, Volume 48, Issue 2, pp 507–530 | Cite as

Being Born Under Adverse Economic Conditions Leads to a Higher Cardiovascular Mortality Rate Later in Life: Evidence Based on Individuals Born at Different Stages of the Business Cycle

  • Gerard J. van den Berg
  • Gabriele Doblhammer-Reiter
  • Kaare Christensen


We connect the recent medical and economic literatures on the long-run effects of early-life conditions by analyzing the effects of economic conditions on the individual cardiovascular (CV) mortality rate later in life, using individual data records from the Danish Twin Registry covering births since the 1870s and including the cause of death. To capture exogenous variation of conditions early in life, we use the state of the business cycle around birth. We find significant negative effects of economic conditions around birth on the individual CV mortality rate at higher ages. There is no effect on the cancer-specific mortality rate. From variation within and between monozygotic and dizygotic twin pairs born under different conditions, we conclude that the fate of an individual is more strongly determined by genetic and household-environmental factors if early-life conditions are poor. Individual-specific qualities come more to fruition if the starting position in life is better.


Longevity Genetic determinants Health Recession Developmental origins 



We thank three anonymous referees; Angus Deaton, Hans Christian Johansen, Adriana Lleras-Muney, Jim Oeppen, Bernard van Praag, Andreas Wienke; and participants at seminars at St. Gallen, VU Amsterdam, Groningen, INSEE-CREST, Rostock, CHESS (Stockholm), Lund, and UCL London, and conferences in Mölle/Lund and Berlin for helpful comments. We also thank Axel Skytthe for help with the Danish Twin Registry data and Ingrid Henriksen, Mette Bjarnholt, and Mette Erjnaes for help with the Danish historical time series data. Most of this project was carried out while van den Berg was at VU University Amsterdam.

Supplementary material

13524_2011_21_MOESM1_ESM.pdf (102 kb)
ESM 1 (PDF 102 kb)


