Independent and additive association of prenatal famine exposure and intermediary life conditions with adult mortality between age 18-63 years
Independent and additive association of prenatal famine exposure and intermediary life conditions with adult mortality between age 18-63 years
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DOI：
10.1016/j.socscimed.2013.10.027
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发表时间：
2014-10-01
影响因子：
5.4
通讯作者：
Lumey, L. H.
中科院分区：
文献类型：
--
作者：
Ekamper, P.;van Poppel, F.;Lumey, L. H.
目的：为了量化产前饥荒暴露与成人死亡率之间的关系，考虑到中间生活条件的中介作用。设计：历史随访研究。背景：荷兰饥荒（饥饿的冬天）的1944年至1945年，其中发生了对第二次世界大战结束在被占领的荷兰。从1944-1947年出生的408，015名18岁时接受兵役检查的荷兰男性中，我们选择了在荷兰西部六个受影响城市饥荒期间出生的所有男性进行随访（n = 25，283），以及未暴露时间（n = 10，667）和地点（n = 9087）对照样本。通过国家人口和死亡记录系统追踪和跟踪这些人的死亡率。结果测量：使用考克斯比例风险模型调整中间生活条件的18至63岁之间的全因死亡率。结果：妊娠早期饥荒暴露后死亡率增加（HR 1.12; 95%置信区间（CI）：1.01-1.24），但妊娠晚期未发生（HR 1.04; 95% CI：0.96-1.13）。在18岁的中间生活条件中，教育水平与死亡率呈负相关，父亲从事体力劳动与非体力劳动的男性死亡率升高（HR 1.08; CI：1.02-1.16），被宣布不适合服兵役的男性死亡率升高（HR 1.44; CI：1.31-1.58）。中间因素与死亡率的关联独立于早期生活中的饥荒暴露，产前饥荒暴露与成人死亡率之间的关联独立于社会阶层和18岁时的教育程度。结论：与妊娠阶段相关的暴露时间可能对以后的健康结果至关重要，独立于中间生活条件。(C)2013爱思唯尔有限公司保留所有权利。
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; Cl: 1.02-1.16) and in men who were declared unfit for military service (HR 1.44; Cl: 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. (C) 2013 Elsevier Ltd. All rights reserved.