Hurling alone? How social capital failed to save the Irish from cardiovascular disease in the United States

Epidemiological transition: a historical analysis of immigration patterns by country of origin (1861-1986) related to circulatory system diseases and all-cause mortality in twentieth-century Australia

BACKGROUND AND OBJECTIVES

Circulatory system disease (CSD) patterns vary over time and between countries, related to lifestyle risk factors, associated in turn with socioeconomic circumstances. Current global CSD epidemics in developing economies are similar in scale to those observed previously in the USA and Australasia. Australia exhibits an important macroeconomic phenomenon as a rapidly transitioning economy with high immigration throughout the nineteenth and twentieth centuries. We wished to examine how that historical immigration related to CSD patterns subsequently.

METHODS AND SETTING

We provide a novel empirical analysis employing census-derived place of birth by age bracket and sex from 1891 to 1986, in order to map patterns of immigration against CSD mortality rates from 1907 onwards. Age-specific generalised additive models for both CSD mortality in the general population, and all-cause mortality for the foreign-born (FB) only, from 1910 to 1980 were also devised for both males and females.

RESULTS

The percentage of FB fell from 32% in 1891 to 9.8% in 1947. Rates of CSD rose consistently, particularly from the 1940s onwards, peaked in the 1960s, then declined sharply in the 1980s and showed a strong period effect across age groups and genders. The main effects of age and census year and their interaction were highly statistically significant for CSD mortality for males (p<0.001, each term) and for females (p<0.001, each term). The main effect of age and year were statistically significant for all-cause mortality minus net migration rates for the FB females (each p<0.001), and for FB males, age (p<0.001) was significant.

CONCLUSIONS

We argue our empirical calculations, supported by historical and socioepidemiological evidence, employing immigration patterns as a proxy for epidemiological transition, affirm the life course hypothesis that both early life circumstances and later life lifestyle drive CSD patterns.

The Great Irish Famine (1845-52) and the Irish asylum system: remembering, forgetting, and remembering again

The Great Irish Famine (1845-52) saw the Irish population fall by 20% as one million people died and another million emigrated. The Famine occurred at a time when the Irish asylums were growing rapidly anyway, so its precise effects on mental health are difficult although not impossible to study. Three groups merit consideration. First, for adults living through the Famine, starvation and poverty contributed to the continued rise in asylum presentations. Second, babies in utero during the Famine were reported to have accounted for an increase in first admissions when they reached the high-risk age for mental illness (1860-75). Third, the possibility of epigenetic effects (inherited changes in gene expression) as a result of Famine has been discussed as a possible mechanism whereby Famine survivors might have passed on experiences of physical and psychological trauma to their children and subsequent generations in a lasting, biological way. Intriguing as it is, this hypothesis requires further study, as does the distinctly uneven historiography of the Famine in relation to the Irish mental hospitals.

Parental population exposure to historical socioeconomic and political periods and grand-child's birth weight in the Lifeways Cross-Generation Cohort Study in the Republic of Ireland

