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Projection studies have often focused on mortality and, more recently, migration. Fertility is less studied, although even small changes can have significant repercussions for the size and age structure of future populations. Across Europe, there is no consensus on how fertility is best projected. In this article, we identify different approaches used to project fertility among statistical agencies in Europe and provide an assessment of the different approaches according to the producers themselves. Data were collected using a mixed-method approach. First, European statistical agencies answered a questionnaire regarding fertility projection practices. Second, an in-depth review of select countries was performed. Most agencies combine formal models with expert opinion. While many attempt to maximise the use of relevant inputs, there is more variation in the detail of outputs, with some agencies unable to account for changing age patterns. In a context of limited resources, most are satisfied with their approaches, though some are assessing alternative methodologies to improve accuracy and increase transparency. This study highlights the diversity of approaches used in fertility projections across Europe. Such knowledge may be useful to statistical agencies as they consider, test and implement different approaches, perhaps in collaboration with other agencies and the wider scientific community.

The role of intergenerational geographic proximity in individuals' migration decisions has been well-established. The circumstances under which parents and their adult children move away from or remain close to each other are, however, less clear. Drawing on Norwegian register data for 2014–2016 and three-level logistic regression models, we examine whether formal care needs of older parents (aged ≥65) deter parent-child geographic divergence and whether variation in the likelihood of divergence is associated with municipal-level characteristics. After accounting for location-specific capital and parents' and children's sociodemographic characteristics, parents and children were less likely to diverge after the onset of parental care needs. Utilising in-home nursing decreased the likelihood of divergence for mothers while utilising institutionalised care decreased the likelihood of divergence for fathers. The use of in-home nursing care among single mothers further reduced the likelihood of divergence. Parents and adult children living in central areas were the least likely to diverge geographically. The likelihood of intergenerational divergence was lower for fathers and children living in municipalities with high healthcare spending.

BACKGROUND The impact of cancer on socioeconomic outcomes is attracting attention as the number of survivors of cancer in young age continues to rise. This study examines economic independence in a national cohort of survivors of cancer at a young age in Norway. METHODS Through the linkage of several national registries, the study cohort comprised 1,212,013 individuals born in Norway during 1965 through 1985, of which 5440 had received a cancer diagnosis before age 25 years. Follow‐up was through 2007, and the main outcomes were receipt of governmental financial assistance, employment, income, and occupation. Analytic methods included Cox proportional hazard regression, log‐binomial regression, and quantile regression models. RESULTS Individuals in the cancer survivor group had an increased probability of receiving governmental financial assistance (men: hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.3‐1.5; women: HR, 1.5; 95% CI, 1.3‐1.6) and of not being employed (men: HR, 1.4; 95% CI, 1.2‐1.7; women: HR, 1.4; 95% CI, 1.2‐1.6) compared with those in the noncancer group. Income discrepancies were particularly pronounced for survivors of central nervous system tumors. There was no difference in representation in higher skilled occupations. CONCLUSIONS Survivors of cancer at a young age in Norway had an increased risk of being economically dependent and unemployed. This was evident in several tumor groups and was most pronounced in female survivors. There were only small differences in income or representation in higher skilled occupations for most employed survivors compared with the noncancer group. The current results are important for understanding the impact of a cancer diagnosis at a young age on subsequent job market outcomes. Cancer 2016;122:3873–3882. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society., Cancer during childhood, adolescence, and young adulthood can influence subsequent economic and occupational outcomes. In a national cohort study from Norway, increased economic dependence and unemployment is demonstrated; however, overall, there are no substantial differences in income or occupational fields among survivors of cancer diagnosed before age 25 years when compared with cancer‐free references except for survivors of central nervous system tumors.

Objectives: While poor health contributes to early work exits, it is less clear how early work exits affect health. This study therefore examines changes in health associated with retirement. Method: Survey data from gainfully employed individuals aged 57 to 66 in 2002 were used to assess changes in health status and behaviors associated with retirement (49%) 5 years later ( N = 546). Results: Compared with workers, retirees were more likely to report improvements in mental health (odds ratio [OR] = 1.67), and less likely to report mental health deteriorations (OR = 0.56). Retirees were more likely to both increase (OR = 2.03) and reduce (OR = 1.87) their alcohol intake, and to increase physical activity (OR = 2.01) and lose weight (OR = 1.75). Discussion: As welfare states aim to extend working life to counteract repercussions of population aging, findings on possible health benefits for retirees may warrant more focus on the pros and cons of a prolonged working life.

