Survival of offspring who experience early parental death: early life conditions and later-life mortality

The embodiment of parental death in early life through accelerated epigenetic aging: Implications for understanding how parental death before 18 shapes age-related health risk among older adults

Parental death in early life has been linked to various adverse health outcomes in older adulthood. This study extends prior research to evaluate how parental death in early life is tied to accelerated epigenetic aging, a potentially important biological mechanism from which social and environmental exposures impact age-related health. We used data from the 2016 Venous Blood Study (VBS), a component of the Health and Retirement Study (HRS), to examine the association between parental death in early life and accelerated epigenetic aging as measured by three widely used epigenetic clocks (PCPhenoAge, PCGrimAge, and DunedinPACE). We also assessed whether some of the association is explained by differences in educational attainment, depressive symptoms, and smoking behavior. Methods included a series of linear regression models and formal mediation analysis. Findings indicated that parental death in early life is associated with accelerated epigenetic aging for PCPhenoAge and DunedinPACE. The inclusion of educational attainment, depressive symptoms, and smoking behavior attenuated this association, with formal mediation analysis providing additional support for these observations. Parental death in early life may be one of the most difficult experiences an individual may face. The elevated biological risk associated with parental death in early life may operate through immediate changes but also through more downstream risk factors. This study highlights how early life adversity can set in motion biological changes that have lifelong consequences.

Depressive symptoms mediate associations of adverse childhood experiences and chronic lung diseases: A mediation effect analysis

BACKGROUND

Adverse childhood experiences (ACEs) have been found to be related to the risk of chronic lung diseases (CLDs). However, the role of depressive symptoms (DS) in this link has not been fully examined. The present study aimed to explore the mediating effect of DS on the relationship between ACEs and CLDs.

METHODS

Data for this retrospective cohort study were obtained from participants enrolled in the China Health and Retirement Longitudinal Study (CHARLS). To assess DS, the 10-item Center for Epidemiological Research Depression Scale was utilized. Logistic regression was employed to explore the associations between ACEs and DS, ACEs and CLDs, as well as depressive symptoms- chronic lung diseases (DS-CLDs). Mediation analysis was conducted to assess the mediating role of DS in the relationship between ACEs and CLDs.

RESULTS

A total of 12,277 participants, comprising 5942 males and 6335 females, were included in this study. Logistic regression analysis identified associations between ACEs and the risk of DS, CLDs, and DS-CLDs. Mediating effect analysis demonstrated that DS had partial mediating effects on the association between CLDs and 7 ACEs, including feel alone, peer bullied, self-reported poor health status, health limitations, death of siblings, physical abuse, and parental mental health. Additionally, DS fully mediated the relationship between CLDs and hunger.

CONCLUSIONS

Our study establishes a significant association between ACEs and CLDs, as well as with DS and DS-CLDs in the elderly population. Furthermore, DS acts as a mediating factor in the ACEs and CLDs relationship.

Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S

Bereavement is a risk factor for poor health, yet prior research has not considered how exposure to parental death across the life course may contribute to lasting social isolation and, in turn, poor health among older adults. Moreover, prior research often fails to consider the racial context of bereavement in the United States wherein Black and Hispanic Americans are much more likely than White Americans to experience parental death earlier in life. The present study uses longitudinal data from the Health and Retirement Study (HRS; 1998-2016) to consider linkages of parental death, social isolation, and health (self-rated health, functional limitations) for Black, Hispanic, and White older adults. Findings suggest that exposure to parental death is associated with higher levels of isolation, greater odds of fair/poor self-rated health, and greater odds of functional limitations in later life. Moreover, social isolation partially explains associations between parental bereavement and later-life health. These patterns persist net of psychological distress-an additional psychosocial response to bereavement. Racial inequities in bereavement are central to disadvantage: Black and Hispanic adults are more likely to experience a parent's death earlier in the life course, and this differential exposure to parental death in childhood or young adulthood has implications for racial and ethnic inequities in social isolation and health throughout life.

Early learning difficulties, childhood stress, race, and risk of cognitive impairment among US adults over age 50: A cross-sectional analysis

Background and Aims

Most literature linking childhood factors to cognitive health outcomes has focused on educational attainment-defined as years of education attained. However, less has been studied about the other aspects of education, such as early learning problems, and stressful family environments. This study examined whether early learning problems and childhood stressors were associated with mid- and later life cognitive impairment among US adults, and if these associations varied by race.

Methods

We conducted a cross-sectional analysis using the Health and Retirement Study (HRS) along with respondents' early educational experiences from the 2015 to 2017 Life History Mail Survey (N = 9703). Early learning problems were defined as having any of the following: scholastic problems (reading, writing, mathematics), speaking/language issues, and sensorimotor issues- hearing, vision, speech, and motor-coordination. Cognitive status was classified as three levels (normal, cognitively impaired not demented [CIND], and demented) using the HRS Langa-Weir algorithm. Multinomial logistic regression models using generalized logits, estimated relative risk ratios (RRRs), and 95% confidence intervals (CI) with adjustment for sociodemographic factors.

