1
|
Lim YH, Bilsteen JF, Mortensen LH, Lanzky LRM, Zhang J, Tuffier S, Brandt J, Ketzel M, Flensborg-Madsen T, Wimmelmann CL, Okholm GT, Hegelund ER, Napolitano GM, Andersen ZJ, Loft S. Lifetime exposure to air pollution and academic achievement: A nationwide cohort study in Denmark. Environ Int 2024; 185:108500. [PMID: 38430583 DOI: 10.1016/j.envint.2024.108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/04/2024]
Abstract
Recent research suggests a link between air pollution and cognitive development in children, and studies on air pollution and academic achievement are emerging. We conducted a nationwide cohort study in Denmark to explore the associations between lifetime exposure to air pollution and academic performance in 9th grade. The study encompassed 785,312 children born in Denmark between 1989 and 2005, all of whom completed 9th-grade exit examinations. Using linear mixed models with a random intercept for each school, we assessed the relationship between 16 years of exposure to PM2.5, PM10, and gaseous pollutants and Grade Point Averages (GPA) in exit examinations, covering subjects such as Danish literature, Danish writing, English, mathematics, and natural sciences. The study revealed that a 5 µg/m3 increase in PM2.5 and PM10 was associated with a decrease of 0.99 (95 % Confidence Intervals: -1.05, -0.92) and 0.46 (-0.50, -0.41) in GPA, respectively. Notably, these negative associations were more pronounced in mathematics and natural sciences compared to language-related subjects. Additionally, girls and children with non-Danish mothers were found to be particularly susceptible to the adverse effects of air pollution exposure. These results underscore the potential long-term consequences of air pollution on academic achievement, emphasizing the significance of interventions that foster healthier environments for children's cognitive development.
Collapse
Affiliation(s)
- Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Josephine Funck Bilsteen
- Ministry of Children and Education, National Agency for Education and Quality, Copenhagen, Denmark
| | | | | | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stéphane Tuffier
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Trine Flensborg-Madsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Gunhild Tidemann Okholm
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | | | - George Maria Napolitano
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Sentenac M, Benhammou V, Aden U, Ancel PY, Bakker LA, Bakoy H, Barros H, Baumann N, Bilsteen JF, Boerch K, Croci I, Cuttini M, Draper E, Halvorsen T, Johnson S, Källén K, Land T, Lebeer J, Lehtonen L, Maier RF, Marlow N, Morgan A, Ni Y, Raikkonen K, Rtimi A, Sarrechia I, Varendi H, Vollsaeter M, Wolke D, Ylijoki M, Zeitlin J. Maternal education and cognitive development in 15 European very-preterm birth cohorts from the RECAP Preterm platform. Int J Epidemiol 2022; 50:1824-1839. [PMID: 34999864 DOI: 10.1093/ije/dyab170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies are sparse and inconclusive about the association between maternal education and cognitive development among children born very preterm (VPT). Although this association is well established in the general population, questions remain about its magnitude among children born VPT whose risks of medical and developmental complications are high. We investigated the association of maternal education with cognitive outcomes in European VPT birth cohorts. METHODS We used harmonized aggregated data from 15 population-based cohorts of children born at <32 weeks of gestational age (GA) or <1500 g from 1985 to 2013 in 13 countries with information on maternal education and assessments of general development at 2-3 years and/or intelligence quotients between 4 and 15 years. Term-born controls (≥37 weeks of GA) were available in eight cohorts. Maternal education was classified as: low (primary/lower secondary); medium (upper secondary/short tertiary); high (bachelor's/higher). Pooled standardized mean differences (SMDs) in cognitive scores were estimated (reference: high educational level) for children assessed at ages 2-3, 4-7 and 8-15 years. RESULTS The study included 10 145 VPT children from 12 cohorts at 2-3 years, 8829 from 12 cohorts at 4-7 years and 1865 children from 6 cohorts at 8-15 years. Children whose mothers had low, compared with high, educational attainment scored lower on cognitive measures [pooled unadjusted SMDs: 2-3 years = -0.32 (95% confidence intervals: -0.43 to -0.21); 4-7 years = -0.57 (-0.67; -0.47); 8-15 years = -0.54 (-0.72; -0.37)]. Analyses by GA subgroups (<27 vs ≥27 weeks) in children without severe neonatal morbidity and term controls yielded similar results. CONCLUSIONS Across diverse settings and regardless of the degree of prematurity, low maternal education was associated with lower cognition.
