course: findings from two Million Males and Females Born in Sweden 1975-19982013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no S 1, p. A46-Article in journal (Refereed)
    Abstract [en]

    Background: Recent years have seen considerable interest in the developmental origins of eating disorders (ED) but results have been conflicting, perhaps reflecting low power in many studies. Limited power has also prevented robust comparisons of associations with ED subtypes or the use of within-family designs to address the potential for confounding.

    Methods: We used total population data to create a cohort of 2,011,908 males and females, born 1975-1998 in Sweden to Swedish-born mothers. Birth characteristics included twin/triplet status; gestational age; birthweight; birth length; premature rupture of the membranes; delivery method; Apgar score at 5 minutes; birth traumas; mother’s smoking during pregnancy; and mother’s weight gain during pregnancy. We adjusted for multiple family and social characteristics, and conducted within-family analyses to test for confounding at the maternal/family level. Our outcomes were hospitalisation for anorexia, bulimia or eating disorder not-otherwise-specified (EDNOS)’ after age 12, with follow-up period until end 2010.

    Results: Anorexia was independently predicted by multiple birth (AOR 1.33 [95% CI 1.15, 1.53] for twin/triplet vs. singleton) and lower gestational age (HR 0.96 [0.95, 0.98] per extra week of gestation). Gestational age showed a clear dose-response pattern. These associations were largely specific to anorexia, and were only seen in the cohort members affected; within-family analyses revealed that the maternal siblings of twins or preterm individuals showed no increased risk, and provided no evidence of residual maternal-level confounding. Higher birthweight for gestational age showed a strong, positive dose-response association with bulimia (HR 1.15 [1.09, 1.22]) per sex-standardised standard deviation increase). Again, this association was specific to bulimia and within-family analyses provided no evidence of residual confounding. By contrast, although mother’s smoking predicted anorexia, this did seem likely to reflect maternal-level confounding. Other birth characteristics showed little or no association with any ED outcome, except a trend towards increased bulimia and EDNOS among mothers who gained excessive weight during pregnancy.

    Conclusion: These findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia. Further research is needed to elucidate the mechanisms, but the dose-response nature of these associations indicates that they do not simply reflect pathological responses at the extremes of the distribution. The strong association with multiple births is noteworthy as many of the largest population-based studies of ED prevalence have been conducted in twins: our findings suggest the possibility that such studies substantially overestimate ED prevalence.

  • 37.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    Kajantie, Eero
    Osmond, Clive
    Eriksson, Johan
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Thornburg, Kent
    Phillips, David IW
    The relationship between umbilical cord length and chronic rheumatic heart disease: a prospective cohort study2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 9, p. 1154-1160Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One previous, preliminary study reported that the length of the umbilical cord at birth is related to the risk of developing chronic rheumatic heart disease in later life. We sought to replicate this finding.

    DESIGN: Prospective, population-based birth cohort.

    METHODS: We traced 11,580 individuals born between 1915 and 1929 in Uppsala, Sweden. We identified cases with a main or secondary diagnosis of chronic rheumatic heart disease in the Swedish national inpatient, outpatient or death registers. Archived obstetric records provided data on umbilical cord length, gestational age, birthweight and placental weight.

    RESULTS: There were 136 patients with chronic rheumatic heart disease (72 men and 64 women) with a mean age at first hospital admission of 68 years (range 36-92). There was evidence of a positive association between umbilical cord length and risk of subsequent chronic rheumatic heart disease. The overall hazard ratio in the Swedish study (1.13, 95% confidence interval 1.01 to 1.27) was similar to that of the previous study, with some suggestion of larger effect in men than in women. No other birth characteristics were predictive except for weak evidence of a protective effect of higher birthweight in men.

    CONCLUSIONS: People with longer umbilical cords at birth are more likely to develop chronic rheumatic heart disease in later life. As longer umbilical cords have more spiral arteries and a higher vascular resistance, we hypothesize that the increased pressure load on the heart leads to changes in endothelial biology and increased vulnerability to the autoimmune process initiated by infection with β-haemolytic streptococci.