Results

Having at least one early learning problem was associated with increased risk of later life cognitive impairment (RRR: 1.75, 95% CI: 1.34-2.29 for dementia, RRR: 1.42, 95% CI: 1.20-1.67 for CIND). Parental death before the age of 16 was associated with 17% higher risk of CIND in later life (RRR: 1.17, 95% CI: 1.01-1.34). However, learning problem-related differences in risk of cognitive impairment were dependent on race (learning problems × race, p = 0.0001). In the demented group, Blacks were 2.7 times more likely to be demented (RRR: 2.66, 95% CI: 1.69-4.17) amongst older adults that experienced childhood learning problems.

Conclusions

Early life exposures predicted risk of cognitive impairment. Policies and interventions that enhance diagnosis of early learning problems and improve childhood social contexts are needed to promote healthy cognitive aging amongst Americans, regardless of race.

Family Ties at End-of-Life: Characteristics of Nursing Home Decedents With and Without Family

Background

Little is known about nursing home (NH) residents' family characteristics despite the important role families play at end-of-life (EOL).

Objective

To describe the size and composition of first-degree families (FDFs) of Utah NH residents who died 1998-2016 (n = 43,405).

Methods

Using the Utah Population Caregiving Database, we linked NH decedents to their FDF (n = 124,419; spouses = 10.8%; children = 55.3%; siblings = 32.3%) and compared sociodemographic and death characteristics of those with and without FDF members (n = 9424).

Results

Compared to NH decedents with FDF (78.3%), those without (21.7%) were more likely to be female (64.7% vs. 57.1%), non-White/Hispanic (11.2% vs. 4.2%), less educated (<9th grade; 41.1% vs. 32.4%), and die in a rural/frontier NH (25.3% vs. 24.0%, all p < 0.001). Despite similar levels of disease burden (Charlson Comorbidity score 3 + 37.7% vs. 38.0%), those without FDF were more likely to die from cancer (14.2% vs. 12.4%), Chronic Obstructive Pulmonary Disease (COPD) (6.0% vs. 4.0%), and dementia (17.1% vs. 16.6%, all p < 0.001), and were less likely to have 2+ hospitalizations at EOL (20.5% vs. 22.4%, p < 0.001).

Conclusions

Among NH decedents, those with and without FDF have different sociodemographic and death characteristics-factors that may impact care at EOL. Understanding the nature of FDF relationship type on NH resident EOL care trajectories and outcomes is an important next step in clarifying the role of families of persons living and dying in NHs.

Long-run intergenerational health benefits of women empowerment: Evidence from suffrage movements in the US

An ongoing body of research documents that women empowerment is associated with improved outcomes for children. However, little is known about the long-run effects on health outcomes. This paper adds to this literature and studies the association between maternal exposure to suffrage reforms and children's old-age longevity. We utilize changes in suffrage laws across US states and over time as a source of incentivizing maternal investment in children's health and education. Using the universe of death records in the US over the years 1979-2020 and implementing a difference-in-difference econometric framework, we find that cohorts exposed to suffrage throughout their childhood live 0.6 years longer than unexposed cohorts. Furthermore, we show that these effects are not driven by preexisting trends in longevity, endogenous migration, selective fertility, and changes in the demographic composition of the sample. Additional analysis reveals that improvements in education and income are candidate mechanisms. Moreover, we find substantial improvements in early-adulthood socioeconomic standing, height, and height-for-age outcomes due to childhood exposure to suffrage movements. A series of state-level analyses suggest reductions in infant and child mortality following suffrage law change. We also find evidence that counties in states that passed the law experienced new openings of County Health Departments and increases in physicians per capita.

Mortality in Women across the FMR1 CGG Repeat Range: The Neuroprotective Effect of Higher Education

Higher education has been shown to have neuroprotective effects, reducing the risk of Alzheimer's and Parkinson's diseases, slowing the rate of age-related cognitive decline, and is associated with lower rates of early mortality. In the present study, the association between higher education, fragile X messenger ribonucleoprotein 1 (FMR1) cytosine-guanine-guanine (CGG) repeat number, and mortality before life expectancy was investigated in a population cohort of women born in 1939. The findings revealed a significant interaction between years of higher education and CGG repeat number. Counter to the study's hypothesis, the effects of higher education became more pronounced as the number of CGG repeats increased. There was no effect of years of higher education on early mortality for women who had 25 repeats, while each year of higher education decreased the hazard of early mortality by 8% for women who had 30 repeats. For women with 41 repeats, the hazard was decreased by 14% for each additional year of higher education. The interaction remained significant after controlling for IQ and family socioeconomic status (SES) measured during high school, as well as factors measured during adulthood (family, psychosocial, health, and financial factors). The results are interpreted in the context of differential sensitivity to the environment, a conceptualization that posits that some people are more reactive to both negative and positive environmental conditions. Expansions in CGG repeats have been shown in previous FMR1 research to manifest such a differential sensitivity pattern.

Bereavement in childhood and young adulthood and the risk of atrial fibrillation: a population-based cohort study from Denmark and Sweden

BACKGROUND

Adverse childhood life events are associated with increased risks of hypertension, ischemic heart disease, and stroke later in life. Limited evidence also suggests that stress in adulthood may increase the risk of atrial fibrillation (AF). Whether childhood adversity may lead to the development of AF is unknown. We investigated whether the loss of a parent or sibling in childhood is associated with an increased risk of AF and compared this effect to that of similar losses in young adulthood.

