Modin Bitte, Vågerö Denny, Hallqvist Johan, Koupil Ilona
Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, 106 91 Stockholm, Sweden.
Soc Sci Med. 2008 Feb;66(4):822-34. doi: 10.1016/j.socscimed.2007.11.001. Epub 2007 Dec 26.
Men born out of wedlock in early twentieth century Sweden who never married have previously been shown to have a doubled mortality risk from ischaemic heart disease compared to the corresponding group of men born to married parents. This study further explores the question of childhood social disadvantage and its long-term consequences for cardiovascular health by examining the two subsequent generations. The question posed is whether the sons and grandsons of men and women born out of wedlock in early twentieth century Sweden have an increased risk of circulatory disease compared with the corresponding descendants of those born inside marriage. We examined this by use of military conscription data. The material used is the Uppsala Birth Cohort Multigenerational database consisting of individuals born at Uppsala University Hospital between 1915 and 1929 (UG1), their children (UG2) and grandchildren (UG3). Conscription data were available for UG2s born between 1950 and 1982 (n=5,231) and UG3s born between 1953 and 1985 (n=10,074) corresponding to 72.1% and 73.6%, respectively, of all males born in each time-period. Logistic regression showed that significant excess risk of circulatory disease diagnoses was present only among descendants of men born outside marriage, with sons and grandsons demonstrating odds ratios of 1.64 and 1.83, respectively, when BMI and height at the time of conscription, father's social class in mid-life and father's or grandfather's history of circulatory disease had been adjusted for. Separate analyses showed that the effect of the maternal and paternal grandfather was of approximately the same magnitude. Further analyses revealed an interaction between the father's social class and the grandfather's legitimacy status at birth on UG3-men's likelihood of having a circulatory disease, with elevated odds only among those whose fathers were either manual workers or self-employed. The results of this study suggest that social disadvantage in one generation can be linked to health disadvantage in the subsequent two generations.
在20世纪初的瑞典，非婚生且从未结婚的男性与父母已婚的男性相比，患缺血性心脏病的死亡风险高出一倍。本研究通过考察其后的两代人，进一步探讨童年社会劣势及其对心血管健康的长期影响。提出的问题是，20世纪初瑞典非婚生男性和女性的儿子和孙子患循环系统疾病的风险是否高于婚内出生者的相应后代。我们利用征兵数据对此进行了研究。所用材料是乌普萨拉出生队列多代数据库，该数据库由1915年至1929年在乌普萨拉大学医院出生的个体（UG1）、他们的子女（UG2）和孙辈（UG3）组成。有1950年至1982年出生的UG2（n = 5231）和1953年至1985年出生的UG3（n = 10074）的征兵数据，分别对应各时期出生男性总数的72.1%和73.6%。逻辑回归显示，只有非婚生男性的后代存在患循环系统疾病诊断的显著额外风险，在对征兵时的体重指数和身高、父亲中年时的社会阶层以及父亲或祖父的循环系统疾病史进行调整后，儿子和孙子的比值比分别为1.64和1.83。单独分析表明，外祖父和祖父的影响大致相同。进一步分析显示，父亲的社会阶层与祖父出生时的合法性状况对UG3男性患循环系统疾病的可能性存在交互作用，只有父亲是体力劳动者或自营职业者的人群中比值比升高。本研究结果表明，一代人的社会劣势可能与随后两代人的健康劣势相关。