Exposure to deprived socioeconomic conditions during the peri-conception and early childhood periods can have a negative long-term impact on individuals' health and that of their progeny. We aimed to examine whether relatives' birth period affected index-child (grand-child) birthweight status in the Lifeways Cross-Generation Cohort in the Republic of Ireland. Participants were 943 mothers and offspring, 890 fathers, 938 maternal grandmothers (MGM), 700 maternal grandfathers (MGF) 537 paternal grandmothers (PGM) and 553 paternal grandfathers (PGF). Index-child's birthweight was sex-for-gestational age standardised (UK1990 population), and then classified into low birthweight (≤10th percentile) and high-birthweight (≥90th percentile) and compared against normal-birthweight (>10th to <90th percentiles). Four adult birth periods were considered: The Free State (FS, 1916-1938); Emergency Act (EA, 1939-1946); Post-World War-II Baby-Boom (PWWII-BB, 1947-1964); and Modern Ireland (MI, 1964 onwards). Logistic regression was used to assess the crude and adjusted relationship between index-child's birthweight status and relatives' birth periods. Overall, there were 8.7% (n=82) index-children in the low-birthweight category, 77.9% (n=735) and 13.4% (n=126) within the normal and high birthweight groups respectively. Index-children whose mothers were born during the PWWII-BB had higher birthweight infants (Crude OR(COR)=1.81 (1.08-3.03) which remained the case only for male index-children when adjusted for co-variables (Adjusted OR(AOR)=4.61(1.71-12.42)). Parents' combined PWWII-BB birth period was positively associated with male index-child higher birthweight, even adjusted for maternal characteristics (AOR=4.60(1.69-12.50)). MGFs born during the EA were more likely to have grandchildren with low birthweight after adjustment for maternal characteristics (AOR=2.45(1.03-5.85)), particularly for female index-children (AOR=4.74(1.16-19.25)). Both PGMs and PGFs born during the FS period had higher birthweight grandchildren, adjusted for maternal-related co-variables (PGM, AOR=3.23(1.21-8.63); PGF, AOR=3.93(1.11-13.96)), with the effect of PGM more evident in her granddaughter (AOR=6.53(1.25-34.04)). In conclusion, there is some evidence that period of grandparental birth is associated with their grandchildren's birthweights, suggesting that transgenerational exposures may be particular to historical context, meriting further exploration.

Social capital and health among older adults in South Africa

Background

Little is known about social capital and health among older adults in South Africa. This study investigates the association between social capital and several health variables, namely: self-rated health, depressive symptoms, cognitive functioning and physical inactivity, among older South Africans.

Methods

We conducted a national population-based cross-sectional study with a national probability sample of 3840 individuals aged 50 years or older who participated in the Study of Global Ageing and Adults Health (SAGE wave 1) in 2008 in South Africa. Measures included socio-demographic characteristics, health variables, cognitive functioning and physical activity. Social capital was assessed with six components, namely: marital status, social action, sociability, trust and solidarity, safety, and civic engagement.

Results

The social capital assessment revealed that 56% of the respondents were married or cohabiting, 45% reported low (0) social action, 42% reported medium (2–3) sociability, 43% reported high (2) trust and solidarity, 50% reported high (2–4) civic engagement and 42% reported medium (6) psychological resources. In multivariate analysis, self-reported good health was associated with younger age, having secondary education and higher social capital (being married or cohabiting, high trust and solidarity and greater psychological resources). Depressive symptoms were associated with lower social capital (not being married or cohabiting, lack of high trust and solidarity and low psychological resources). Better cognitive functioning was associated with younger age, higher educational level, greater wealth and higher social capital (being married or cohabiting, high trust and solidarity, lack of safety, higher civic engagement and greater psychological resources). Physical inactivity was associated with older age and lower social capital (lower social action, lack of safety, lower civic engagement and poorer psychological resources).

Conclusions

Given the basis of these findings on cross sectional data and subsequent limitation, it was found that these study findings mimic the findings of many European and American studies. Social capital among the elderly generation in South Africa is imperative for better health.

Does childhood adversity account for poorer mental and physical health in second-generation Irish people living in Britain? Birth cohort study from Britain (NCDS)

OBJECTIVES

Worldwide, the Irish diaspora experience elevated mortality and morbidity across generations, not accounted for through socioeconomic position. The main objective of the present study was to assess if childhood disadvantage accounts for poorer mental and physical health in adulthood, in second-generation Irish people.

DESIGN

Analysis of prospectively collected birth cohort data, with participants followed to midlife.

SETTING

England, Scotland and Wales.

PARTICIPANTS

Approximately 17 000 babies born in a single week in 1958. Six per cent of the cohort were of second-generation Irish descent.

OUTCOMES

Primary outcomes were common mental disorders assessed at age 44/45 and self-rated health at age 42. Secondary outcomes were those assessed at ages 23 and 33.

