Being born in the aftermath of World War II increases the risk for health deficit accumulation in older age: results from the KORA-Age study

  • Anna-Janina StephanEmail author
  • Ralf Strobl
  • Lars Schwettmann
  • Christa Meisinger
  • Karl-Heinz Ladwig
  • Birgit Linkohr
  • Barbara Thorand
  • Annette Peters
  • Eva Grill


Morbidity trends may result from cohort experiences in critical developmental age. Our objective was to compare the health status of 65–71 year-olds who were in critical developmental age before (1937–June 1945), during (June 1945–June 1948) and after (June 1948–1950) the early reconstruction and food crisis (ERFC) period in Germany following World War II. Data originate from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study in Southern Germany. We used the 2008 baseline sample born 1937–1943 and the 2015 enrichment sample born 1944–1950. Health status was assessed as the number of accumulated health deficits using a Frailty Index (FI). Cohorts were defined based on co-occurrence of critical developmental age (gestation and the first 2 years of life) and the ERFC period. Cohort, age and sex effects on older-age health status were analyzed using generalized linear models. We included 590 (53% male) pre-war and war (PWW), 475 (51% male) ERFC and 171 post-currency reform (PCR) cohort participants (46% male). Adjusted for covariates, FI levels were significantly higher for the ERFC (Ratio 1.14, CL [1.06, 1.23]) but not for the PCR (Ratio 1.06, CL [0.94, 1.20]) as compared to the PWW cohort. Being in critical developmental age during the ERFC period increased FI levels in adults aged 65–71 years. Covariates did not explain these effects, suggesting a direct detrimental effect from being in critical developmental age during the ERFC period on older-age health. This expansion of morbidity in Germany was not detected in the PCR cohort.


Aged Health status Deficit accumulation Frailty Index Birth cohorts Morbidity trends 



The authors would like to thank the members of the field staff in Augsburg who were involved in conducting the studies and the team at the Helmholtz Zentrum München for maintaining this complex data.


The KORA research platform (KORA, Cooperative Health Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria. The KORA-Age project was financed by the German Federal Ministry of Education and Research (BMBF FKZ 01ET0713 and 01ET1003A, C) as part of the ‘Health in old age’ program. ‘Functioning and disability among aged persons’ was funded by the German Research Foundation (GR 3608/1-1). ‘Determinants and trajectories of healthy life expectancy and deficit accumulation’ was funded by the German Research Foundation (GR3608/3-1). The financial sponsors played no role in the design, execution, analysis, and interpretation of data, or writing of the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (DOCX 6719 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Institute for Medical Information Processing, Biometry and EpidemiologyLudwig-Maximilians-Universität MünchenMunichGermany
  2. 2.German Center for Vertigo and Balance DisordersKlinikum der Universität MünchenMunichGermany
  3. 3.Institute of Health Economics and Health Care Management, Helmholtz Zentrum MünchenGerman Research Center for Environmental Health (GmbH)NeuherbergGermany
  4. 4.Independent Research Group Clinical Epidemiology, Helmholtz Zentrum MünchenGerman Research Center for Environmental Health (GmbH)NeuherbergGermany
  5. 5.Chair of EpidemiologyLudwig-Maximilians-Universität München at UNIKA-T AugsburgAugsburgGermany
  6. 6.Institute of Epidemiology, Helmholtz Zentrum MünchenGerman Research Center for Environmental Health (GmbH)NeuherbergGermany
  7. 7.Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der IsarTechnical University of MunichMunichGermany
  8. 8.Munich Center of Health SciencesLudwig-Maximilians-Universität MünchenMunichGermany

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