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Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database

Abstract

Reproductive lives of men and women may provide significant insight into later-life morbidity and mortality. Sociological, biological, and evolutionary theories predict a relationship between reproductive history and later-life health; however, current research is lacking consensus on the direction of the relationship. Parity, early age at first birth and last birth, birth weight of offspring, having a child die as an infant, and having a preterm birth may have long-term effects on health for both men and women. In this study, the relationship between these measures of reproductive history and later-life health is examined using the Utah Population Database (a rich source of longitudinal data), and Medicare claims data from 1992–2009. Later-life health is measured using annual Charlson comorbidity index scores, a construct that summarizes most serious illnesses afflicting older individuals. Group-based trajectory modeling that accounts for nonrandom attrition due to death is used to identify the number and types of morbidity trajectories by sex and age for 52,924 individuals aged 65–84 in 1992. For females, early age at first birth, high parity, and having a preterm or high-birth-weight baby are associated with increased risks of comorbidity; later age at last birth is associated with a decreased risk of comorbidity. For males, early age at first birth and having a child with an abnormal birth weight leads to increased risk of comorbidity. The results suggest that both biological and social factors play important roles in the relationships between fertility and morbidity profiles at older ages.

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References

  • Andersson, T., Hogberg, U., & Åkerman, S. (1996). Survival of orphans in 19th century Sweden—The importance of remarriages. Acta Paediatrica, 85, 981–985.

    Article  Google Scholar 

  • Arland, T. (1979). Religion and fertility: The case of Mormonism. Journal of Marriage and Family, 41, 131–142.

    Article  Google Scholar 

  • Arulampalam, W., & Stewart, M. B. (2009). Simplified implementation of the Heckman estimator of the dynamic probit model and a comparison with alternative estimators. Oxford Bulletin of Economics and Statistics, 71, 659–681.

    Article  Google Scholar 

  • Bastian, L. A., West, N. A., Corcoran, C., & Munger, R. G. (2005). Number of children and the risk of obesity in older women. Preventive Medicine, 40, 99–104.

    Article  Google Scholar 

  • Bellamy, L., Casas, J.-P., Hingorani, A. D., & Williams, D. (2009). Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis. Lancet, 373, 1773–1779.

    Article  Google Scholar 

  • Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186–204.

    Google Scholar 

  • Carr, D. B., Utzschneider, K. M., Hull, R. L., Tong, J., Wallace, T. M., Kodama, K., . . . American Diabetes Association GENNID Study Group. (2006). Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care, 29, 2078–2083.

  • Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383.

    Article  Google Scholar 

  • Conde-Agudelo, A., Rosas-Bermudez, A., & Kafury-Goeta, A. C. (2007). Effects of birth spacing on maternal health: A systematic review. American Journal of Obstetrics and Gynecology, 196, 297–308.

    Article  Google Scholar 

  • Davey Smith, G., Sterne, J. A. C., Tynelius, P., & Rasmussen, F. (2004). Birth characteristics of offspring and parental diabetes: Evidence for the fetal insulin hypothesis. Journal of Epidemiology and Community Health, 58, 126–128.

    Article  Google Scholar 

  • Doblhammer, G. (2000). Reproductive history and mortality later in life: A comparative study of England and Wales and Austria. Population Studies, 54, 169–176.

    Article  Google Scholar 

  • Doblhammer, G., & Oeppen, J. (2003). Reproduction and longevity among the British peerage: The effect of frailty and health selection. Proceedings of the Royal Society of London, Series B: Biological Sciences, 270, 1541–1547.

    Article  Google Scholar 

  • Eisenberg, M. L. (2012). Parenthood, host resistance to the common cold, and impaired fertility [Letter to the editor]. Psychosomatic Medicine, 74, 988.

    Article  Google Scholar 

  • Eisenberg, M. L., Park, Y., Brinton, L. A., Hollenbeck, A. R., & Schatzkin, A. (2011). Fatherhood and incident prostate cancer in a prospective US cohort. International Journal of Epidemiology, 40, 480–487.

    Article  Google Scholar 

  • Enstrom, J. E., & Breslow, L. (2008). Lifestyle and reduced mortality among active California Mormons, 1980–2004. Preventive Medicine, 46, 133–136.