Objectives: To assess five-year changes in health behaviours in later life and associations with onset of chronic health problems. The results may inform policy and interventions to promote healthy life years in ageing populations.Methods: Data are derived from the Norwegian study on Life-course, Ageing and Generation (NorLAG), a five-year (2002-2007) panel survey comprising a nation wide community sample. The present analyses include a sample of 1,019 respondents aged 60 years and older. Five-year changes in smoking, alcohol use, physical exercise and Body Mass Index (BMI) are assessed according to prevalent and incident chronic health problems. Multivariate logistic analyses of “healthy” behavioural changes are conducted.Results: A total of 453 respondents (45%) reported at least one chronic condition and 13% (N=133) reported onset of chronic conditions in the course of the past five years. Over a five-year period, there was an overall reduction in smoking rates and a decrease in regular physical activity. Alcohol consumption in older people slightly increased over time, but the incidence of chronic health problems tended to reduce alcohol intake. Older persons experiencing chronic health problems were less likely to initiate physical activity.Conclusions: The results provide limited support for the assumption that the onset of a chronic health condition triggers improved health behaviours. This suggests that the health care system could do more in targeting a potential “window of opportunity” for individuals to adopt new healthy behaviours in later life.

Background: Cancer is a disease closely associated with aging. Aging populations will thus lead to a pronounced increase in the absolute number of elderly persons with cancer, resulting in profound public health challenges in the coming decades. Older patients have distinct treatment and care needs, but are nevertheless largely overlooked in studies. We therefore examine cancer incidence, prevalence and survival among older cancer patients to help guide various stakeholders in the acute and more long-term handling of this patient group.Data and methods: >400 000 cancers diagnosed in individuals age 65+ in 1975-2009 were extracted from the Cancer Registry of Norway. Descriptive analyses of incidence and prevalence were undertaken, and survival analysis was used to model survival.Results: The absolute number of elderly (65-79 years) and oldest old (80+ years) patients has more than doubled since 1975, and will continue to grow towards 2030. A more than threefold increase in patients 80+ years has taken place. The largest patients groups comprise colorectal, prostate, lung and breast cancer. For all patients 65 and older, the median survival has increased with 135%. The increase has been most pronounced for the elderly patients. Surgical resection rates decline with increasing patient age. The difference in relative survival is around 8 percentage points at three years (60% vs 52%). It has been constant over time.Conclusion: “Best practice” guidelines for the large and increasing group of older cancer patients remain to be established. The gain in length of lives must be balanced against patients’ quality of life, and considered in a cost-benefit perspective for society at large.

Video abstract Video, Background Today many people are choosing to have children later in life. Additionally, the use of sophisticated diagnostic tools and screening modalities has increased over recent years. Because of these factors, cancer is being diagnosed more frequently during the child-rearing years. Sociodemographic and cancer-related information on families and minor (0–18 years) and young adult (YA) (19–25 years) children experiencing parental cancer is scarce, but this information is vital for healthcare initiatives aimed toward those potentially adversely affected. Therefore, the aim of this study was to describe features of families and minor and YA children affected by parental cancer in a nationwide population. Methods Complete Norwegian birth cohort data were obtained from national registries. Descriptive prevalence and incidence statistics were collected for parents and minor and YA children. Logistic regression models were used to assess factors likely to influence parental death. Results Every year around 0.3% of all families with children under the age of 18 years encounter parental cancer, and 3.1% of minors and 8.4% of YAs have a parent who has been diagnosed with cancer. This study found skin, breast, testicular, and colorectal cancers were the most common forms of cancer diagnosed. The sociodemographic features of those affected were fairly similar to those of the general population. One in five children experienced parental death from cancer; parental death was more often paternal than maternal and was most common in parents diagnosed with leukemia or brain, colorectal, and lung tumors. Deaths are uncommon among parents without cancer. Conclusion Adequate assistance for minor and YA children affected by parental cancer requires knowledge of their number and characteristics. Parental cancer is more common than previously suggested: the annual incidence of parental cancer for children under 18 years of age is 0.3%, whereas approximately 4% of children aged 0–25 years have or have had parents diagnosed with cancer, corresponding to a population prevalence of 1.4%. Around 20% of these children experience parental death, and surveys of live respondents should account for this.