Collapse
Affiliation(s)
- Mariane Sentenac
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France
| | - Valérie Benhammou
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France
| | - Ulrika Aden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Pierre-Yves Ancel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France
| | - Leonhard A Bakker
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Hannah Bakoy
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, UK
| | - Josephine Funck Bilsteen
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Boerch
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area, Bambino Gesù Pediatric Hospital, Roma, Lazio, Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Pediatric Hospital, Roma, Lazio, Italy
| | - Elizabeth Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Karin Källén
- Department of Obstetrics and Gynecology, Unit of Reproduction Epidemiology, Institution of Clinical Sciences, University of Lund, Lund, Sweden
| | - Tuuli Land
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Jo Lebeer
- Department of Family Medicine & Population Health, Disability Studies, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital Turku, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Andrei Morgan
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Yanyan Ni
- Department of Psychology, University of Warwick, Coventry, UK
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Katri Raikkonen
- Department of Psychology and Logopedics, University Of Helsinki, Helsinki, Finland
| | - Anass Rtimi
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France
| | - Iemke Sarrechia
- Department of Family Medicine & Population Health, Disability Studies, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Heili Varendi
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Maria Vollsaeter
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - Milla Ylijoki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital Turku, Turku, Finland
- Department of Paediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France
| |
Collapse
|
3
|
Bilsteen JF, Alenius S, Bråthen M, Børch K, Ekstrøm CT, Kajantie E, Lashkariani M, Nurhonen M, Risnes K, Sandin S, van der Wel KA, Wolke D, Andersen AMN. Gestational Age, Parent Education, and Education in Adulthood. Pediatrics 2022; 149:183795. [PMID: 34877601 PMCID: PMC9645686 DOI: 10.1542/peds.2021-051959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adults born preterm (<37 weeks) have lower educational attainment than those born term. Whether this relationship is modified by family factors such as socioeconomic background is, however, less well known. We investigated whether the relationship between gestational age and educational attainment in adulthood differed according to parents' educational level in 4 Nordic countries. METHODS This register-based cohort study included singletons born alive from 1987 up to 1992 in Denmark, Finland, Norway, and Sweden. In each study population, we investigated effect modification by parents' educational level (low, intermediate, high) on the association between gestational age at birth (25-44 completed weeks) and low educational attainment at 25 years (not having completed upper secondary education) using general estimation equations logistic regressions. RESULTS A total of 4.3%, 4.0%, 4.8%, and 5.0% singletons were born preterm in the Danish (n = 331 448), Finnish (n = 220 095), Norwegian (n = 292 840), and Swedish (n = 513 975) populations, respectively. In all countries, both lower gestational age and lower parental educational level contributed additively to low educational attainment. For example, in Denmark, the relative risk of low educational attainment was 1.84 (95% confidence interval 1.44 to 2.26) in adults born at 28 to 31 weeks whose parents had high educational level and 5.25 (95% confidence interval 4.53 to 6.02) in adults born at 28 to 31 weeks whose parents had low educational level, compared with a reference group born at 39 to 41 weeks with high parental educational level. CONCLUSIONS Although higher parental education level was associated with higher educational attainment for all gestational ages, parental education did not mitigate the educational disadvantages of shorter gestational age.