    Article  Google Scholar 

  • Fried, V., Bernstein, A., & Bush, M. (2012). Multiple chronic conditions among adults aged 45 and over: Trends over the past 10 years (NCHS Data Brief No. 100). Atlanta, GA: Centers for Disease Control and Prevention.

  • Fu, V. K., Winship, C., & Mare, R. D. (2004). Sample selection bias models. In M. Hardy & A. Bryman (Eds.), Handbook of data analysis (pp. 409–430). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Gagnon, A., Smith, K. R., Tremblay, M., Vézina, H., Paré, P. P., & Desjardins, B. (2009). Is there a trade off between fertility and longevity? A comparative study of women from three large historical databases accounting for mortality selection. American Journal of Human Biology, 21, 533–540.

    Article  Google Scholar 

  • Galobardes, B., Lynch, J. W., & Smith, G. D. (2008). Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review. Journal of Epidemiology and Community Health, 62, 387–390.

    Article  Google Scholar 

  • Garibotti, G., Smith, K. R., Kerber, R. A., & Boucher, K. M. (2006). Longevity and correlated frailty in multigenerational families. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61, 1253–1261.

    Article  Google Scholar 

  • Gavrilov, L. A., & Gavrilova, N. S. (2012). Biodemography of exceptional longevity: Early-life and mid-life predictors of human longevity. Biodemography and Social Biology, 58, 14–39.

    Article  Google Scholar 

  • Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity & Disease, 2, 207–221.

    Google Scholar 

  • Geronimus, A. T., & Korenman, S. (1992). The socioeconomic consequences of teen childbearing reconsidered. Quarterly Journal of Economics, 107, 1187–1214.

    Article  Google Scholar 

  • Grundy, E., & Kravdal, Ø. (2014). Do short birth intervals have long-term implications for parental health? Results from analyses of complete cohort Norwegian Register data. Journal of Epidemiology and Community Health, 68, 958–964.

    Article  Google Scholar 

  • Grundy, E., & Read, S. (2012). Social contacts and receipt of help among older people in England: Are there benefits of having more children? Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 67, 742–754.

  • Grundy, E., & Tomassini, C. (2005). Fertility history and health in later life: A record linkage study in England and Wales. Social Science & Medicine, 61, 217–228.

    Article  Google Scholar 

  • Haviland, A. M., Jones, B. L., & Nagin, D. S. (2011). Group-based trajectory modeling extended to account for nonrandom participant attrition. Sociological Methods & Research, 40, 367–390.

    Article  Google Scholar 

  • Haviland, A., Nagin, D. S., Rosenbaum, P. R., & Tremblay, R. E. (2008). Combining group-based trajectory modeling and propensity score matching for causal inferences in nonexperimental longitudinal data. Developmental Psychology, 44, 422–436.

    Article  Google Scholar 

  • Hawkes, K. (2010). How grandmother effects plus individual variation in frailty shape fertility and mortality: Guidance from human–chimpanzee comparisons. Proceedings of the National Academy of Sciences, 107(Suppl. 2), 8977–8984.

    Article  Google Scholar 

  • Healthcare Delivery Research. (2010). SEER-Medicare: Calculation of comorbidity weights. Bethesda, MD: National Cancer Institute. Retrieved from http://healthcaredelivery.cancer.gov/seermedicare/program/comorbidity.html

    Google Scholar 

  • Heckman, J. J. (1979). Sample selection bias as a specification error. Econometrica, 47, 153–161.

    Article  Google Scholar 

  • Henretta, J. C., Grundy, E. M., Okell, L. C., & Wadsworth, M. E. (2008). Early motherhood and mental health in midlife: A study of British and American cohorts. Aging & Mental Health, 12, 605–614.

    Article  Google Scholar 

  • House, J., Landis, K., & Umberson, D. (1988). Social relationships and health. Science, 241, 540–545.

    Article  Google Scholar 

  • Jelliffe, D. B., & Jelliffe, E. F. P. (1978). Human milk in the modern world: Psychological, nutritional, and economic significance. New York, NY: Oxford University Press.

    Google Scholar 

  • Jones, B. L., & Nagin, D. S. (2007). Advances in group-based trajectory modeling and an SAS procedure for estimating them. Sociological Methods & Research, 35, 542–571.

    Article  Google Scholar 

  • Kelsey, J. L., Gammon, M. D., & John, E. M. (1993). Reproductive factors and breast cancer. Epidemiologic Reviews, 15, 36–47.

