Effects of childhood and middle-adulthood family conditions on later-life mortality: evidence from the Utah Population Database, 1850-2002

Risk of colorectal cancer and adenomas in the families of patients with adenomas: a population-based study in Utah

BACKGROUND

Guidelines recommend that individuals with a first-degree relative (FDR) diagnosed with colorectal cancer (CRC) or advanced adenoma before age 60 years should undergo colonoscopy starting at age 40 years. The authors quantified the risk of adenomas and CRC in FDRs, second-degree relatives (SDRs), and third-degree relatives (TDRs) of patients diagnosed with adenomas and advanced adenomas.

METHODS

A population-based, retrospective, case-control study was performed of residents of the state of Utah aged 50 years to 80 years who underwent colonoscopy between 1995 and 2009 at Intermountain Healthcare or the University of Utah. Controls were selected from the population of colonoscopy patients who were free of adenomas or CRC and matched to each case based on sex and birth year. Colonoscopy results were linked with cancer and pedigree information from the Utah Population Database to investigate the familial aggregation of adenomas and CRC using Cox regression analysis. The unit of analysis was the relatives of cases and controls.

RESULTS

Of 126,936 patients who underwent colonoscopy, 43,189 had adenomas and 5563 had advanced adenomas and defined the case population. An elevated risk of CRC was found in FDRs (relative risk [RR], 1.35; 95% confidence interval [95% CI], 1.25-1.46), SDRs (RR, 1.15; 95% CI, 1.07-1.23) of adenoma cases, and in FDRs of advanced adenoma cases (RR, 1.68; 95% CI, 1.29-2.18) compared with controls. Approximately 10% of CRCs diagnosed in relatives would have been missed if the current screening guidelines were strictly adhered to.

CONCLUSIONS

Relatives of colonoscopy patients with adenomas and advanced adenomas appear to have a significantly elevated risk of developing colorectal neoplasia. These data should be considered when establishing CRC screening guidelines for individuals and their families.

The association between adult mortality risk and family history of longevity: the moderating effects of socioeconomic status

Studies consistently show that increasing levels of socioeconomic status (SES) and having a familial history of longevity reduce the risk of mortality. But do these two variables interact, such that individuals with lower levels of SES, for example, may experience an attenuated longevity penalty by virtue of having long-lived relatives? This article examines this interaction by analysing survival past age 40 based on data from the Utah Population Database on an extinct cohort of men born from the years 1840 to 1909. Cox proportional hazards regression and logistic regression are used to test for the main and interaction mortality effects of SES and familial excess longevity (FEL), a summary measure of an individual's history of longevity among his or her relatives. This research finds that the mortality hazard rate for men in the top 15th percentile of occupational status decreases more as FEL increases than it does among men in the bottom 15th percentile. In addition, the mortality hazard rate among farmers decreases more as FEL increases than it does for non-farmers. With a strong family history of longevity as a proxy for a genetic predisposition, this research suggests that a gene-environment interaction occurs whereby the benefits of familial excess longevity are more available to those who have occupations with more autonomy and greater economic resources and/or opportunities for physical activity.

The male-female health-survival paradox and sex differences in cohort life expectancy in Utah, Denmark, and Sweden 1850-1910

PURPOSE

In Utah, the prevalence of unhealthy male risk behaviors are lower than in most other male populations, whereas women experience higher mortality risk because of higher fertility rates. Therefore, we hypothesize that the Utah sex differential in mortality would be small and less than in Sweden and Denmark.

METHODS

Life tables from Utah, Denmark, and Sweden were used to calculate cohort life expectancies for men and women born in 1850-1910.

RESULTS

The sex difference in cohort life expectancy was similar or larger in Utah when compared with Denmark and Sweden. The change over time in the sex differences in cohort life expectancy was approximately 2 years smaller for active Mormons in Utah than for other groups suggesting lifestyle as an important component for the overall change seen in cohort life expectancy. Sex differences in cohort life expectancy at the age of 50 years were similar for individuals actively affiliated with the Church of Jesus Christ of Latter-day Saints and for Denmark and Sweden.