METHODS

We studied 6,394,975 live-born individuals included in the Danish (1973-2018) and Swedish Medical Birth Registers (1973-2014). We linked data from several national registers to obtain information on the death of parents and siblings and on personal and familial sociodemographic and health-related factors. We analyzed the association between bereavement and AF using Poisson regression.

RESULTS

Loss of a parent or sibling was associated with an increased AF risk both when the loss occurred in childhood and in adulthood; the adjusted incident rate ratios and 95% confidence intervals were 1.24 (1.14-1.35) and 1.24 (1.16-1.33), respectively. Bereavement in childhood was associated with AF only if losses were due to cardiovascular diseases or other natural causes, while loss in adulthood was associated with AF not only in case of natural deaths, but also unnatural deaths. The associations did not differ substantially according to age at loss and whether the deceased was a parent or a sibling.

CONCLUSIONS

Bereavement both in childhood and in adulthood was associated with an increased AF risk.

The Case for the Patient-Centric Development of Novel Digital Sleep Assessment Tools in Major Depressive Disorder

Background

Depression imposes a major burden on public health as the leading cause of disability worldwide. Sleep disturbance is a core symptom of depression that affects the vast majority of patients. Nonetheless, it is frequently not resolved by depression treatment and may even be worsened through some pharmaceutical interventions. Disturbed sleep negatively impact patients' quality of life, and persistent sleep disturbance increases the risk of recurrence, relapse, and even suicide. However, the development of novel treatments that might improve sleep problems is hindered by the lack of reliable low-burden objective measures that can adequately assess disturbed sleep in this population.

Summary

Developing improved digital measurement tools that are fit for use in clinical trials for major depressive disorder could promote the inclusion of sleep as a focus for treatment, clinical drug development, and research. This perspective piece explores the path toward the development of novel digital measures, reviews the existing evidence on the meaningfulness of sleep in depression, and summarizes existing methods of sleep assessments, including the use of digital health technologies.

Key Messages

Our objective was to make a clear call to action and path forward for the qualification of new digital outcome measures which would enable assessment of sleep disturbance as an aspect of health that truly matters to patients, promoting sleep as an important outcome for clinical development, and ultimately ensure that disturbed sleep will not remain the forgotten symptom of depression.

Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults

Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.

Early life adversity, reproductive history and breast cancer risk

Background and objectives

Individuals who experience early life adversity are at an increased risk for chronic disease later in life. Less is known about how early life factors are associated with cancer susceptibility. Here, we use a life history framework to test whether early life adversity increases the risk of breast cancer. We predict that early life adversity can shift investment in somatic maintenance and accelerate the timing of reproduction, which may mediate or interact with the risk of breast cancer.

Methodology

We use population-wide data from the Utah Population Database (UPDB) and Utah Cancer Registry, leading to 24 957 cases of women diagnosed with breast cancer spanning 20 years (1990-2010) and 124 785 age-matched controls. We generated a cumulative early life adversity summation score to evaluate the interaction (moderation) and mediation between early life adversity, reproductive history and their association with breast cancer risk.

Results

Our analyses led to three key findings: (i) more early life adversity, when considered as a main effect, accelerates the time to first birth and death, (ii) early age at first birth and high parity decreases the risk of breast cancer and (iii) we find no association between early adversity and breast cancer risk either as a main effect or in its interaction with reproductive history.

Conclusion and implications

Early adversity elevates the risk of overall mortality through mechanisms other than breast cancer risk. This suggests early life factors can generate different effects on health. Future work should incorporate more complex view of life history patterns, including multiple life stages, when making predictions about cancer susceptibility.

Death of a Parent and the Risk of Ischemic Heart Disease and Stroke in Denmark and Sweden

IMPORTANCE

Increasing evidence suggests that parental death is associated with unhealthy behaviors and mental ill-health. Knowledge regarding the link between parental death and the risk of ischemic heart disease (IHD) and stroke remains limited.

OBJECTIVES

To investigate whether parental death is associated with an increased risk of IHD and stroke and whether these associations differ by the characteristics of the loss.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study, involving linkages between several nationwide registers, included 3 766 918 individuals born between 1973 and 1998 in Denmark and between 1973 and 1996 in Sweden. Participants were followed up until 2016 in Denmark and 2014 in Sweden. Data were analyzed from December 2019 to May 2021.

EXPOSURES

Death of a parent.

MAIN OUTCOMES AND MEASURES

Diagnosis with or death due to IHD or stroke. Poisson regression was used to analyze the associations between parental death and IHD and stroke risk.

RESULTS

Altogether, 48.8% of the participants were women, and 42.7% were from Denmark. A total of 523 496 individuals lost a parent during the study period (median age at loss, 25 years; IQR, 17-32 years). Parental death was associated with a 41% increased risk of IHD (incidence rate ratio [IRR], 1.41; 95% CI, 1.33-1.51) and a 30% increased risk of stroke [IRR, 1.30; 95% CI, 1.21-1.38). The associations were observed not only if the parent died because of cardiovascular or other natural causes but also in cases of unnatural deaths. The associations were stronger when both parents had died (IHD: IRR, 1.87; 95% CI, 1.59-2.21; stroke: IRR, 1.64; 95% CI, 1.35-1.98) than when 1 parent had died (IHD: IRR, 1.37; 95% CI, 1.28-1.47; stroke: IRR, 1.27; 95% CI, 1.19-1.36) but did not differ substantially by the offspring's age at loss or the deceased parents' sex. The risk of acute myocardial infarction was highest in the first 3 months after loss.

