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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Surveys and meta-studies of the epidemiological and medical evidence of associations of birth weight indicators and CVD later in life have been published in Huxley et al. (2007), Poulter et al. (1999), and Rasmussen (2001). The survey in Eriksson (2007) also focuses on medical early-life indicators measured after birth. Gluckman et al. (2005) and Barker (2007) give overviews of the underlying medical mechanisms. Some studies also point to long-run effects on other diseases, such as Type 2 diabetes and breast cancer. Pollitt et al. (2005) provide a survey and meta-study of the life course literature on causal pathways in which early-life socioeconomic status (SES) is associated with CV morbidity and mortality later in life. Galobardes et al. (2004) survey studies on early-life SES and cause-specific mortality in adulthood. See also Case et al. (2005) and Case et al. (2002) and references therein for influential studies focusing on economic household conditions early in life.
They addressed CVD as one of the outcomes. Based on interviews that were conducted every two years beginning in 1992, they did not find evidence of a long-run effect on CVD among those who survived until 1992. One explanation the authors offered is that deaths due to CVD between interview dates may be underreported. This suggests that registered causes of death may be more informative about long-run CV effects than self-reported health statuses. Another explanation they posited is that there may have been sufficient opportunities for consumption smoothing, and sufficient relief payments, to mitigate adverse effects of this recession.
The virtual disappearance of infant mortality implies that those who would have died if born under adverse conditions in the nineteenth century survive into adulthood if born in current times. This can be seen as a factor that contributes to the potential relevance of long-run effects in modern societies.
All time series used in this article, including descriptions of their origin and/or construction, are available upon request.
The figure is essentially the same if we average over the actual transitory component of log annual real per capita GDP instead of over the binary indicator.
In terms of ICD revision 8, our CHD subcategory contains codes 394–429, and our CVA subcategory contains 290, 430–441, and 794.
Ahlgren, M., Wohlfahrt, J., Olsen, L. W., Sørensen, T. I., & Melbye, M. (2007). Birth weight and risk of cancer. Cancer, 110, 412–419.
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.
Andersen, P. K., Borgan, Ø., Gill, R. D., & Keiding, N. (1993). Statistical models based on counting processes. New York: Springer.
Andreev, K. (2002). Evolution of the Danish population from 1835 to 2000. Odense: University Press of Southern Denmark.
Barker, D. J. (2007). The origins of the developmental origins theory. Journal of Internal Medicine, 261, 412–417.
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.
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.
Ben-Shlomo, Y. (2001). Commentary: Are birthweight and cardiovascular associations due to fetal programming? International Journal of Epidemiology, 30, 862–863.
Case, A., Fertig, A., & Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics, 24, 365–389.
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.
Christensen, J. (1985). Landbostatistik: Håndbog I Dansk Landbohistorisk Statistik 1830–1900 [Agricultural statistics: Handbook of Danish historical agricultural statistics 1830–1900]. Copenhagen: Landbohistorisk Selskab.
Christensen, K., & McGue, M. (2008). Academic achievement in twins: Yet another twin-singleton difference is diminishing. British Medical Journal, 337, 245–246.
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.
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.
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.
Doblhammer, G. (2004). The late life legacy of very early life. Berlin, Germany: Springer.
Eriksson, J. G. (2007). Epidemiology, genes and the environment: Lessons learned from the Helsinki Birth Cohort Study. Journal of Internal Medicine, 261, 418–425.
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.
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.
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.
Gluckman, P. D., Hanson, M. A., & Pinal, C. (2005). The developmental origins of adult disease. Maternal & Child Nutrition, 1, 130–141.
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.
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.
Henriksen, I. (2006). An economic history of Denmark. In R. Whaples (Ed.), EH.Net encyclopedia. Miami, FL: Economic History Services.
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.
Holemans, K., Caluwaerts, S., & Van Assche, F. A. (2002). Unravelling the fetal origins hypothesis. Lancet, 360, 2073.
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.
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.
Johansen, H. C. (1985). Dansk Historisk Statistik 1814–1980 [Danish historical statistics 1814–1980]. Copenhagen, Denmark: Gyldendal.
Johansen, H. C. (2002a). Danish population history 1600–1939. Odense: University Press of Southern Denmark.
Johansen, H. C. (2002b). Denmark—Production and communications—Trends in employment and trades. In Denmark. Copenhagen: Royal Danish Ministry of Foreign Affairs.
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.
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.
Kuh, D., & Ben-Shlomo, Y. (2004). A life course approach to chronic disease epidemiology. Oxford, UK: Oxford University Press.
Lawlor, D. A. (2008). The developmental origins of health and disease: Where do we go from here? Epidemiology, 19, 206–208.
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.
Lindegaard, H. (2001). The debate on the sewerage system in Copenhagen from the 1840 to the 1930s. Ambio, 30, 323–326.
Løkke, A. (2002). Infant mortality in nineteenth century Denmark: Regionality, feeding habits, illegitimacy and causes of death. Hygiea Internationalis, 3, 115–149.
Løkke, A. (2007). State and insurance: The long-term trends in Danish health policy from 1672 to 1973. Hygiea Internationalis, 6, 7–24.
Mitchell, B. R. (2003). International historical statistics: Europe, 1750–2002. New York: Palgrave Macmillan.
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.
National Board of Health. (1983). Mortality and causes of death in Denmark 1931–80. Copenhagen, Denmark: National Board of Health.
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.
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.
Rasmussen, K. M. (2001). The “fetal origins” hypothesis: Challenges and opportunities for maternal and child nutrition. Annual Review of Nutrition, 21, 73–95.
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.
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.
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.
Statistics Denmark. (1902). Statistisk Årbog 1902 [Statistical yearbook 1902]. Copenhagen: National Statistical Bureau.
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.
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.
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.
van den Berg, G. J., Lindeboom, M., & Portrait, F. (2006). Economic conditions early in life and individual mortality. American Economic Review, 96, 290–302.
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.
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.
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.
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.
Electronic Supplementary Materials
Below is the link to the electronic supplementary material.
(PDF 102 kb)
About this article
Cite this article
van den Berg, G.J., Doblhammer-Reiter, G. & Christensen, K. 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. Demography 48, 507–530 (2011). https://doi.org/10.1007/s13524-011-0021-8
- Genetic determinants
- Developmental origins