  • 38. Goodman, Anna
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social and biological determinants of reproductive success in Swedish males and females2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63(SupplI), p. A2-A3Article in journal (Refereed)
  • 39. Goodman, Anna
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social and biological determinants of reproductive success in Swedish males and females born 1915-19292009In: Evolution and human behavior, ISSN 1090-5138, E-ISSN 1879-0607, Vol. 30, no 5, p. 329-341Article in journal (Refereed)
    Abstract [en]

    Studying biological and social determinants of mortality and fertility provides insight into selective pressures in a population and the possibility of trade-offs between short- and long-term reproductive success. Limited data is available from post-demographic transition populations. We studied determinants of reproductive success using multi-generational data from a large, population-based cohort of 13,666 individuals born in Sweden between 1915 and 1929. We studied the effects of birthweight for gestational age, preterm birth, birth multiplicity, birth order, mother's age, mother's marital status and family socioeconomic position (SEP) upon reproductive success, measured as total number of children and grandchildren. We further tested the hypothesis that number of grandchildren would peak at intermediate family size, as predicted by some life history explanations for fertility limitation. Reproductive success was associated with both social and biological characteristics at birth. In both sexes, a higher birthweight for gestational age, a term birth and a younger mother were independently associated with a greater number of descendants. A married mother and higher family SEP were also associated with a greater number of descendants in males (but not in females), while higher birth order was associated with a greater number of descendents in females (but not males). These effects were mediated by sex-specific effects upon the probability of marriage. Marriage was also affected by other early life characteristics including birthweight, indicating how ‘biological’ characteristics may operate via social pathways. Number of grandchildren increased with increasing number of children in both sexes, providing no evidence for a trade-off between quantity of offspring and their subsequent reproductive ‘quality’.

  • 40. Goodman, Anna
    et al.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The effect of school performance upon marriage and long-term reproductive success in 10,000 Swedish males and females born 1915–19292010In: Evolution and human behavior, ISSN 1090-5138, E-ISSN 1879-0607, Vol. 31, no 6, p. 425-435Article in journal (Refereed)
    Abstract [en]

    Humans are an exceptionally intelligent species, and the selective pressures which may have shaped these advanced cognitive powers are therefore of interest. This study investigates the fitness consequences of pre-reproductive school performance in a Swedish population-based cohort of 5244 males and 4863 females born 1915-1929. School performance was measured at around age 10 using three variables: mean school marks, being promoted/held back in school, and recognised learning difficulties. Our primary outcomes were probability of ever marrying, total number of children and total number of grandchildren. In males (but not females), poorer school performance predicted fewer children and grandchildren. This was primarily mediated via probability of marriage; mortality and fertility within marriage were not important mediating pathways. The effect of school performance upon marriage in males was independent of early-life social and biological characteristics, including birth weight for gestational age, preterm birth, family composition, and family socioeconomic position. The effect of school performance upon the probability of marriage in males was, however, largely mediated by adult socioeconomic position. This suggests that in general sexual selection for cognitive abilities per se did not play a major role in either males or females in this cohort. Adult socioeconomic position did not, however, fully explain the marriage disadvantage in males or (at marginal significance) females with particularly poor school performance. We conclude that school performance can affect long-term reproductive success. In this population, however, the effect is confined to males and is largely mediated by the increased probability of marriage which comes with their greater socioeconomic success.

  • 41.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lawson, David W.
    Low fertility increases descendant socioeconomic position but reduces long-term fitness in a modern post-industrial society.2012In: Proceedings of the Royal Society of London. Biological Sciences, ISSN 0962-8452, E-ISSN 1471-2954, Vol. 279, no 1746, p. 4342-4351Article in journal (Refereed)
    Abstract [en]

    Adaptive accounts of modern low human fertility argue that small family size maximizes the inheritance of socioeconomic resources across generations and may consequently increase long-term fitness. This study explores the long-term impacts of fertility and socioeconomic position (SEP) on multiple dimensions of descendant success in a unique Swedish cohort of 14 000 individuals born during 1915-1929. We show that low fertility and high SEP predict increased descendant socioeconomic success across four generations. Furthermore, these effects are multiplicative, with the greatest benefits of low fertility observed when SEP is high. Low fertility and high SEP do not, however, predict increased descendant reproductive success. Our results are therefore consistent with the idea that modern fertility limitation represents a strategic response to the local costs of rearing socioeconomically competitive offspring, but contradict adaptive models suggesting that it maximizes long-term fitness. This indicates a conflict in modern societies between behaviours promoting socioeconomic versus biological success. This study also makes a methodological contribution, demonstrating that the number of offspring strongly predicts long-term fitness and thereby validating use of fertility data to estimate current selective pressures in modern populations. Finally, our findings highlight that differences in fertility and SEP can have important long-term effects on the persistence of social inequalities across generations.