CONCLUSIONS AND RELEVANCE

In this cohort study, parental death in the first decades of life was associated with an increased risk of IHD and stroke. The associations were observed not only in cases of parental cardiovascular and other natural deaths but also in cases of unnatural deaths. Family members and health professionals may need to pay attention to the cardiovascular disease risk among parentally bereaved individuals.

Death of a Parent During Childhood and the Risk of Ischemic Heart Disease and Stroke in Adult Men

OBJECTIVE

The death of a parent during childhood is a severe life event with potentially long-term consequences. Earlier studies have shown an increased risk of cardiovascular diseases (CVD) after the death of a spouse, child, or sibling. Whether parental death during childhood is associated with an increased risk of incident CVD is unknown and was investigated in this study.

METHODS

We studied 48,992 men born 1949 to 1951 and enlisted for military conscription in 1969 to 1970. We obtained information on death of a parent during childhood, CVD up to 2008, and covariates by linking the questionnaire and the clinical examination data from conscription with nationwide socioeconomic and health registers.

RESULTS

Men who lost a parent during childhood had an increased risk of ischemic heart disease (IHD; adjusted hazard ratio (HR) and 95% confidence interval [CI] = 1.30 [1.13-1.49]) but not of stroke during the 39-year follow-up (adjusted HR [95% CI] = 0.87 [0.66-1.15]). Maternal death was associated with IHD both when the loss was due to cardiovascular (adjusted HR [95% CI] = 2.04 [1.02-4.08]) and unnatural causes (adjusted HR [95% CI] = 2.50 [1.42-4.42]); in case of paternal death, an increased IHD risk was observed only when the loss was due to cardiovascular causes (adjusted HR [95% CI] = 1.82 [1.37-2.42]). There were no substantial differences in CVD according to the child's age at the loss.

CONCLUSIONS

Parental death during childhood was associated with an increased risk of IHD in men. If these associations are confirmed in future studies, the long-term effects of childhood bereavement may warrant attention.

Parental Death and Cognitive Impairment: An Examination by Gender and Race-ethnicity

OBJECTIVES

We provide the first nationally representative longitudinal study of cognitive impairment in relation to parental death from childhood through early adulthood, midlife, and later adulthood, with attention to heterogeneity in the experience of parental death.

METHOD

We analyzed data from the Health and Retirement Study (2000-2016). The sample included 13,392 respondents, contributing 72,860 person-periods. Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status (TICS). Discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS

Both exposure and timing of parental death were related to risk of cognitive impairment in late life and associations vary by gender. The detrimental effect of a father's death was comparable for daughters and sons although exposure to mother's death had stronger effects on daughter's than son's risk of cognitive impairment. Father's death at younger ages had the strongest effect on sons' late-life risk of cognitive impairment whereas mother's death in middle adulthood had the strongest effect on daughters' risk. We found no significant racial-ethnic variation in the association between parental death and cognitive impairment.

DISCUSSION

It is important to explore the gender-specific pathways through which parental death leads to increased risk of cognitive impairment so that effective interventions can be implemented to reduce risk.

Developmental Impact of Early Parental Death: Sustaining Posttraumatic Growth Throughout the Lifespan

Impacting millions of youth across the globe, early parental death is an important topic to investigate. This causal-comparative study (N = 256) examined a group of young adults who experienced a parental death during adolescence and a group of young adults who had not experienced an early parental death. The researchers examined the psychosocial developmental impact of early parental death and developed a predictive model of posttraumatic growth (PTG) for young adults who have experienced early parental death. When compared to non-bereaved peers, young adults who experienced an early parental death had lower psychosocial developmental strength. The findings of the study emphasized social support, spirituality, and psychosocial development as significant predictors of PTG in young adults who experienced an early parental death. The study also provided insight into sustaining PTG throughout the lifespan. Implications for the counseling profession are considered.

Was Cinderella just a fairy tale? Survival differences between stepchildren and their half-siblings