    Google Scholar 

  • Kerber, R. A., O’Brien, E., Boucher, K. M., Smith, K. R., & Cawthon, R. M. (2012). A genome-wide study replicates linkage of 3p22-24 to extreme longevity in humans and identifies possible additional loci. PLoS ONE, 7(4), e34746.

    Article  Google Scholar 

  • Kerber, R. A., O’Brien, E., Smith, K. R., & Cawthon, R. M. (2001). Familial excess longevity in Utah genealogies. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, B130–B139.

    Article  Google Scholar 

  • Kirkwood, T. B. L., & Rose, M. R. (1991). Evolution of senescence: Late survival sacrificed for reproduction. Philosophical Transactions of the Royal Society of London, Series B: Biological Sciences, 332(1262), 15–24.

    Article  Google Scholar 

  • Kitagawa, E. M., & Hauser, P. M. (1973). Differential mortality in the United States: A study in socioeconomic epidemiology. Cambridge, MA: Harvard University Press.

    Book  Google Scholar 

  • Klabunde, C. N., Potosky, A. L., Legler, J. M., & Warren, J. L. (2000). Development of a comorbidity index using physician claims data. Journal of Clinical Epidemiology, 53, 1258–1267.

    Article  Google Scholar 

  • Kobayashi, S., Sugiura, H., Ando, Y., Shiraki, N., Yanagi, T., Yamashita, H., & Toyama, T. (2012). Reproductive history and breast cancer risk. Breast Cancer, 19, 302–308.

    Article  Google Scholar 

  • Kramer, M. S., Séguin, L., Lydon, J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14, 194–210.

    Article  Google Scholar 

  • Kravdal, Ø. (1995). Relationship between childbearing and cancer incidence due to biology or lifestyle? Examples of the importance of using data on men. International Journal of Epidemiology, 24, 477–484.

    Article  Google Scholar 

  • Kuh, D., & Ben-Shlomo, Y. (2004). A life course approach to chronic disease epidemiology. New York, NY: Oxford University Press.

    Book  Google Scholar 

  • Kvale, G., Heuch, I., & Nilssen, S. (1994). Parity in relation to mortality and cancer incidence: A prospective study of Norwegian women. International Journal of Epidemiology, 23, 691–699.

    Article  Google Scholar 

  • Lawlor, D. A., Emberson, J. R., Ebrahim, S., Whincup, P. H., Wannamethee, S. G., Walker, M., & Smith, G. D. (2003). Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Circulation, 107, 1260–1264.

    Article  Google Scholar 

  • Lukanova, A., & Kaaks, R. (2005). Endogenous hormones and ovarian cancer: Epidemiology and current hypotheses. Cancer Epidemiology, Biomarkers & Prevention, 14, 98–107.

    Google Scholar 

  • MacMahon, B., Cole, P., & Brown, J. (1973). Etiology of human breast cancer: A review. Journal of the National Cancer Institute, 50, 21–42.

    Google Scholar 

  • McCormick, M. C., Shapiro, S., & Starfield, B. (1984). High-risk young mothers: Infant mortality and morbidity in four areas in the United States, 1973–1978. American Journal of Public Health, 74, 18–23.

    Article  Google Scholar 

  • Mineau, G. P., Smith, K. R., & Bean, L. L. (2002). Historical trends of survival among widows and widowers. Social Science & Medicine, 54, 245–254.

    Article  Google Scholar 

  • Mirowsky, J. (2005). Age at first birth, health, and mortality. Journal of Health and Social Behavior, 46, 32–50.

    Article  Google Scholar 

  • Moorad, J. A., Promislow, D. E. L., Smith, K. R., & Wade, M. J. (2011). Mating system change reduces the strength of sexual selection in an American frontier population of the 19th century. Evolution and Human Behavior, 32, 147–155.

    Article  Google Scholar 

  • Myklestad, K., Vatten, L. J., Magnussen, E. B., Salvesen, K. Å., Smith, G. D., & Romundstad, P. R. (2012). Offspring birth weight and cardiovascular risk in parents—A population-based Hunt 2 study. American Journal of Epidemiology, 175, 546–555.

    Article  Google Scholar 

  • Nagin, D. S. (2005). Group-based modeling of development. Cambridge, MA: Harvard University Press.