Collapse
Affiliation(s)
- Josephine Funck Bilsteen
- Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Address correspondence to Josephine Funck Bilsteen, MSc, Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, Øster Farimagsgade 5, 1014 København K. E-mail:
| | - Suvi Alenius
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Magne Bråthen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - Klaus Børch
- Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eero Kajantie
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mariam Lashkariani
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markku Nurhonen
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Department of Research, Innovation, and Education and Children’s Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York
| | - Kjetil A. van der Wel
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - Dieter Wolke
- Department of Psychology and Centre of Early Life, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Bilsteen JF, Ekstrøm CT, Børch K, Nybo Andersen A. The role of parental education on the relationship between gestational age and school outcomes. Paediatr Perinat Epidemiol 2021; 35:726-735. [PMID: 34080707 PMCID: PMC8597013 DOI: 10.1111/ppe.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals born preterm may experience difficulties beyond the neonatal period, such as poorer school outcomes. However, whether these outcomes are modified by family factors is less well-known. OBJECTIVES To investigate whether parental educational level modify the relationship of gestational age with completion of final examinations and grade point average in compulsory education. METHODS This nationwide register-based cohort study included singletons born in Denmark during 1995-2001. We investigated the differences in the associations between gestational age (24-44 weeks) and two school outcomes at 16 years according to parental educational level (lower (≤10 years), intermediate (11-13 years), and higher (>13 years)). Mixed-effect logistic regression and mixed-effect linear regression were used to model completion of final examination and grade point average, respectively. RESULTS Of the 425 101 singletons, 4.7% were born before 37 weeks. The risk of not completing final examination increased with shorter gestational age and lower parental educational level. For instance, among adolescents whose parents had a lower educational level, the risk increased from 23.9% (95% CI, 23.1, 24.6) for those born in week 40 to 36.6% (95% CI, 31.5, 42.1) for those born in week 28. For adolescents whose parents had a higher educational level, the corresponding risk increase was 5.9% (95% CI, 5.7, 6.1) to 10.5% (95% CI, 8.6, 12.8), respectively. Grade point average decreased with shorter gestational age in adolescents born before 30 weeks and with lower parental educational level. The associations between gestational age and grade point average were similar across parental educational levels. For completions of final examination, the associations with gestational age were weaker with higher parental educational level. CONCLUSIONS Shorter gestational age and lower parental educational level were associated with poorer school outcomes. Our findings suggest that parental educational level mitigates the adverse effects of shorter gestational age on some school outcomes.
Collapse
Affiliation(s)
- Josephine Funck Bilsteen
- Department of PaediatricsHvidovre University HospitalHvidovreDenmark,Section of EpidemiologyDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Claus Thorn Ekstrøm
- Section of BiostatisticsDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Klaus Børch
- Department of PaediatricsHvidovre University HospitalHvidovreDenmark
| | | |
Collapse
|
5
|
Kornerup N, Andersen AMN, Andersen PK, Bilsteen JF, Urhoj SK. Social, demographic and health characteristics of men fathering children at different ages. Sci Rep 2021; 11:21021. [PMID: 34697360 PMCID: PMC8545932 DOI: 10.1038/s41598-021-00482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to examine associations between selected sociodemographic, socioeconomic, and health characteristics and the rates of fatherhood in different age groups. We investigated rates between 2011 and 2015 in a population-based register study including all men born from 1945 to 1995 residing in Denmark in 2011. The study population consisted of 1,867,108 men who fathered 268,612 children during the follow-up. The associations were quantified as incidence rate ratios using Poisson regression. Young men had higher rates of fathering a child if they lived outside the Capital Region, had a relatively high income, were previously diagnosed with cardiovascular disease, psychoactive substance abuse, personality disorders, schizophrenia or behavioural and emotional disorders. Men of advanced age had higher rates of fathering a child when born outside Denmark, living in the Capital Region, were in the lower or upper 10th percentile income group, were self-employed or unemployed or previously diagnosed with depression. Men of advanced age had lower rates of fathering a child if previously diagnosed with somatic diseases, psychoactive substance abuse or mental retardation. The findings highlight the importance of consideration of various sociodemographic, socioeconomic, and health characteristics when studying associations between paternal age and offspring health.