The death of a parent, particularly the mother, is linked to a suite of negative outcomes across the life-course. Compounding concerns for child outcomes are expectations of poor treatment by step-parents after parental remarriage. Indeed, folk tales of step-parental abuse abound cross-culturally and are embedded into stories taught to children. To understand why child outcomes might be sensitive to levels of relatedness within the household, evolutionary-oriented research targets patterning in parental expenditure in ways predicted to maximize inclusive fitness. In particular, parents are expected to prioritize investments in their biological children. However, stepfamilies are only formed after children experience multiple unfortunate events (e.g. parental loss, poverty), blurring causal interpretations between step-parental presence and stepchild outcomes. Moreover, stepchildren have been shown to be integral to household functioning, caring for their half-siblings and stabilizing relationships. These results challenge narrow views of adaptive behaviour; specifically, that step-parents, unlike biological parents, do no stand to reap fitness benefits from the care that they provide to their stepchildren. To evaluate these critiques, we analyse the survival outcomes of stepchildren. We include over 400 000 individuals from across a natural fertility period (1847-1940) in the United States state of Utah and examine the consequences of parental loss and step-parental introduction. Our analyses yield three key results: (i) exposure to maternal loss in childhood is associated with elevated mortality risk, (ii) parental remarriage does not increase the risk of mortality among stepchildren compared to non-stepchildren who too had lost a parent, and (iii) stepchildren enjoy higher survival than their half-siblings within the same family. Ultimately, this work contributes to the increasingly recognized importance of cooperative relationships among non-kin for childcare and household functioning. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Time to retire? A register-based study of GPs' practice style prior to retirement

In many healthcare systems a large share of general practitioners (GPs) is retiring. The literature has shown a negative correlation between physicians' age and their quality of care. However, little is known about whether GPs exhibit different practice styles in the years prior to retirement. This study investigates whether GPs who are closer to retirement make different professional choices than GPs who are not as close to retirement. Using detailed administrative data on 555 Danish GPs and their patients from 2005 to 2017, we study GPs' practice styles across a ten-year period prior to retirement and compare these with GPs who retire at a later date ('non-retiring GPs'), while controlling for age differences as well as exogenous factors affecting healthcare provision. We focus on the GPs' number of enlisted patients, revenue, provision of consultations, and treatment behaviour in consultations. We find no differences between retiring and non-retiring GPs for key outcomes such as 'revenue per patient' and 'consultations per patient'. However, we find that retiring GPs have fewer enlisted patients in their final years of practicing. This finding is driven by more patients leaving rather than fewer patients joining their lists. We also find that retirement is associated with other dimensions of GPs' practice style, e.g. their provision of home visits, prescribing, and referral rates. Overall, we find a modest association between GPs' retirement and their practice style.

Death of a parent during childhood and blood pressure in youth: a population-based cohort study of Swedish men

OBJECTIVE

Compelling evidence suggests that childhood adversities are associated with an increased risk of hypertension in middle age and old age. The link between childhood adversities and blood pressure in youth is less clear. In this cohort study, we examined the association between death of a parent during childhood and blood pressure in early adulthood in men.

SETTING

Sweden.

PARTICIPANTS

We studied 48 624 men born in 1949-1951 who participated in the compulsory military conscription in 1969/1970 in Sweden. Information on death of a parent during childhood was obtained from population-based registers. Information on covariates was obtained from the questionnaire and the clinical examination completed at conscription and from population-based registers.

OUTCOME MEASURES

Blood pressure was measured at conscription according to standard procedures.

RESULTS

The multivariable least square means of systolic and diastolic blood pressure did not differ between bereaved (128.25 (127.04-129.46) and 73.86 (72.89-74.84) mm Hg) and non-bereaved study participants (128.02 (126.86-129.18) and 73.99 (73.06-74.93) mm Hg). Results were similar when considering the cause of the parent's death, the gender of the deceased parent or the child's age at loss. Loss of a parent in childhood tended to be associated with an increased hypertension risk (OR and 95% CI: 1.10 (1 to 1.20)); the association was present only in case of natural deaths.

CONCLUSION

We found no strong support for the hypothesis that stress following the loss of a parent during childhood is associated with blood pressure or hypertension in youth in men.

Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study

BACKGROUND

Previous studies have shown that the experience of parental death during childhood is associated with increased mortality risk. However, few studies have examined potential pathways that may explain these findings. The aim of this study is to examine whether familial and behavioural factors during adolescence and socioeconomic disadvantages in early adulthood mediate the association between loss of a parent at age 0 to 12 and all-cause mortality by the age of 63.

METHODS AND FINDINGS

A cohort study was conducted using data from the Stockholm Birth Cohort Multigenerational Study for 12,615 children born in 1953, with information covering 1953 to 2016. Familial and behavioural factors at age 13 to 19 included psychiatric and alcohol problems in the surviving parent, receipt of social assistance, and delinquent behaviour in the offspring. Socioeconomic disadvantage in early adulthood included educational attainment, occupational social class, and income at age 27 to 37. We used Cox proportional hazard regression models, combined with a multimediator analysis, to separate direct and indirect effects of parental death on all-cause mortality. Among the 12,582 offspring in the study (men 51%; women 49%), about 3% experienced the death of a parent in childhood. During follow-up from the age of 38 to 63, there were 935 deaths among offspring. Parental death was associated with an elevated risk of mortality after adjusting for demographic and household socioeconomic characteristics at birth (hazard ratio [HR]: 1.52 [95% confidence interval: 1.10 to 2.08, p-value = 0.010]). Delinquent behaviour in adolescence and income during early adulthood were the most influential mediators, and the indirect associations through these variables were HR 1.03 (1.00 to 1.06, 0.029) and HR 1.04 (1.01 to 1.07, 0.029), respectively. After accounting for these indirect paths, the direct path was attenuated to HR 1.35 (0.98 to 1.85, 0.066). The limitations of the study include that the associations may be partly due to genetic, social, and behavioural residual confounding, that statistical power was low in some of the subgroup analyses, and that there might be other relevant paths that were not investigated in the present study.