Background Rates of all-cause and cause-specific mortality are higher among unmarried than married individuals. Cancer survival is also poorer in the unmarried population. Recently, some studies have found that the excess all-cause mortality of the unmarried has increased over time, and the same pattern has been shown for some specific causes of death. The objective of this study was to investigate whether there has been a similar change over time in marital status differences in cancer survival. Methods Discrete-time hazard regression models for cancer deaths among more than 440 000 women and men diagnosed with cancer 1970-2007 at age 30-89 were estimated, using register data encompassing the entire Norwegian population. More than 200 000 cancer deaths during over 2 million person-years of exposure were analyzed. Results The excess mortality of the never-married compared to the married has increased steadily for men, in particular the elderly. Among elderly women, the excess mortality of the never-married compared to the married has increased, and there are indications of an increasing excess mortality of the widowed. The excess mortality of divorced men and women, however, has been stable. Conclusions There is no obvious explanation for the increasing disadvantage among the never-married. It could be due to a relatively poorer general health at time of diagnosis, either because of a more protective effect of partnership in a society that may have become less cohesive or because of more positive selection into marriage. Alternatively, it could be related to increasing differentials with respect to treatment. Today's complex cancer therapy regimens may be more difficult for never-married to follow, and health care interventions directed and adapted more specifically to the broad subgroup of never-married patients might be warranted.

Discrete-time hazard regression models were employed to register and census data on 1.4 million Norwegian married couples from 1974-2001 to explore the probability of divorce following cancer illness. Divorce rates for around 215 000 persons diagnosed with cancer were compared to divorce rates for persons for whom all the other observed variables were the same. No overall harmful influence of a cancer diagnosis was observed. Most cancer forms resulted in small, immediate declines in divorce rates the first years following diagnosis. Exceptions were significant increases in the divorce rates for persons diagnosed with cervical and testicular cancer.

Finding a life partner is of great importance for persons' life satisfaction, but cancer's potential impact on family life is not well described. Cancer's impact on marriage formation rates was therefore explored.Data on the entire unmarried Norwegian population aged 17-44 in 1974-2001 (N = 2.2 million) come from the Cancer Registry and the Central Population Register. Marriage rates for 12,100 persons diagnosed with cancer were compared to marriage rates for otherwise similar persons using discrete-time hazard regression models.Men with cancer had a marriage probability that was five percent higher (OR 1.05, CI 1.01-1.11) than cancer-free men. No cancer forms reduced men's marriage rates, and significantly elevated rates were seen after skin and testicular cancer (OR 1.16 and 1.11). Cancer did not impact significantly on women's overall marriage rate (OR 0.95, CI 0.90-1.00), but pronounced deficiencies were seen after brain and breast cancer (OR 0.62 and 0.74). Skin cancer elevated women's marriage rate (OR 1.27). Male cancer survivors with children were more likely to marry than their female counterparts. Significant increases in cancer survivors' marriage rates were observed over time.Marrying after cancer is more common today than previously, and only slight overall differences were observed in cancer survivors' marriage rates relative to those of the cancer-free population. However, while brain and breast cancer in women is associated with reduced marriage rates, testicular cancer is associated with increased rates. The differences observed between common cancer forms in young adults deserve further exploration.In general, marriage rates in survivors of most types of cancer are very similar to those in the population as a whole. Women with brain and breast cancer have lower marriage rates than their cancer-free counterparts. While it is necessary to identify exactly why this was observed, the information can alert those with these cancers to the potential impact on marriage and thus work to reduce the possible effect, if desired.

Cancer's impact on family formation in older adulthood is not well described. Marriage rates among older adults were therefore explored.Data on the unmarried Norwegian population aged 45-80 in 1974-2001 (N = 306 000) was retrieved from the Cancer Registry, the Central Population Register, and population censuses. Marriage rates for 27,600 persons diagnosed with cancer were compared to those of the general population by means of discrete-time hazard regression models.Men with cancer had a similar marriage rate as cancer-free men, whereas women experienced a 25% marriage deficit after cancer. This deficit was most pronounced after ovarian (OR 0.48) and breast (OR 0.69) cancer. Marriage rates decreased with time from diagnosis. No cancer forms elevated marriage rates.Marriage rates among older male cancer survivors are similar to those of the general population. Ovarian and breast cancer in older women was associated with pronounced marriage deficits. A possible explanation is that these gender-specific cancers relate to aspects of persons' psychological well-being, body image, and sense of femininity. Long-term adverse treatment effects are also common for the cancers in question. To explore explanations further, more details on treatment and illness progression are needed.Increased awareness of how ovarian and breast cancer may affect (prospects of) interpersonal relationships is valuable for cancer survivors and clinicians, and may facilitate communication of relevant, related issues during consultations. Our findings may suggest a need for more extensive psychosocial follow-up after these gender-specific cancer forms in older women, but further research is clearly warranted.