RESULTS

Relative to the rest of the cohort, second-generation Irish children grew up in marked material and social disadvantage, which tracked into early adulthood. By midlife, parity was reached between second-generation Irish cohort members and the rest of the sample on most disadvantage indicators. At age 23, Irish cohort members were more likely to screen positive for common mental disorders (OR 1.44; 95% CI 1.06 to 1.94). This had reduced slightly by midlife (OR 1.27; 95% CI 0.96 to 1.69). Although at age 23 second-generation cohort members were just as likely to report poorer self-rated health (OR 1.06; 95% CI 0.79 to 1.43), by midlife this difference had increased (OR 1.25; 95% CI 0.98 to 1.60). Adjustment for childhood and early adulthood adversity fully attenuated differences in adult health disadvantages.

CONCLUSIONS

Social and material disadvantage experienced in childhood continues to have long-range adverse effects on physical and mental health at midlife, in second-generation Irish cohort members. This suggests important mechanisms over the life-course, which may have important policy implications in the settlement of migrant families.

The effect of rural-to-urban migration on obesity and diabetes in India: a cross-sectional study

BACKGROUND

Migration from rural areas of India contributes to urbanisation and may increase the risk of obesity and diabetes. We tested the hypotheses that rural-to-urban migrants have a higher prevalence of obesity and diabetes than rural nonmigrants, that migrants would have an intermediate prevalence of obesity and diabetes compared with life-long urban and rural dwellers, and that longer time since migration would be associated with a higher prevalence of obesity and of diabetes.

METHODS AND FINDINGS

The place of origin of people working in factories in north, central, and south India was identified. Migrants of rural origin, their rural dwelling sibs, and those of urban origin together with their urban dwelling sibs were assessed by interview, examination, and fasting blood samples. Obesity, diabetes, and other cardiovascular risk factors were compared. A total of 6,510 participants (42% women) were recruited. Among urban, migrant, and rural men the age- and factory-adjusted percentages classified as obese (body mass index [BMI] >25 kg/m(2)) were 41.9% (95% confidence interval [CI] 39.1-44.7), 37.8% (95% CI 35.0-40.6), and 19.0% (95% CI 17.0-21.0), respectively, and as diabetic were 13.5% (95% CI 11.6-15.4), 14.3% (95% CI 12.2-16.4), and 6.2% (95% CI 5.0-7.4), respectively. Findings for women showed similar patterns. Rural men had lower blood pressure, lipids, and fasting blood glucose than urban and migrant men, whereas no differences were seen in women. Among migrant men, but not women, there was weak evidence for a lower prevalence of both diabetes and obesity among more recent (

CONCLUSIONS

Migration into urban areas is associated with increases in obesity, which drive other risk factor changes. Migrants have adopted modes of life that put them at similar risk to the urban population. Gender differences in some risk factors by place of origin are unexpected and require further exploration. Please see later in the article for the Editors' Summary.

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Key Words Collapse

MESH Headings

• Adolescent
• Adult
• Aged
• Cross-Sectional Studies
• Diabetes Mellitus/epidemiology
• Female
• Humans
• India/epidemiology
• Male
• Middle Aged
• Obesity/epidemiology
• Population Dynamics
• Risk Factors
• Socioeconomic Factors
• Young Adult

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Grants

• Wellcome Trust
• 084674 Wellcome Trust
• G0600705 Medical Research Council
• GR070797MF Wellcome Trust

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Affiliation(s)

Shah Ebrahim Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Sanjay Kinra
Liza Bowen
Elizabeth Andersen
Yoav Ben-Shlomo
Tanica Lyngdoh
Lakshmy Ramakrishnan
R C Ahuja
Prashant Joshi
S Mohan Das
Murali Mohan
George Davey Smith
Dorairaj Prabhakaran
K Srinath Reddy

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Changes in food habits after migration among South Asians settled in Oslo: the effect of demographic, socio-economic and integration factors

The aim is to explore changes in food habits after migration, and the resultant present food consumption patterns, as well as the effect of demographic, socio-economic and integration factors on these changes. Analyses were based on data collected through the Oslo Immigrant Health study, from 629 persons 30-60 years of age, born in Sri Lanka and Pakistan, and living in Oslo, Norway. A majority of the Sri Lankans reported increase in the consumption of meat, milk, butter, margarine and potatoes. Around half of those from Pakistan reported increased consumption of oil, meat, fish and potatoes. Both groups reported a decrease in bean and lentil consumption. Multivariate regression showed that age was negatively related to increases in butter and margarine consumption, and a good command of the Norwegian language reduced the likelihood of increased consumption of oil and butter. The likelihood of having present fat and sugar rich food patterns were reduced with age and years of education, whereas scoring high on an index of integration increased the likelihood of a fat rich food pattern. In conclusion, a number of demographic and socio-cultural factors may modify the changes in food habits after migration. Some of these may have substantial health implications.