CONCLUSIONS

Our findings from this cohort study suggest that childhood parental death is associated with increased mortality and that the association was mediated through a chain of disadvantages over the life course including delinquency in adolescence and lower income during early adulthood. Professionals working with bereaved children should take the higher mortality risk in bereaved offspring into account and consider its lifelong consequences. When planning and providing support to bereaved children, it may be particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality.

Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities

OBJECTIVES

This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk.

METHODS

We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000-2014.

RESULTS

Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time.

DISCUSSION

The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.

Early parental death and psychosocial risk factors for dementia: A case-control study in Europe

OBJECTIVES

To assess the association between early parental death and the risk of dementia in adult life and to examine the risk factors associated with early parental death in people with and without dementia.

METHODS/DESIGN

A population-based case-control study of a sample of 65 997 participants from the Survey of Health, Ageing and Retirement in Europe study. Early parental death was operationalized as parental death at the age of ≤16 years. Main analyses were conducted using bivariate and multivariate logistic regression analyses.

RESULTS

The odds ratio (OR) for dementia in individuals who experienced early parental death (father or mother) at the age of ≤16 years was 1.83 (95%CI 1.61-2.09) and 1.54 (95%CI 1.35-1.76) adjusted for age, gender and education. In the multivariate logistic regression analysis carried out with the whole sample, early parental death increased the risk of dementia (OR = 1.50, 95%CI 1.31-1.72), along with older age (OR = 5.92, 95%CI 4.86-7.17), neuroticism (OR = 2.94, 95%CI 2.61-3.31), low education level (OR = 1.84, 95%CI 1.64-2.05) and low income (OR = 1.49, 95%CI 1.34-1.67).

DISCUSSION

Early parental death (≤16 years) was associated with an increased risk of dementia. We discuss the neurobiological markers associated with adverse childhood experiences (ACEs) and dementia as well as interventions to counteract the negative health effects on adults. J Am Geriatr Soc 68:-, 2020.

Parental death due to natural death causes during childhood abbreviates the time to a diagnosis of a psychiatric disorder in the offspring: A follow-up study

Parental death before adulthood has been shown to increase offspring's risk of poor health and adverse social consequences. In a sample of 422 subjects with parental death (334 (79.1%) due to natural causes), and 6172 matched controls, those with parental death were given a diagnosis of a psychiatric disorder up to 28 years of age earlier than their controls (10-year survival proportions: 88.6% vs. 93.1%, p = 0.001). Our findings indicate that psychosocial support must be provided as early as when a parent falls ill, especially with those illnesses that are the most common causes of death in the population.

Is it time to establish age restrictions in ART?

Providers specializing in reproductive medicine are treating increasing numbers of women pursuing parenthood in their 40s, 50s, and beyond. The rise in later-life parenting can be linked to factors ranging from the advent of assisted reproductive technologies and donor oocytes to the highly publicized pregnancies of older celebrities. We explore the medical and psychosocial implications of this trend for both older parents and their children. We also discuss ethical arguments regarding older parents' access to fertility care, existing professional guidelines, and both public and provider opinions about setting age limits for fertility treatment. Finally, we share preliminary considerations of whether age policies should be established, applied to men as well as women, and standardized or considered on a case-by-case basis.

The Impact of Parental Death in Childhood on Sons' and Daughters' Status Attainment in Young Adulthood in the Netherlands, 1850-1952

Previous research on the impact of parental loss on labor market outcomes in adulthood has often suffered from low sample sizes. To generate further insights into the long-term consequences of parental death, I use the Historical Sample of the Netherlands (HSN). The HSN contains occupational information on life courses of a sample of more than 8,000 males and almost 7,000 females born between 1850 and 1922, a period of important labor market transformations. Roughly 20 % of the sample population experienced parental death before age 16. Linear regression models show that maternal loss is significantly associated with lower occupational position in adulthood for both men and women, which points to the crucial importance of maternal care in childhood for socioeconomic outcomes in later life. This interpretation is supported by the finding that a stepmother's entry into the family is positively related with sons' occupational position later in life. In contrast to expectations, the loss of economic resources related to the father's death is generally not associated with lower status attainment in adulthood for men or for women. The results indicate, however, that the negative consequences of paternal death on men's socioeconomic outcomes decreased over time, illustrating the complex interaction between individual life courses and surrounding labor market transformations.

Caring for Daughters Without Mothers

The death of one's mother during childhood is the severing of one of the most important human bonds. The child may suffer periods of grief that continue into adulthood and throughout life. The nurse has a vital role in assisting women traumatized by loss of a mother at a young age. This article discusses the experience of maternal loss and notes care needs of the motherless child-adult woman. Identification of women in this situation should be made as early as possible.

Opportunities for life course research through the integration of data across Clinical and Translational Research Institutes

Introduction

Early life exposures affect health and disease across the life course and potentially across multiple generations. The Clinical and Translational Research Institutes (CTSIs) offer an opportunity to utilize and link existing databases to conduct lifespan research.

