Independent and additive association of prenatal famine exposure and intermediary life conditions with adult mortality between age 18-63 years.

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.

Sensitivity analysis in a multidimensional demographic projection model with a two-sex algorithm.

"Formulas are derived for the effect that a slight change in the occurrence/exposure rate of the multidimensional projection model has on the elements of the population vector. The projection model classifies the population by sex, age, and marital status. The model includes a two-sex algorithm in order to ensure consistency between numbers of male and female marriages, number of divorces for the two sexes, and new widows (widowers) and deceased spouses. The sensitivity functions and elasticities are applied to data from the Netherlands for the period 1980-1984. The results indicate that marriage market mechanisms, in particular competition and substitution effects, are reasonably well modelled."