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2014 ; 119
(ä): 232-9
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Independent and additive association of prenatal famine exposure and intermediary
life conditions with adult mortality between age 18-63 years
#MMPMID24262812
Ekamper P
; van Poppel F
; Stein AD
; Lumey LH
Soc Sci Med
2014[Oct]; 119
(ä): 232-9
PMID24262812
show ga
OBJECTIVES: To quantify the relation between prenatal famine exposure and adult
mortality, taking into account mediating effects of intermediary life conditions.
DESIGN: Historical follow-up study. SETTING: The Dutch famine (Hunger Winter) of
1944-1945 which occurred towards the end of WWII in occupied Netherlands. STUDY
POPULATION: From 408,015 Dutch male births born 1944-1947, examined for military
service at age 18, we selected for follow-up all men born at the time of the
famine in six affected cities in the Western Netherlands (n=25,283), and a sample
of unexposed time (n=10,667) and place (n=9087) controls. These men were traced
and followed for mortality through the national population and death record
systems. OUTCOME MEASURE: All-cause mortality between ages 18 and 63 years using
Cox proportional hazards models adjusted for intermediary life conditions.
RESULTS: An increase in mortality was seen after famine exposure in early
gestation (HR 1.12; 95% confidence interval (CI): 1.01-1.24) but not late
gestation (HR 1.04; 95% CI: 0.96-1.13). Among intermediary life conditions at age
18 years, educational level was inversely associated with mortality and mortality
was elevated in men with fathers with manual versus non-manual occupations (HR
1.08; CI: 1.02-1.16) and in men who were declared unfit for military service (HR
1.44; CI: 1.31-1.58). Associations of intermediate factors with mortality were
independent of famine exposure in early life and associations between prenatal
famine exposure and adult mortality were independent of social class and
education at age 18. CONCLUSIONS: Timing of exposure in relation to the stage of
pregnancy may be of critical importance for later health outcomes independent of
intermediary life conditions.