Methods

A survey with Lifespan Domain Taskforce expert input was created and distributed to lead lifespan researchers at each of the 64 CTSIs. The survey requested information regarding institutional databases related to early life exposure, child-maternal health, or lifespan research.

Results

Of 64 CTSI, 88% provided information on a total of 130 databases. Approximately 59% (n=76/130) had an associated biorepository. Longitudinal data were available for 72% (n=93/130) of reported databases. Many of the biorepositories (n=44/76; 68%) have standard operating procedures that can be shared with other researchers.

Conclusions

The majority of CTSI databases and biorepositories focusing on child-maternal health and lifespan research could be leveraged for lifespan research, increased generalizability and enhanced multi-institutional research in the United States.

Optical Coherence Tomography of Small Retinoblastoma

PURPOSE

To investigate hand-held optical coherence tomography (HH-OCT) characteristics of small (<1 mm thickness) retinoblastoma.

DESIGN

Retrospective observational case series.

METHODS

Patient and tumor data were extracted from the medical record and analyzed along with HH-OCT scans. Determination of tumor layer of origin was performed using a layer-by-layer analysis of HH-OCT data and specific HH-OCT-related features were described.

RESULTS

There were 20 sub-millimeter retinoblastomas from 16 eyes of 15 patients. Mean largest tumor basal diameter by HH-OCT was 2.2 mm (median, 1.9; range, 0.7-4.1 mm), and mean tumor thickness was 468 μm (median, 441; range, 151-998 μm). In all cases, the retinoblastoma caused discontinuity or disruption of the inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and external limiting membrane (ELM) layers (20/20, 100%). Tumor origin was in the INL in 19/20 (95%) and equivocal (INL vs ONL) in 1/20 (5%). Intratumoral microcalcification was present in 14/20 tumors (70%). There were 2 characteristic findings (signs) on HH-OCT including the INL "fish tail" sign with splaying of the INL at the tumor margin (19/20, 95%) and the ONL "shark fin" sign with folding of the ONL and OPL, conforming to the lateral tumor margins (15/20, 75%). Both signs were concurrently present in 15 tumors (15/20, 75%).

CONCLUSIONS

HH-OCT demonstrated that sub-millimeter retinoblastoma seems to originate from the INL, with tumor base and thickness growth progressing in a linear relationship. Characteristic HH-OCT findings included intratumoral microcalcification, INL "fish tail" sign, and ONL "shark fin" sign.

Predictive Values of Early Parental Loss and Psychopathological Risk for Physical Problems in Early Adolescents

Background: Several studies have suggested that the early loss of parents is a potentially traumatic experience, exposing adolescents to a higher risk for the onset of psychopathological symptoms. Furthermore, research has shown an association between the loss of a parent in childhood and subsequent physical illnesses, but much less attention has been given to the predictive role of loss in the development of physical illness in adolescence. Methods: From a larger normative sample, we selected 418 early adolescents (and their surviving parents) each of whom had lost a parent in their first 3 years of life. We evaluate the offspring's and parents' psychopathological symptoms, dissociation, and physical problems over a 6-year period. Univariate and multivariate Cox proportional hazard regression analyses with time-dependent variables were used to examine the predictive values of the adolescents' and surviving parents' psychopathological symptoms, and youths' demographic characteristics (sex and age) for the occurrence of physical illness during a 6-year period of follow-up. Results: Independently of sex, the psychopathological risk of the surviving parents' and adolescents' affective problems and dissociation has been found to predict the occurrence of physical illnesses. Furthermore, dissociation was the most significant predictor of significant physical problems. Conclusion: These results may be relevant and an addition to the previous literature, opening up new possibilities for prevention and intervention that are oriented toward greater support for children who have experienced the loss of one parent and for surviving parents.

Does childhood trauma influence offspring's birth characteristics?

Background

: A recent epigenetic hypothesis postulates that 'a sex-specific male-line transgenerational effect exists in humans', which can be triggered by childhood trauma during 'the slow growth period' just before puberty. The evidence is based on a few rather small epidemiological studies. We examine what response childhood trauma predicts, if any, in the birth size and prematurity risk of almost 800 000 offspring.

Methods

Children of parity 1, 2 or 3, born 1976-2002 in Sweden, for whom we could trace both parents and all four grandparents, constituted generation 3 (G3, n = 764 569). Around 5% of their parents, G2, suffered parental (G1) death during their own childhood. The association of such trauma in G2 with G3 prematurity and birthweight was analysed, while controlling for confounders in G1 and G2. We examined whether the slow growth period was extra sensitive to parental loss.

Results

Parental (G1) death during (G2) childhood predicts premature birth and lower birthweight in the offspring generation (G3). This response is dependent on G2 gender, G2 age at exposure and G3 parity, but not G3 gender.

Conclusions

The results are compatible with the Pembrey-Bygren hypothesis that trauma exposure during boys' slow growth period may trigger a transgenerational response; age at trauma exposure among girls seems less important, suggesting a different set of pathways for any transgenerational response. Finally, parental death during childhood was not important for the reproduction of social inequalities in birthweight and premature birth.

Is Cancer Protective for Subsequent Alzheimer's Disease Risk? Evidence From the Utah Population Database

OBJECTIVE

Several studies have suggested that cancer is associated with a reduced risk of the development of Alzheimer's disease (AD). This study seeks to improve our understanding of the association between cancer and the development of AD by showing how mortality selection alters this relationship.