Collapse
Affiliation(s)
- Nina Kornerup
- Faculty of Health and Medical Sciences, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, Copenhagen K, Denmark.
- Department of Gynecology and Obstetrics, Holbæk Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark.
| | - Anne-Marie Nybo Andersen
- Faculty of Health and Medical Sciences, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, Copenhagen K, Denmark
| | - Per Kragh Andersen
- Faculty of Health and Medical Sciences, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5 opg. B, P.O. Box 2099, 1014, Copenhagen K, Denmark
| | - Josephine Funck Bilsteen
- Faculty of Health and Medical Sciences, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, Copenhagen K, Denmark
| | - Stine Kjaer Urhoj
- Faculty of Health and Medical Sciences, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5A, Box 2099, 1014, Copenhagen K, Denmark
| |
Collapse
|
6
|
Abstract
IMPORTANCE Adverse long-term outcomes in individuals born before full gestation are not confined to individuals born at extreme gestational ages. Little is known regarding mortality patterns among individuals born in the weeks close to ideal gestation, and the exact causes are not well understood; both of these are crucial for public health, with the potential for modification of risk. OBJECTIVE To examine the risk of all-cause and noncommunicable diseases (NCD) deaths among young adults born preterm and early term. DESIGN, SETTING, AND PARTICIPANTS This multinational population-based cohort study used nationwide birth cohorts from Norway, Sweden, Denmark, and Finland for individuals born between 1967 and 2002. Individuals identified at birth who had not died or emigrated were followed up for mortality from age 15 years to 2017. Analyses were performed from June 2019 to May 2020. EXPOSURES Categories of gestational age (ie, moderate preterm birth and earlier [23-33 weeks], late preterm [34-36 weeks], early term [37-38 weeks], full term [39-41 weeks] and post term [42-44 weeks]). MAIN OUTCOMES AND MEASURES All-cause mortality and cause-specific mortality from NCD, defined as cancer, diabetes, chronic lung disease, and cardiovascular disease (CVD). RESULTS A total of 6 263 286 individuals were followed up for mortality from age 15 years. Overall, 339 403 (5.4%) were born preterm, and 3 049 100 (48.7%) were women. Compared with full-term birth, the adjusted hazard ratios (aHRs) for all-cause mortality were 1.44 (95% CI, 1.34-1.55) for moderate preterm birth and earlier; 1.23 (95% CI, 1.18-1.29) for late preterm birth; and 1.12 (95% CI, 1.09-1.15) for early-term birth. The association between gestational age and all-cause mortality were stronger in women than in men (P for interaction = .03). Preterm birth was associated with 2-fold increased risks of death from CVD (aHR, 1.89; 95% CI, 1.45-2.47), diabetes (aHR, 1.98; 95% CI, 1.44-2.73), and chronic lung disease (aHR, 2.28; 95% CI, 1.36-3.82). The main associations were replicated across countries and could not be explained by familial or individual confounding factors. CONCLUSIONS AND RELEVANCE The findings of this study strengthen the evidence of increased risk of death from NCDs in young adults born preterm. Importantly, the increased death risk was found across gestational ages up to the ideal term date and includes the much larger group with early-term birth. Excess mortality associated with shorter gestational age was most pronounced for CVDs, chronic lung disease, and diabetes.