    Book  Google Scholar 

  • Nagin, D. S., & Odgers, C. L. (2010). Group-based trajectory modeling in clinical research. Annual Review of Clinical Psychology, 6, 109–138.

    Article  Google Scholar 

  • Nagin, D. S., & Tremblay, R. E. (2001). Analyzing developmental trajectories of distinct but related behaviors: A group-based method. Psychological Methods, 6, 18–34.

    Article  Google Scholar 

  • Nam, C. B., & Powers, M. G. (1983). The socioeconomic approach to status measurement: With a guide to occupational and socioeconomic status scores. Houston, TX: Cap and Gown Press.

    Google Scholar 

  • Norton, M. C., Smith, K. R., Østbye, T., Tschanz, J. T., Schwartz, S., Corcoran, C., . . . Cache County Investigators. (2011). Early parental death and remarriage of widowed parents as risk factors for alzheimer disease: The Cache County study. American Journal of Geriatric Psychiatry, 19, 814–824.

  • Paul, C., Mason, W., McCaffrey, D., & Fox, S. (2008). A cautionary case study of approaches to the treatment of missing data. Statistical Methods and Applications, 17, 351–372.

    Article  Google Scholar 

  • Perls, T. T., Alpert, L., & Fretts, R. C. (1997). Middle-aged mothers live longer. Nature, 389, 133.

    Article  Google Scholar 

  • Permuth-Wey, J., & Sellers, T. (2009). Epidemiology of ovarian cancer. In M. Verma (Ed.), Cancer epidemiology (pp. 413–437). Totowa, NJ: Humana Press.

    Chapter  Google Scholar 

  • Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(Suppl. 1), S28–S40.

    Article  Google Scholar 

  • Porter, D. V. (1996). WIC nutrition risk criteria: A scientific assessment. Nutrition Today, 31, 216.

    Article  Google Scholar 

  • Preston, S. H., Hill, M. E., & Drevenstedt, G. L. (1998). Childhood conditions that predict survival to advanced ages among African-Americans. Social Science & Medicine, 47, 1231–1246.

    Article  Google Scholar 

  • Rich-Edwards, J. (2002). A life course approach to women’s reproductive health. In D. Kuh & R. Hardy (Eds.), A life course approach to women’s health (pp. 23–43). Oxford, UK: Oxford University Press.

    Chapter  Google Scholar 

  • Robson, S. L., & Smith, K. R. (2011). Twinning in humans: Maternal heterogeneity in reproduction and survival. Proceedings of the Royal Society B: Biological Sciences, 278, 3755–3761.

    Article  Google Scholar 

  • Robson, S. L., & Smith, K. R. (2012). Parity progression ratios confirm higher lifetime fertility in women who bear twins. Proceedings of the Royal Society B: Biological Sciences, 279, 2512–2514.

    Article  Google Scholar 

  • Ross, C. E., & Huber, J. (1985). Hardship and depression. Journal of Health and Social Behavior, 26, 312–327.

    Article  Google Scholar 

  • Schiller, J., Lucas, J., & Peregoy, J. (2012). Summary health statistics for U.S. adults: National Health Interview Survey, 2011 (Vital Halth Statistics Series 10, No.256). Hyattsville, MD: National Center for Health Statistics.

  • Sewell, J. E. (1998). Cesarean section—A brief history. In History of Medicine. Bethesda, MD: U.S. National Library of Medicine. Retrieved from https://www.nlm.nih.gov/exhibition/cesarean/

  • Smith, K. R., Gagnon, A., Cawthon, R. M., Mineau, G. P., Mazan, R., & Desjardins, B. (2009a). Familial aggregation of survival and late female reproduction. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 64, 740–744.

    Article  Google Scholar 

  • Smith, K. R., Hanson, H. A., & Zimmer, Z. (2012a, May). Early life conditions and later life (65+) co-morbidity trajectories: The Utah Population Database linked to medicare claims data. Paper presented at the annual meeting of the Population Association of America, San Francisco, CA.

  • Smith, G. D., Hart, C., Ferrell, C., Upton, M., Hole, D., Hawthorne, V., & Watt, G. (1997). Birth weight of offspring and mortality in the Renfrew and Paisley study: Prospective observational study. BMJ, 315, 1189–1193.