The “Americanisation” of migrants: Evidence for the contribution of ethnicity, social deprivation, lifestyle and life-course processes to the mid-20th century Coronary Heart Disease epidemic in the US

We investigated the contribution of the large-scale immigration of White Europeans into the US between 1850 and 1930 to the timing and extent of the epidemic pattern of heart disease between 1900 and 1980. The analyses are based on data collected through the United States Federal Census from 1850 to the present. The hardcopy historical record confirms that census reports themselves and related monographs were concerned from 1850 with excessive mortality from heart disease of immigrants, particularly of Northern European origin and initially at least, their first-generation native-born children. Our analysis of the electronic database indicates a strong relationship between the percentage of US population foreign born and native born of foreign parentage and age adjusted mortality from heart disease. We identified a lag of 50 years giving the maximum linear correlation coefficient for men (r(2) = 0.92), and for women a shorter lag of 38 years and an earlier decline in Coronary Heart Disease (CHD) rates (r(2) = 0.96). Both the rise and fall of the CHD epidemic over an 80-year period correspond closely to the rise and fall of the foreign population in previous years. For the foreign born only, age adjusted negative binomial general estimated equation (GEE) models calculate the relative risk of dying of heart disease per 10% increase in proportion foreign born. There is an independent influence for men until 1930 and for women throughout the period from 1910 onwards. We conclude there is an impact of immigration on the pattern of the epidemic, mediated through a combination of factors, such as accumulated life-course susceptibility, deprived socio-economic conditions upon arrival, and the enthusiastic uptake of behaviours related to the classic risk factors of smoking, high saturated fat and salt diet. Our analysis provides a more contextualised understanding of the scale and timing of the epidemic of CHD in the US.

Sib-recruitment for studying migration and its impact on obesity and diabetes

BACKGROUND

Urban-rural comparisons are of limited relevance in examining the effects of urban migration in developing countries where urbanisation is due to growth of existing urban populations, expansion of urban boundaries, and rural in-migration. Cultural, genetic and life-style backgrounds of migrants and host populations further limit the value of rural-urban comparisons. Therefore we evaluated a sib-comparison design intended to overcome the limitations of urban-rural comparisons.

METHODS

Using the framework of a current cardiovascular risk factor screening study conducted in Indian factories, we recruited the non-migrant rural sibs of migrant urban factory workers and the urban sibs of non-migrant factory workers. The response rate, completed interviews and examinations conducted were assessed. Adequacy of generic food frequency questionnaires and WHO quality of life questionnaire were assessed.

RESULTS

All the urban factory workers and spouses approached agreed to be interviewed. Of the 697 participants interviewed, 293 (42%) had at least one rural dwelling sibling. Twenty (22%) siblings lived further than 100 km from the study site. An additional 21 urban siblings of non-migrant factory workers were also investigated to test the logistics of this element of the study. Obesity (BMI >25 kg/m2) was more common in rural sibs than urban factory workers (age adjusted prevalence: 21.1% (17.1 to 25.0) vs. 16.1% (11.9, 20.3). Diabetes prevalence (fasting plasma glucose greater than 126 mg/dl) was higher than expected (age-adjusted prevalence: 12.5% (22 out of 93) in urban migrants and 4.5% (8 out of 90) in rural non-migrant sibs.

CONCLUSION

The sib-comparison design is robust and has been adopted in the main study. It is possible that simple urban-rural study designs under-estimate the true differences in diabetes risk between migrants and non-migrants.