  1. Ahlgren, M., Wohlfahrt, J., Olsen, L. W., Sørensen, T. I., & Melbye, M. (2007). Birth weight and risk of cancer. Cancer, 110, 412–419.CrossRefGoogle Scholar
  2. Almond, D. V. (2002). Cohort differences in health: A duration analysis using the National Longitudinal Mortality Study (Discussion paper series: 2002–13). Chicago, IL: Population Research Center, University of Chicago.Google Scholar
  3. Andersen, P. K., Borgan, Ø., Gill, R. D., & Keiding, N. (1993). Statistical models based on counting processes. New York: Springer.Google Scholar
  4. Andreev, K. (2002). Evolution of the Danish population from 1835 to 2000. Odense: University Press of Southern Denmark.Google Scholar
  5. Barker, D. J. (2007). The origins of the developmental origins theory. Journal of Internal Medicine, 261, 412–417.CrossRefGoogle Scholar
  6. Bengtsson, T., & Lindström, M. (2000). Childhood misery and disease in later life: The effects on mortality in old age of hazards experienced in early life, Southern Sweden, 1760–1894. Population Studies, 54, 263–277.CrossRefGoogle Scholar
  7. Bengtsson, T., & Lindström, M. (2003). Airborne infectious diseases during infancy and mortality in later life in Southern Sweden, 1766–1894. International Journal of Epidemiology, 32, 286–294.CrossRefGoogle Scholar
  8. Ben-Shlomo, Y. (2001). Commentary: Are birthweight and cardiovascular associations due to fetal programming? International Journal of Epidemiology, 30, 862–863.CrossRefGoogle Scholar
  9. Case, A., Fertig, A., & Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics, 24, 365–389.CrossRefGoogle Scholar
  10. Case, A., Lubotsky, D., & Paxson, C. (2002). Economic status and health in childhood: The origins of the gradient. The American Economic Review, 92, 1308–1334.CrossRefGoogle Scholar
  11. Christensen, J. (1985). Landbostatistik: Håndbog I Dansk Landbohistorisk Statistik 1830–1900 [Agricultural statistics: Handbook of Danish historical agricultural statistics 1830–1900]. Copenhagen: Landbohistorisk Selskab.Google Scholar
  12. Christensen, K., & McGue, M. (2008). Academic achievement in twins: Yet another twin-singleton difference is diminishing. British Medical Journal, 337, 245–246.CrossRefGoogle Scholar
  13. Christensen, K., Vaupel, J. W., Holm, N. V., & Yashin, A. I. (1995). Mortality among twins after age 6: Fetal origins hypothesis versus twin method. British Medical Journal, 310, 432–436.Google Scholar
  14. Christensen, K., Wienke, A., Skytthe, A., Holm, N. V., Vaupel, J. W., & Yashin, A. I. (2001). Cardiovascular mortality in twins and the fetal origins hypothesis. Twin Research and Human Genetics, 4, 344–349.CrossRefGoogle Scholar
  15. Cutler, D. M., Miller, G., & Norton, D. M. (2007). Evidence on early-life income and late-life health from America’s Dust Bowl era. Proceedings of the National Academy of Sciences, 104, 13244–13249.CrossRefGoogle Scholar
  16. Doblhammer, G. (2004). The late life legacy of very early life. Berlin, Germany: Springer.Google Scholar
  17. Eriksson, J. G. (2007). Epidemiology, genes and the environment: Lessons learned from the Helsinki Birth Cohort Study. Journal of Internal Medicine, 261, 418–425.CrossRefGoogle Scholar
  18. Farah, M. J., Noble, K. G., & Hurt, H. (2008). Poverty, privilege, and brain development: Empirical findings and ethical implications (Working paper). Philadelphia, PA: University of Pennsylvania.Google Scholar
  19. Fogel, R. W. (1997). New findings on secular trends in nutrition and mortality: Some implications for population theory. In M. R. Rosenzweig & O. Stark (Eds.), Handbook of population and family economics (pp. 433–481). North-Holland, Amsterdam: Elsevier.Google Scholar
  20. Galobardes, B., Lynch, J. W., & Davey Smith, G. (2004). Childhood socioeconomic circumstances and cause-specific mortality in adulthood: Systematic review and interpretation. Epidemiologic Reviews, 26, 7–21.CrossRefGoogle Scholar
  21. Gluckman, P. D., Hanson, M. A., & Pinal, C. (2005). The developmental origins of adult disease. Maternal & Child Nutrition, 1, 130–141.CrossRefGoogle Scholar
  22. Greasley, D., & Madsen, J. B. (2006). A tale of two peripheries: Real wages in Denmark and New Zealand. Scandinavian Economic History Review, 54, 116–137.CrossRefGoogle Scholar
  23. Harvald, B., Hauge, G., Kyvik, K. O., Christensen, K., Skytthe, A., & Holm, N. V. (2004). The Danish twin registry: Past and present. Twin Research and Human Genetics, 7, 318–335.CrossRefGoogle Scholar
  24. Henriksen, I. (2006). An economic history of Denmark. In R. Whaples (Ed.), EH.Net encyclopedia. Miami, FL: Economic History Services.Google Scholar
  25. Henriksen, I., & O’Rourke, K. H. (2005). Incentives, technology and the shift to year-round dairying in late nineteenth-century Denmark. Economic History Review, 58, 520–554.CrossRefGoogle Scholar
  26. Holemans, K., Caluwaerts, S., & Van Assche, F. A. (2002). Unravelling the fetal origins hypothesis. Lancet, 360, 2073.CrossRefGoogle Scholar
  27. Huxley, R., Owen, C. G., Whincup, P. H., Cook, D. G., Rich-Edwards, J., Davey Smith, G., et al. (2007). Is birth weight a risk factor for ischemic heart disease in later life? The American Journal of Clinical Nutrition, 85, 1244–1250.Google Scholar
  28. Järvelin, M. R., Sovio, U., King, V., Lauren, L., Xu, B., McCarthy, M. I., et al. (2004). Early life factors and blood pressure at age 31 years in the 1966 Northern Finland Birth Cohort. Hypertension, 44, 838–846.CrossRefGoogle Scholar
  29. Johansen, H. C. (1985). Dansk Historisk Statistik 1814–1980 [Danish historical statistics 1814–1980]. Copenhagen, Denmark: Gyldendal.Google Scholar
  30. Johansen, H. C. (2002a). Danish population history 1600–1939. Odense: University Press of Southern Denmark.Google Scholar