CONCLUSIONS

The hypothesis that a smaller sex difference in cohort life expectancies in Utah would be detected in relation to Denmark and Sweden was not supported. In Utah, the male-female differences in life expectancy remain substantial pointing toward biological mechanisms or other unmeasured risk factors.

Determinants of exceptional human longevity: new ideas and findings

Studies of centenarians are useful in identifying factors leading to long life and avoidance of fatal diseases. In this article we consider several approaches to study effects of early-life and midlife conditions on survival to advanced ages: use of non-biological relatives as controls, the within-family analysis, as well as a sampling of controls from the same population universe as centenarians. These approaches are illustrated using data on American centenarians, their relatives and unrelated shorter-lived controls obtained from the online genealogies. The within-family analysis revealed that young maternal age at person's birth is associated with higher chances of exceptional longevity. Comparison of centenarians and their shorter-lived peers (died at age 65 and sampled from the same pool of online genealogies) confirmed that birth timing in the second half of the calendar year predicts survival to age 100. Parental longevity as well as some childhood and midlife characteristics also proved to be significant predictors of exceptional longevity.

Family, frailty, and fatal futures? Own-health and family-health predictors of subjective life expectancy

Subjective life expectancy is a powerful predictor of a variety of health and economic behaviors. This research expands upon the life expectancy literature by examining the influence of familial health histories. Using a genetic/environmental model, we hypothesize that individuals' assessments of their life expectancies will be linked to the health of first-degree and second-degree relatives, with same-sex relatives' health exercising a stronger effect than that of opposite-sex relatives. Multivariate analyses based on data from a 2009 survey merged with familial health records (N = 1,019) confirm that the health experiences of same-sex, first-degree relatives are linked to respondents' subjective life expectancy. The relationship between the health experiences of second-degree relatives and subjective life expectancy is much less pronounced. These findings have the potential not only to inform our understanding of health behaviors but also to encourage communication between patients and health professionals aimed at promoting preventative behaviors.

Maternal age and offspring adult health: evidence from the health and retirement study

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age-offspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25-34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age-offspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.

Younger age at crisis following parental death in male children and adolescents is associated with higher risk for dementia at old age

AIMS

To examine the association of midlife report of crisis following parental death (CFPD) during childhood and adolescence, with dementia at old age.

METHODS

In 1965, 9362 male participants of the Israel Ischemic Heart Disease study were asked whether they have experienced CFPD (paternal or maternal) during the following ages: 0 to 6, 7 to 12, 13 to 18, or >18 years. Dementia was assessed over 3 decades later in 1889 survivors of the original cohort, 1652 of whom were assessed for CFPD in 1965.

RESULTS

Controlling for age, the estimated odds ratios for dementia relative to individuals who reported crisis following paternal parental death (CFPD-P) at the age of 18 years and above were 3.06 (95% CI: 1.42-6.61), 2.15 (95% CI: 0.87-5.31), and 2.35 (95% CI: 1.05-5.28) for those who reported CFPD-P at the ages of 0 to 6, 7 to 12, and 13 to 18 years, respectively. Odds ratios for dementia were 0.60 (95% CI: 0.32-1.11) for participants who reported CFPD-P at ages of 18 and above compared with participants who did not report such a crisis. Similar results were obtained for the association of crisis reported following maternal parental death (CFPD-M) at different age groups and dementia.

CONCLUSIONS

CFPD during childhood is associated with an increased risk for dementia in men who survived until old age.

Parental divorce and adult longevity

OBJECTIVE

Life course research has established associations between adverse childhood events and later life health. We examine the relationship of experiencing parental divorce before the age of 16 and survival across 34 years of adulthood.

METHODS

Analysis of panel data from a USA-based survey of 6,928 adults residing in Alameda County, California in 1965. Cox regression was used to examine associations between parental divorce and longevity.