Collapse
Affiliation(s)
- Kari Risnes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innovation, and Education, Children’s Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Josephine Funck Bilsteen
- Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Paul Brown
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Pulakka
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Signe Opdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
- Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology, and Ophthalmology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York
| |
Collapse
|
7
|
Clotworthy A, Dissing AS, Nguyen TL, Jensen AK, Andersen TO, Bilsteen JF, Elsenburg LK, Keller A, Kusumastuti S, Mathisen J, Mehta A, Pinot de Moira A, Rod MH, Skovdal M, Strandberg-Larsen K, Tapager IW, Varga TV, Vinther JL, Xu T, Hoeyer K, Hulvej Rod N. 'Standing together - at a distance': Documenting changes in mental-health indicators in Denmark during the COVID-19 pandemic. Scand J Public Health 2020; 49:79-87. [PMID: 32907495 PMCID: PMC7859573 DOI: 10.1177/1403494820956445] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims: There is a need to document the mental-health effects of
the COVID-19 pandemic and its associated societal lockdowns. We initiated a
large mixed-methods data collection, focusing on crisis-specific worries and
mental-health indicators during the lockdown in Denmark.
Methods: The study incorporated five data sources,
including quantitative surveys and qualitative interviews. The surveys included
a time series of cross-sectional online questionnaires starting on 20 March
2020, in which 300 (3×100) Danish residents were drawn every three days from
three population groups: the general population (N=1046),
families with children (N=1032) and older people
(N=1059). These data were analysed by trend analysis.
Semi-structured interviews were conducted with 32 people aged 24–83 throughout
Denmark to provide context to the survey results and to gain insight into
people’s experiences of the lockdown. Results: Absolute level
of worries, quality of life and social isolation were relatively stable across
all population groups during the lockdown, although there was a slight
deterioration in older people’s overall mental health. Many respondents were
worried about their loved ones’ health (74–76%) and the potential long-term
economic consequences of the pandemic (61–66%). The qualitative interviews
documented significant variation in people’s experiences, suggesting that the
lockdown’s effect on everyday life had not been altogether negative.
Conclusions: People in Denmark seem to have
managed the lockdown without alarming changes in their mental health.
However, it is important to continue investigating the effects of the
pandemic and various public-health measures on mental health over time and
across national contexts.
Collapse
Affiliation(s)
- Amy Clotworthy
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Agnete Skovlund Dissing
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Tri-Long Nguyen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Andreas Kryger Jensen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Thea Otte Andersen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Josephine Funck Bilsteen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Leonie K Elsenburg
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Amélie Keller
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Sasmita Kusumastuti
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Jimmi Mathisen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Amar Mehta
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Angela Pinot de Moira
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | | | - Morten Skovdal
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Katrine Strandberg-Larsen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | | | - Tibor V Varga
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Johan Lerbech Vinther
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Tianwei Xu
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Klaus Hoeyer
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Denmark
| |
Collapse
|
8
|