  • 42. Goodman, Anna
    et al.
    Mishra, G.D.
    Silva Idos, S.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Maternal pelvic size not predictive of daughter's breast cancer or ovarian cancer in a large Swedish cohort2009In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 18, no 8, p. 2333-2335Article in journal (Refereed)
    Abstract [en]

    Recent studies from Finland reported that maternal pelvic size predicted daughters' breast and ovarian cancer, possibly because maternal pelvic size is a marker for in utero hormone exposure. We sought to replicate this association in 3,845 women born between 1915 and 1929 in Uppsala, Sweden, and followed from 1960 to 2002. Archived obstetric records provided the standard measures of maternal pelvic size (intercristal distance, interspinous distance, the intercristal-interspinous difference, and the external conjugate distance). The Swedish Cancer Registry ascertained cancer incidence, with 273 cohort members developing primary breast cancer, and 52 developing primary ovarian cancer during the follow-up period. There was no evidence (P > 0.1) of an association between any measure of maternal pelvic size and incidence of either breast or ovarian cancer. This was true both before and after adjustment for various characteristics of the women and their mothers, and in analyses stratified by age at diagnosis (<50 versus ≥50 years of age, as a proxy for premenopausal and postmenopausal ages). There was also no evidence of an association in subgroup analyses restricted specifically to those groups in which the Finnish data found the greatest effect. Our study is of comparable size to the Finnish studies and was highly powered (>99%) to detect effects of the magnitude they reported. Our nonreplication therefore casts doubt on the link between maternal pelvic size and risk of breast and ovarian cancer in the offspring. (Cancer Epidemiol Biomarkers

  • 43.
    Heshmati, Amy
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chaparro, M. Pia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Tulane University, USA.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Early life characteristics, social mobility during childhood and risk of stroke in later life: findings from a Swedish cohort2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 4, p. 419-427Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate if early life characteristics and social mobility during childhood are associated with incident thrombotic stroke (TS), haemorrhagic stroke (HS) and other stroke (OS). Methods: Our study population consists of all live births at Uppsala University Hospital in 1915-1929 (Uppsala Birth Cohort; n = 14,192), of whom 5532 males and 5061 females were singleton births and lived in Sweden in 1964. We followed them from 1 January 1964 until first diagnosis of stroke (in the National Patient Register or Causes of Death Register), emigration, death, or until 31 December 2008. Data were analysed using Cox regression, stratifying by gender. Results: Gestational age was negatively associated with TS and OS in women only. Women had increased risk of TS if they were born early preterm (<35 weeks) (HR 1.54 (95% CI 1.02-2.31)) or preterm (35-36 weeks) (HR 1.37 (95% CI 1.03-1.83)) compared to women born at term. By contrast, only women who were early preterm (HR 1.98 (95% CI 1.27-3.10) had an increased risk of OS. Men who were born post-term (42 weeks) had increased risk of HS (HR 1.45 (95% CI 1.04-2.01)) compared with men born at term, with no association for women. TS was associated with social mobility during childhood in women: women whose families were upwardly or downwardly mobile had increased risk of TS compared to women who were always advantaged during childhood. Conclusions: Gestational age and social mobility during childhood were associated with increased risk of stroke later in life, particularly among women, but there was some heterogeneity between stroke subtypes.

  • 44.
    Heshmati, Amy
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chaparro, Pia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Maternal pelvic size, fetal growth and risk of stroke in adult offspring in a large Swedish cohort2016In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 7, no 1, p. 108-113Article in journal (Refereed)
    Abstract [en]

    Earlier research suggests that maternal pelvic size is associated with offspring's stroke risk in later life. We followed 6362 men and women from Uppsala, Sweden, born between 1915 and 1929 from 1964 to 2008 to assess whether maternal pelvic size was associated with incidence of thrombotic stroke (TS), haemorrhagic stroke (HS) and other stroke (OS). Offspring whose mothers had a flat pelvis had lower birth weight and birth-weight-for-gestational-age compared with those who did not. Inverse linear associations of birth-weight-for-gestational-age were observed with TS and OS. Female offspring whose mothers had a flat pelvis had increased risk of TS, but flat pelvis was not associated with other types of stroke. A smaller difference between intercristal and interspinous diameters and a smaller external conjugate diameter were independently associated with HS, whereas no pelvic measurements were associated with OS. We conclude that a smaller pelvis in women may impact the health of their offspring in adulthood.