    Article  Google Scholar 

  • Smith, K. R., Mineau, G. P., & Bean, L. L. (2002). Fertility and post-reproductive longevity. Biodemography and Social Biology, 49, 185–205.

    Article  Google Scholar 

  • Smith, K. R., Mineau, G. P., Garibotti, G., & Kerber, R. (2009b). Effects of childhood and middle-adulthood family conditions on later-life mortality: Evidence from the Utah Population Database, 1850–2002. Social Science & Medicine, 68, 1649–1658.

    Article  Google Scholar 

  • Smith, K. R., Reed, D. L., Hanson, H. A., Mineau, G. P., & Fraser, A. (2012b, November). All in the family: Fertility and mortality consequences for child survivors of the 1918 Influenza Pandemic. Paper presented at the Social Science History Association 2012 Annual Meeting, Vancouver, British Columbia, Canada.

  • Smith, G. D., Whitley, E., Gissler, M., & Hemminki, E. (2000). Birth dimensions of offspring, premature birth, and the mortality of mothers. Lancet, 356, 2066–2067.

    Article  Google Scholar 

  • Spence, N. J. (2008). The long-term consequences of childbearing: Physical and psychological well-being of mothers in later life. Research on Aging, 30, 722–751.

    Article  Google Scholar 

  • Uhlenberg, P., & Cooney, T. M. (1990). Family size and mother-child relations in later life. Gerontologist, 30, 618–625.

    Article  Google Scholar 

  • Umberson, D., & Chen, M. D. (1994). Effects of a parent’s death on adult children: Relationship salience and reaction to loss. American Sociological Review, 59, 152–168.

    Article  Google Scholar 

  • Waldron, I., Weiss, C. C., & Hughes, M. E. (1998). Interacting effects of multiple roles on women’s health. Journal of Health and Social Behavior, 39, 216–236.

    Article  Google Scholar 

  • Walsh, T. J., Croughan, M. S., Schembri, M., Chan, J. M., & Turek, P. J. (2009a). Increased risk of testicular germ cell cancer among infertile men. Archives of Internal Medicine, 169, 351–356.

    Article  Google Scholar 

  • Walsh, T. J., Pera, R. R., & Turek, P. J. (2009b). The genetics of male infertility. Seminars in Reproductive Medicine, 27, 124–136.

    Article  Google Scholar 

  • Walsh, T. J., Schembri, M., Turek, P. J., Chan, J. M., Carroll, P. R., Smith, J. F., . . . Croughan, M. S. (2010). Increased risk of high-grade prostate cancer among infertile men. Cancer, 116, 2140–2147.

  • Westoff, C. F. (1986). Fertility in the United States. Science, 234, 554–559.

    Article  Google Scholar 

  • Williams, K., & Umberson, D. (2004). Marital status, marital transitions, and health: A gendered life course perspective. Journal of Health and Social Behavior, 45, 81–98.

    Article  Google Scholar 

  • Yi, Z., & Vaupel, J. W. (2004). Association of late childbearing with healthy longevity among the oldest-old in China. Population Studies, 58, 37–53.

    Article  Google Scholar 

  • Zimmer, Z., Martin, L., Nagin, D., & Jones, B. (2012). Modeling disability trajectories and mortality of the oldest-old in China. Demography, 49, 291–314.

    Article  Google Scholar 

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Acknowledgments

This work was supported by the National Institutes of Health – National Institute of Aging (Grant Nos. 1R21AG036938-01 and 2R01 AG022095). This work was performed under CMS DUA 14187. The authors wish to thank the Huntsman Cancer Foundation for database support provided to the Pedigree and Population Resource of the HCI, University of Utah. We also thank Alison Fraser and Diana Lane Reed for valuable assistance in managing the data. We are also grateful to Rebecca L. Utz, Antoinette Stroup, and Ming Wen for their invaluable feedback. Partial support for all datasets within the UPDB was provided by the HCI Cancer Center Support Grant (P30 CA42014) from National Cancer Institute.

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Correspondence to Heidi A. Hanson.

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Hanson, H.A., Smith, K.R. & Zimmer, Z. Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database. Demography 52, 2021–2049 (2015). https://doi.org/10.1007/s13524-015-0439-5

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Keywords

  • Fertility
  • Health trajectories
  • Life course
  • Morbidity
  • Biodemography