Bilsteen JF, Taylor-Robinson D, Børch K, Strandberg-Larsen K, Nybo Andersen AM. Gestational Age and Socioeconomic Achievements in Young Adulthood: A Danish Population-Based Study. JAMA Netw Open 2018; 1:e186085. [PMID: 30646301 PMCID: PMC6324359 DOI: 10.1001/jamanetworkopen.2018.6085] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE The poor health outcomes associated with preterm birth are well established. However, it is less clear how small variations in gestational age, even within the term range, are associated with long-term opportunities and well-being, as measured by socioeconomic outcomes in adulthood. OBJECTIVE To examine the association of gestational age at birth with educational achievement, income, and primary source of income in adulthood. DESIGN, SETTING, AND PARTICIPANTS This Danish population-based, register-based cohort study examined all live-born singletons born in Denmark from 1982 to 1986 without congenital anomalies and who lived in Denmark at age 28 years. Data analysis was conducted from November 2, 2017, to June 15, 2018. EXPOSURES Gestational age at birth in completed weeks (22-45 weeks). MAIN OUTCOMES AND MEASURES Educational attainment, personal income, and primary source of income at age 28 years. RESULTS In a population of 228 030 singletons (4.0% preterm, 12.1% early term; 49.4% female), 36.3% had a tertiary education at age 28 years. Among adults born at 22 to 27 weeks of gestation, 21.6% had a tertiary education, and 23.2% had an income in the highest tertile. Using 40 weeks of gestation as the reference, the adjusted odds ratio for tertiary education for individuals born at 22 to 27 weeks of gestation was 0.21 (95% CI, 0.13-0.35) and the corresponding figures for 28 to 31, 33, 36, 38, and 43 to 45 weeks of gestation were 0.45 (95% CI, 0.37-0.55), 0.67 (95% CI, 0.54-0.83), 0.84 (95% CI, 0.77-0.93), 0.85 (95% CI, 0.81-0.89), and 0.93 (95% CI, 0.83-1.04), respectively. The adjusted odds ratio for highest income tertile for individuals born at 22 to 27 weeks of gestation was 0.66 (95% CI, 0.41-1.06) and the corresponding figures for 28 to 31, 33, 36, 38, and 43 to 45 weeks of gestation were 0.80 (95% CI, 0.68-0.94), 0.77 (95% CI, 0.63-0.93), 0.89 (95% CI, 0.82-0.96), 0.95 (95% CI, 0.91-0.99), and 1.00 (95% CI, 0.91-1.12), respectively. All estimates were adjusted for sex, birth year, parity, maternal age, maternal education, and maternal country of origin. CONCLUSIONS AND RELEVANCE Shorter gestational duration even within the term range was associated with poorer socioeconomic outcomes in adulthood. While adults born at 35 to 38 weeks of gestation experienced only slightly increased risk of adverse socioeconomic outcomes, this may have a significant impact on public health, since a large proportion of all children are born in these weeks.
Collapse
Affiliation(s)
- Josephine Funck Bilsteen
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Klaus Børch
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Bilsteen JF, Andresen JB, Mortensen LH, Hansen AV, Andersen AMN. Educational disparities in perinatal health in Denmark in the first decade of the 21st century: a register-based cohort study. BMJ Open 2018; 8:e023531. [PMID: 30413512 PMCID: PMC6231602 DOI: 10.1136/bmjopen-2018-023531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate socioeconomic differences in six perinatal health outcomes in Denmark in the first decade of the 21st century. DESIGN A population-based cohort study. SETTING Danish national registries. PARTICIPANTS A total of 646 829 live born children and 3076 stillborn children (≥22+0 weeks of gestation) born in Denmark from 2000 to 2009. We excluded children with implausible relations between birth weight and gestational age (n=644), children without information on maternal country of origin (n=138) and implausible values of maternal year of birth (n=36). MAIN OUTCOME MEASURES We investigated the following perinatal health outcomes: stillbirth, neonatal and postneonatal mortality, small-for-gestational age, preterm birth grated into moderate preterm, very preterm and extremely preterm, and congenital anomalies registered in the first year of life. RESULTS Maternal educational level was inversely associated with all adverse perinatal outcomes. For all examined outcomes, the risk association displayed a clear gradient across the educational levels. The associations remained after adjustment for maternal age, maternal country of origin and maternal year of birth. Compared with mothers with vocational education, mothers with more than 15 years of education had an adjusted risk ratio for stillbirth of 0.64(95% CI 0.56 to 0.72). The corresponding adjusted risk ratios for neonatal mortality, postneonatal mortality, congenital anomalies, moderate preterm birth and small-for-gestational age were, respectively, 0.79(95% CI 0.67 to 0.93), 0.57(95% CI 0.42 to 0.78), 0.87(95% CI 0.83 to 0.91), 0.80(95% CI 0.77 to 0.83) and 0.83(95% CI 0.81 to 0.85). CONCLUSION Substantial educational inequalities in perinatal health were still present in Denmark in the first decade of the 21st century.
Collapse
Affiliation(s)
- Josephine Funck Bilsteen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Laust Hvas Mortensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Vinkel Hansen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|