RESULTS

Controlling for age, race/ethnicity, gender, and childhood socioeconomic position, respondents who recalled a parental divorce during childhood had increased risk of mortality compared to those with no separation. The association was stronger for premature mortality and deaths due to cardiovascular disease. Divorce in childhood was also associated with lowered adult education, fewer social network ties, more depression, and worse health practices. These factors appeared to explain the association with longevity.

CONCLUSION

Parental divorce in childhood is associated with lowered well-being in adulthood and long-term survival. Early prevention and health promotion efforts may be warranted for children who experience parental divorce or discord as a means of supporting enhanced trajectories of health and well-being.

Exceptional longevity is associated with decreased reproduction

A number of leading theories of aging, namely The Antagonistic Pleiotropy Theory (Williams, 1957), The Disposable Soma Theory (Kirkwood, 1977) and most recently The Reproductive-Cell Cycle Theory (Bowen and Atwood, 2004, 2010) suggest a tradeoff between longevity and reproduction. While there has been an abundance of data linking longevity with reduced fertility in lower life forms, human data have been conflicting. We assessed this tradeoff in a cohort of genetically and socially homogenous Ashkenazi Jewish centenarians (average age ~100 years). As compared with an Ashkenazi cohort without exceptional longevity, our centenarians had fewer children (2.01 vs 2.53, p<0.0001), were older at first childbirth (28.0 vs 25.6, p<0.0001), and at last childbirth (32.4 vs 30.3, p<0.0001). The smaller number of children was observed for male and female centenarians alike. The lower number of children in both genders together with the pattern of delayed reproductive maturity is suggestive of constitutional factors that might enhance human life span at the expense of reduced reproductive ability.

Biodemography of exceptional longevity: early-life and mid-life predictors of human longevity

This study explores the effects of early-life and middle-life conditions on exceptional longevity using two matched case-control studies. The first study compares 198 validated centenarians born in the United States between 1890 and 1893 to their shorter-lived siblings. Family histories of centenarians were reconstructed and exceptional longevity validated using early U.S. censuses, the Social Security Administration Death Master File, state death indexes, online genealogies, and other supplementary data resources. Siblings born to young mothers (aged less than 25 years) had significantly higher chances of living to 100 compared to siblings born to older mothers (odds ratio = 2.03, 95% CI = 1.33-3.11, p = .001). Paternal age and birth order were not associated with exceptional longevity. The second study explores whether people living to 100 years and beyond differ in physical characteristics at a young age from their shorter-lived peers. A random representative sample of 240 men who were born in 1887 and survived to age 100 was selected from the U.S. Social Security Administration database and linked to U.S. World War I civil draft registration cards collected in 1917 when these men were 30 years old. These validated centenarians were then compared to randomly selected controls who were matched by calendar year of birth, race, and place of draft registration in 1917. Results showed a negative association between "stout" body build (being in the heaviest 15 percent of the population) and survival to age 100. Having the occupation of "farmer" and a large number of children (4 or more) at age 30 increased the chances of exceptional longevity. The results of both studies demonstrate that matched case-control design is a useful approach in exploring effects of early-life conditions and middle-life characteristics on exceptional longevity.

Season of birth and exceptional longevity: comparative study of american centenarians, their siblings, and spouses

This study explores the effects of month of birth (a proxy for early-life environmental influences) on the chances of survival to age 100. Months of birth for 1,574 validated centenarians born in the United States in 1880-1895 were compared to the same information obtained for centenarians' 10,885 shorter-lived siblings and 1,083 spouses. Comparison was conducted using a within-family analysis by the method of conditional logistic regression, which allows researchers to control for unobserved shared childhood or adulthood environment and common genetic background. It was found that months of birth have significant long-lasting effect on survival to age 100: siblings born in September-November have higher odds to become centenarians compared to siblings born in March. A similar month-of-birth pattern was found for centenarian spouses. These results support the idea of early-life programming of human aging and longevity.