  • 45.
    Heshmati, Amy Frances
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, Gita
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). 2School of Population Health, University of Queensland.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Childhood and adulthood socio-economic position and hypertensive disorders in pregnancy: the Uppsala Birth Cohort Multigenerational Study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 939-946Article in journal (Refereed)
    Abstract [en]

    Background Childhood and adulthood socio-economic position (SEP) is associated with cardiovascular disease in later life, but associations with hypertensive disorders in pregnancy are not well established.                                 

    Objective The aim of this study was to investigate the association of childhood and adulthood SEP with hypertensive disorders in pregnancy (chronic hypertension, gestational hypertension and pre-eclampsia/eclampsia).                                 

    Method Study participants were Swedish women (n=9507) from generation 3 of the Uppsala Birth Cohort Multigenerational Study (UBCoS Multigen) who delivered a live singleton offspring between 1982 and 2008. Social and health data were obtained from routine Swedish registers. Associations of own education (adulthood SEP), and parental education and social class (childhood SEP) with hypertensive disorders were studied using logistic regression with adjustments for age, calendar period, parity, smoking and body mass index.                                 

    Results Low own education was associated with chronic hypertension, but not with gestational hypertension or pre-eclampsia/eclampsia. Increased risk of chronic hypertension was seen in women whose mothers had medium education compared with women whose mothers had high education (OR 2.18, 95% CI 1.03 to 4.62). Women from a manual social class during childhood had twice the risk of chronic hypertension compared with those from non-manual backgrounds (OR 2.19, 95% CI 1.28 to 3.75). Childhood SEP was not associated with gestational hypertension or pre-eclampsia/eclampsia.                                 

    Conclusions Childhood and adulthood SEP was associated with chronic hypertension in pregnancy. In contrast, no association with childhood or adulthood SEP was seen for gestational hypertension or pre-eclampsia/eclampsia.

  • 46.
    Heshmati, Amy
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Placental weight and foetal growth rate as predictors of ischaemic heart disease in a Swedish cohort2014In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 5, no 3, p. 164-170Article in journal (Refereed)
    Abstract [en]

    Studies on placental size and cardiovascular disease have shown inconsistent results. We followed 10,503 men and women born in Uppsala, Sweden, 1915-1929 from 1964 to 2008 to assess whether birth characteristics, including placental weight and placenta/birth weight ratio, were predictive of future ischaemic heart disease (IHD). Adjustments were made for birth cohort, age, sex, mother's parity, birth weight, gestational age and social class at birth. Placental weight and birth weight were negatively associated with IHD. The effect of placental weight on IHD was stronger in individuals from medium social class at birth and in those with low education. Men and women from non-manual social class at birth had the lowest risk for IHD as adults. We conclude that low foetal growth rate rather than placental weight was more predictive of IHD in the Swedish cohort. However, the strong effect of social class at birth on risk for IHD did not appear to be mediated by foetal growth rate.

  • 47. Holowko, N.
    et al.
    Jones, M.
    Tooth, L.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, G.
    Education, educational mobility and weight trajectory in young Australian women2013In: Australasian Epidemiologist, ISSN 1327-8835, Vol. 20, no 2, p. 66-66Article in journal (Other academic)
  • 48. Holowko, N.
    et al.
    Jones, M.
    Tooth, L.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Mishra, G. D.
    Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women's Health2018In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 22, no 12, p. 1713-1724Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women. Methods: Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973-1978 cohort were used (N = 6899, aged 37-42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression. Results: 14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18-27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval. Conclusion: As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.

  • 49. Holowko, N.
    et al.
    Mishra, G.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social differences in pre-pregnancy body mass index (BMI) and gestational weight gain: an opportunity to reduce long-lasting inequality in maternal and offspring health2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no suppl 2, p. 43-43Article in journal (Refereed)
  • 50. Holowko, N
    et al.
    Mishra, G
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social differences in pre-pregnancy body mass index (BMI) and gestational weight gain: an opportunity to reduce long-lasting inequality in maternal and offspring health2012In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, p. 32-32Article in journal (Refereed)
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