METHOD

A retrospective cohort study was carried out examining 92,425 individuals (47,873 women and 44,552 men) from the Utah Population Database with and without a history of any primary cancer identified by the Utah Cancer Registry. All individuals were aged 65-79 years and free of dementia in 1992 and followed for upwards of 18 years (1992-2009) for AD ascertainment, which was identified using diagnostic information from Medicare claims data.

RESULTS

We replicate previous results suggesting that cancer is associated with reduced risk of subsequent AD under specific statistical model specifications. However, these results should not be interpreted as evidence of an etiological association. We conclude that higher rates of overall mortality among individuals with cancer relative to those without cancer induce the widely reported putative protective association with cancer.

CONCLUSION

Careful consideration of model specification and the profound effects of mortality selection in the older adult population is essential when investigating the relationship between aging-related diseases such as cancer and AD. We show that cancer does not provide protection from AD as previously described in the literature. Social scientists seeking to understand social disparities in disease outcomes among older adults may therefore want to strongly consider the role of mortality selection which, if uncorrected, may generate biased associations.

Factors Underlying the Relationship Between Parent and Child Grief

The death of a parent in a child's life is a significant risk factor for later mental and physical health problems. While much has been written about the surviving parent's functioning and its effects on their bereaved children, little work has been done to look into factors underlying this effect such as how the parent copes. The present study recruited 38 parent-child dyads from a community-based grief support center. Parent and child, independently, completed various measures of emotional functioning, including grief symptoms and coping such as social support and locus of control. The results indicated that parental coping did have an impact on children's grief symptoms. This represents a unique view of adaptation in bereaved children: Parental coping strategies can have an impact on the child, independent of the child's coping strategies. By focusing on parent coping, we have highlighted another possible pathway through which parental functioning affects children's grief.

Family Member Deaths in Childhood Predict Systemic Inflammation in Late Life

Biological and epidemiological evidence has linked early-life psychosocial stress with late-life health, with inflammation as a potential mechanism. We report here the association between familial death in childhood and adulthood and increased levels of high-sensitivity C-reactive protein (CRP), a marker of systemic inflammation. The Cache County Memory Study is a prospective study of persons initially aged 65 and older in 1995. In 2002, there were 1,955 persons in the study with data on CRP (42.3 percent male, mean [SD] age = 81.2 [5.8] years), linked with objective data on family member deaths. Using logistic regression, high (> 10 mg/L) versus low (≤ 10 mg/L) CRP was regressed on cumulative parental, sibling, spouse, and offspring deaths during childhood and during early adulthood, adjusted for family size in each period (percentage family depletion; PFD). Findings revealed PFD during childhood to be significantly associated with CRP (OR = 1.02, 95% CI [1.01, 1.04]). Individuals with two or more family deaths were 79 percent more likely to have elevated CRP than those with zero family deaths (OR = 1.79, 95% CI [1.07, 2.99]). Early adulthood PFD was not related to CRP. This study demonstrates a link between significant psychosocial stress in early life and immune-inflammatory functioning in late life, and suggests a mechanism explaining the link between early-life adversity and late-life health.

Differential Vulnerability to Early-Life Parental Death: The Moderating Effects of Family Suicide History on Risks for Major Depression and Substance Abuse in Later Life

Only a portion of those individuals exposed to parental death in early life (PDE) develop behavioral health disorders. We utilized demographic pedigree data from the Utah Population Database to test for differential vulnerability to PDE by creating a risk score of familial susceptibility to suicide (FS) at the population level. Using logistic panel regression models, we tested for multiplicative interactions between PDE and FS on the risks of major depressive disorder (MDD) and substance abuse (SA), measured using Medicare claims, after age 65. The final sample included 155,983 individuals (born 1886-1944), yielding 1,431,060 person-years at risk (1992-2009). Net of several potential confounders, including probability of survival to age 65, we found an FS × PDE interaction for females, in which PDE and FS as main effects had no impact but jointly increased MDD risk. No statistically significant main or interactive effects were found for SA among females or for either phenotype among males. Our findings are consistent with a differential vulnerability model for MDD in females, in which early-life stress increases the risk for poor behavioral health only among the vulnerable. Furthermore, we demonstrate how demographic and pedigree data might serve as tools for investigating differential vulnerability hypotheses.

Grief and Traumatic Grief in Children in the Context of Mass Trauma

Children who have had someone close die as a result of a mass trauma event such as war, armed conflict, acts of terror, political violence, torture, mass accidents, and natural disasters are at risk for biopsychosocial problems. Research on how to classify when grief becomes complicated or traumatic in children is scarce, and while functioning level may provide a good indication, assessing functioning may be difficult in mass trauma environments where routines and structure are often lacking. There are promising trauma- and grief-focused interventions for children post-mass trauma, which are mostly provided in school settings. However, more advanced multi-method interventions are needed that address grief and trauma in the context of the child's overall mental health, parent/caregiver role in assisting the child, family system issues, ways to provide safe caring environments amidst chaos and change, and interventions that take into account local consumer perspectives, including the voices of children.