Evaluation of record linkage between a large healthcare provider and the Utah Population Database

OBJECTIVE

Electronically linked datasets have become an important part of clinical research. Information from multiple sources can be used to identify comorbid conditions and patient outcomes, measure use of healthcare services, and enrich demographic and clinical variables of interest. Innovative approaches for creating research infrastructure beyond a traditional data system are necessary.

MATERIALS AND METHODS

Records from a large healthcare system's enterprise data warehouse (EDW) were linked to a statewide population database, and a master subject index was created. The authors evaluate the linkage, along with the impact of missing information in EDW records and the coverage of the population database. The makeup of the EDW and population database provides a subset of cancer records that exist in both resources, which allows a cancer-specific evaluation of the linkage.

RESULTS

About 3.4 million records (60.8%) in the EDW were linked to the population database with a minimum accuracy of 96.3%. It was estimated that approximately 24.8% of target records were absent from the population database, which enabled the effect of the amount and type of information missing from a record on the linkage to be estimated. However, 99% of the records from the oncology data mart linked; they had fewer missing fields and this correlated positively with the number of patient visits.

DISCUSSION AND CONCLUSION

A general-purpose research infrastructure was created which allows disease-specific cohorts to be identified. The usefulness of creating an index between institutions is that it allows each institution to maintain control and confidentiality of their own information.

Early parental death and remarriage of widowed parents as risk factors for Alzheimer disease: the Cache County study

OBJECTIVES

Early parental death is associated with lifelong tendencies toward depression and chronic stress. We tested the hypothesis that early parental death is associated with higher risk for Alzheimer disease (AD) in offspring.

DESIGN

A population-based epidemiological study of dementia with detailed clinical evaluations, linked to one of the world's richest sources of objective genealogical and vital statistics data.

SETTING

Home visits with residents of a rural county in northern Utah.

PARTICIPANTS

4,108 subjects, aged 65-105.

MEASUREMENTS

Multistage dementia ascertainment protocol implemented in four triennial waves, yielding expert consensus diagnoses of 570 participants with AD and 3,538 without dementia. Parental death dates, socioeconomic status, and parental remarriage after widowhood were obtained from the Utah Population Database, a large genealogical database linked to statewide birth and death records.

RESULTS

Mother's death during subject's adolescence was significantly associated with higher rate of AD in regression models that included age, gender, education, APOE genotype, and socioeconomic status. Father's death before subject age 5 showed a weaker association. In stratified analyses, associations were significant only when the widowed parent did not remarry. Parental death associations were not moderated by gender or APOE genotype. Findings were specific to AD and not found for non-AD dementia.

CONCLUSIONS

Parental death during childhood is associated with higher prevalence of AD, with different critical periods for father's versus mother's death, with strength of these associations attenuated by remarriage of the widowed parent.

Sex differences in the consequences of early-life exposure to epidemiological stress--a life-history approach

OBJECTIVES

Exposure to infectious disease in early life has been suggested to have a negative effect on later-life survival,possibly through the induction of inflammatory responses. Although a life-course perspective emphasizes the importance of both survival and reproduction for individual fitness, to date, no studies have investigated whether early-life exposure to infectious disease has an impact on reproduction as it has been suggested for later survival.

METHODS

To address this question, I have used family reconstitution data from a historical (18th and 19th century) human population in the Krummhörn (Germany) comparing survival and reproduction between an exposed and a non-exposed group. The exposed group comprised those exposed to a high-infectious disease load during prenatal and early postnatal development.

RESULTS

The results show a marked sex difference in the impact of early-life exposure to infectious disease. Exposed females show no effect on their life expectancy but significantly reduced fertility (number of children). For exposed males, however, the effect on survival is opponent over time: mortality is increased during childhood but decreased in late adulthood. Above that, exposed males reproduce earlier and have a smaller proportion of surviving children.

CONCLUSIONS

This study does not support former studies indicating a negative association between early-life disease load and later survival. I argue that due to differences in male and female life strategies, males in general are more vulnerable especially early in life. Hence, adverse environmental conditions may have a stronger effect on male survivability and reproductive performance.