  31. Johansen, H. C. (2002b). Denmark—Production and communications—Trends in employment and trades. In Denmark. Copenhagen: Royal Danish Ministry of Foreign Affairs.Google Scholar
  32. Kåreholt, I. (2001). The long shadow of socioeconomic conditions in childhood: Do they affect class inequalities in mortality? In J. O. Jonsson & C. Mills (Eds.), Cradle to grave: Life-course change in modern Sweden (pp. 29–44). Durham, NC: Sociology Press.Google Scholar
  33. Koupil, I., Leon, D. A., & Lithell, H. O. (2005). Length of gestation is associated with mortality from cerebrovascular disease. Journal of Epidemiology and Community Health, 59, 473–474.CrossRefGoogle Scholar
  34. Kuh, D., & Ben-Shlomo, Y. (2004). A life course approach to chronic disease epidemiology. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  35. Lawlor, D. A. (2008). The developmental origins of health and disease: Where do we go from here? Epidemiology, 19, 206–208.CrossRefGoogle Scholar
  36. Lawlor, D. A., Ben-Shlomo, Y., & Leon, D. A. (2004). Pre-adult influences on cardiovascular disease. In D. Kuh & Y. Ben-Shlomo (Eds.), A life course approach to chronic disease epidemiology (pp. 41–76). Oxford, UK: Oxford University Press.Google Scholar
  37. Lindegaard, H. (2001). The debate on the sewerage system in Copenhagen from the 1840 to the 1930s. Ambio, 30, 323–326.Google Scholar
  38. Løkke, A. (2002). Infant mortality in nineteenth century Denmark: Regionality, feeding habits, illegitimacy and causes of death. Hygiea Internationalis, 3, 115–149.CrossRefGoogle Scholar
  39. Løkke, A. (2007). State and insurance: The long-term trends in Danish health policy from 1672 to 1973. Hygiea Internationalis, 6, 7–24.CrossRefGoogle Scholar
  40. Mitchell, B. R. (2003). International historical statistics: Europe, 1750–2002. New York: Palgrave Macmillan.Google Scholar
  41. Mogren, I., Högberg, U., Stegmayr, B., Lindahl, B., & Stenlund, H. (2001). Fetal exposure, heredity and risk indicators for cardiovascular disease in a Swedish welfare cohort. International Journal of Epidemiology, 30, 853–862.CrossRefGoogle Scholar
  42. National Board of Health. (1983). Mortality and causes of death in Denmark 1931–80. Copenhagen, Denmark: National Board of Health.Google Scholar
  43. Pollitt, R. A., Rose, K. M., & Kaufman, J. S. (2005). Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: A systematic review. BMC Public Health, 5, 1–13.CrossRefGoogle Scholar
  44. Poulter, N. R., Chang, C. L., MacGregor, A. J., Snieder, H., & Spector, T. D. (1999). Association between birth weight and adult blood pressure in twins: Historical cohort study. British Medical Journal, 319, 1330–1333.Google Scholar
  45. Rasmussen, K. M. (2001). The “fetal origins” hypothesis: Challenges and opportunities for maternal and child nutrition. Annual Review of Nutrition, 21, 73–95.CrossRefGoogle Scholar
  46. Sastry, N. (2004). Trends in socioeconomic inequalities in mortality in developing countries: The case of child survival in Sao Paulo, Brazil. Demography, 41, 443–464.CrossRefGoogle Scholar
  47. Saugstad, L. F. (1999). Optimality of the birth population reduces learning and behaviour disorders and sudden infant death after the first month. Acta Paediatrica, 429, 9–28.CrossRefGoogle Scholar
  48. Skytthe, A., Kyvik, K., Holm, N. V., Vaupel, J. W., & Christensen, K. (2002). The Danish twin registry: 127 birth cohorts of twins. Twin Research and Human Genetics, 5, 352–357.CrossRefGoogle Scholar
  49. Statistics Denmark. (1902). Statistisk Årbog 1902 [Statistical yearbook 1902]. Copenhagen: National Statistical Bureau.Google Scholar
  50. Vågerö, D., & Leon, D. (1994). Ischaemic heart disease and low birth weight: A test of the Fetal-origins hypothesis from the Swedish Twin Registry. Lancet, 343, 260–263.CrossRefGoogle Scholar
  51. van den Berg, G. J. (2001). Duration models: Specification, identification, and multiple durations. In J. J. Heckman & E. E. Leamer (Eds.), Handbook of econometrics (Vol. V., pp. 3381–3460). Amsterdam, The Netherlands: North-Holland.Google Scholar
  52. van den Berg, G. J., Lindeboom, M., & López, M. (2009). Inequality in individual mortality and economic conditions earlier in life. Social Science & Medicine, 69, 1360–1367.CrossRefGoogle Scholar
  53. van den Berg, G. J., Lindeboom, M., & Portrait, F. (2006). Economic conditions early in life and individual mortality. American Economic Review, 96, 290–302.CrossRefGoogle Scholar
  54. Vaupel, J. W., & Yashin, A. I. (1985). The deviant dynamics of death in heterogeneous populations. In N. B. Tuma (Ed.), Sociological Methodology, 15 (pp. 179–211). San Francisco, CA: Jossey-Bass.Google Scholar
  55. Wienke, A., Christensen, K., Skytthe, A., & Yashin, A. I. (2002). Genetic analysis of cause of death in a mixture model of bivariate lifetime data. Statistical Modelling, 2, 1–14.CrossRefGoogle Scholar
  56. Wienke, A., Holm, N. V., Skytthe, A., & Yashin, A. I. (2001). The heritability of mortality due to heart diseases: A correlated frailty model applied to Danish twins. Twin Research and Human Genetics, 4, 266–274.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  • Gerard J. van den Berg
    • 1
    • 2
    • 3
    • 4
  • Gabriele Doblhammer-Reiter
    • 5
    • 6
  • Kaare Christensen
    • 7
  1. 1.Department of EconomicsUniversity of MannheimMannheimGermany
  2. 2.IFAU UppsalaUppsalaSweden
  3. 3.VU University AmsterdamAmsterdamNetherlands
  4. 4.IZABonnGermany
  5. 5.University of RostockRostockGermany
  6. 6.Max Planck Institute for Demographic ResearchRostockGermany
  7. 7.The Danish Twin Registry, and The Danish Aging Research CenterUniversity of Southern DenmarkOdenseDenmark

Personalised recommendations