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.
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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.
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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.
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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