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Ethnic disparity in stillbirth and infant death has been demonstrated in Europe. As the relation between migration and health change over time, this population based register study investigated the recent figures and explored if potential differences could be explained by the well-known educational and income inequalities in stillbirth and infant death using a novel approach. Stillbirth and infant mortality varied considerably according to country of origin, with only immigrants from China, Norway, and Poland having an overall lower risk than Danish women. Women of Pakistani, Turkish, and Somali origin had a particularly high risk of both outcomes. Women from recent high conflict areas displayed a pattern with increased stillbirth risk. An observed excess risks across generations was found, which is disturbing and rule out factors related to language barriers or newness. Differences in educational level and household income explained only part of the observed inequalities. Strengthening of the maternity care system to better understand and meet the needs of immigrant women seems needed to mitigate the disparities.

Aim: Social equity in health is an important goal of public health policies in the Nordic countries. Infant mortality is often used as an indicator of the health of societies, and has decreased substantially in the Nordic welfare states over the past 20 years. To identify social patterns in infant mortality in this context the authors set out to review the existing epidemiological literature on associations between social indicators and infant mortality in Denmark, Finland, Norway, and Sweden during the period 1980-2000., Methods: Nordic epidemiological studies in the databases ISI Web of Science, PubMed, and OVID, published between 1980 and 2000 focusing on social indicators of infant, neonatal, and postneonatal mortality, were identified. The selected keywords on social indicators were: education, income, occupation, social factors, socioeconomic status, social position, and social class., Results: Social inequality in infant mortality was reported from Denmark, Finland, Norway, and Sweden, and it was found that these increased during the study period. Post-neonatal mortality showed a stronger association with social indicators than neonatal mortality. Some studies showed that neonatal mortality was associated with social indicators in a non-linear fashion, with high rates of mortality in both the lowest and highest social strata. The pattern differed, however, between countries with Finland and Sweden showing consistently less social inequalities than Denmark and Norway. While the increased inequality shown in most studies was an increase in relative risk, a single study from Denmark demonstrated an absolute increase in infant mortality among children born to less educated women., Conclusions: Social inequalities in infant mortality are observed in all four countries, irrespective of social indicators used in the studies. It is, however, difficult to draw inferences from the comparisons between countries, since different measures of social position and different inclusion criteria are used in the studies. Nordic collaborative analyses of social gradients in infant death are needed, taking advantage of the population-covering registers in longitudinal designs, to explore the mechanisms behind the social patterns in infant mortality.

Aim: Parental separation has been associated with poor mental health in children with better outcomes in children living in joint physical custody compared with those living with one parent after the separation. In this study, we investigated socioeconomic and relational predictors in early childhood of later parental separation and family arrangements thereafter.Methods: This study included 34 768 children from the Danish National Birth Cohort, who were living with both parents at the 6 months' data collection and followed up in 2010-2014 at age 11 years. Questionnaire data from the two data collections were linked with population registers in Statistics Denmark about parental income, education and psychiatric care and analysed in logistic regression models.Results: Socioeconomic indicators of the family and parental psychiatric disorders before birth of the child and family relationships in infancy predicted parental separation at age 11 year. For children with separated parents, a high family income and a high parental educational level were the main predictors of living in joint physical custody at the 11-year follow-up.Conclusion: Socioeconomic living conditions predict parental separation as well as living arrangements thereafter. Studies of consequences of living arrangements after parental separation should account for family factors preceding the separation. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40weeks), it is not known if countries with high preterm birth rates also have high early term birth rates. We examined rate associations between preterm and early term births and mean term GA by mode of delivery onset. Methods: We used routine aggregate data on the GA distribution of singleton live births from up to 34 high-income countries/regions in 1996, 2000, 2004, 2008 and 2010 to study preterm and early term births overall and by spontaneous or indicated onset. Pearson correlation coefficients were adjusted for clustering in time trend analyses. Results: Preterm and early term births ranged from 4.1% to 8.2% (median 5.5%) and 15.6% to 30.8% (median 22.2%) of live births in 2010, respectively. Countries with higher preterm birth rates in 2004-2010 had higher early term birth rates (r>0.50, P<0.01) and changes over time were strongly correlated overall (adjusted-r=0.55, P<0.01) and by mode of onset. Conclusion: Positive associations between preterm and early term birth rates suggest that common risk factors could underpin shifts in the GA distribution. Targeting modifiable population risk factors for delivery before 39weeks GA may provide a useful preterm birth prevention paradigm. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to study the relation between the duration of full and any breastfeeding and risk of type 1 diabetes.Research Design and Methods: We included two population-based cohorts of children followed from birth (1996-2009) to 2014 (Denmark) or 2015 (Norway). We analyzed data from a total of 155,392 children participating in the Norwegian Mother and Child Cohort Study (MoBa) and the Danish National Birth Cohort (DNBC). Parents reported infant dietary practices when their child was 6 and 18 months old. The outcome was clinical type 1 diabetes, ascertained from nationwide childhood diabetes registries. Hazard ratios (HRs) were estimated using Cox regression.Results: Type 1 diabetes was identified in 504 children during follow-up, and the incidence of type 1 diabetes per 100,000 person-years was 30.5 in the Norwegian cohort and 23.5 in the Danish cohort. Children who were never breastfed had a twofold increased risk of type 1 diabetes compared with those who were breastfed (HR 2.29 [95% CI 1.14-4.61] for no breastfeeding vs. any breastfeeding for ≥12 months). Among those who were breastfed, however, the incidence of type 1 diabetes was independent of duration of both full breastfeeding (HR per month 0.99 [95% CI 0.97-1.01]) and any breastfeeding (0.97 [0.92-1.03]).Conclusions: Suggestive evidence supports the contention that breastfeeding reduces the risk of type 1 diabetes. Among those who were breastfed, however, no evidence indicated that prolonging full or any breastfeeding was associated with a reduced risk of type 1 diabetes. [ABSTRACT FROM AUTHOR]

The mechanisms behind social differences in mortality rates have been debated. The authors examined the extent to which shared family background and health in early life could explain the association between educational status and all-cause mortality rates using a sibling design. The study was register-based and included all individuals born in Denmark between 1950 and 1979 who had at least 1 full sibling born in the same time period (n = 1,381,436). All individuals were followed from 28 years of age until death, emigration, or December 2009. The authors used Cox regression analyses to estimate hazard ratios for mortality according to educational level. Conventional cohort and intersibling analyses were carried out and conducted separately for deaths occurring before and after the age of 45 years, respectively. The cohort analyses showed an inverse association between educational status and all-cause mortality that was strongest for males, increased with younger birth cohorts, and tended to be strongest in the analyses of death before 45 years of age. The associations were attenuated slightly in the intersibling analyses and after adjustment for serious health conditions in early life. Hence, health selection and confounding by factors shared by siblings explained only a minor part of the association between educational level and all-cause mortality. [ABSTRACT FROM PUBLISHER]

Introduction: The Danish Medical Birth Register has been used extensively in conjunction with other national registers to examine different aspects of socioeconomic differences in perinatal health outcomes. Here, we review some recent findings. Research topics: Socioeconomic differences were observed in stillbirth, preterm birth, birthweight, congenital anomalies, and infant death. The patterns varied according to the health outcome and measure of socioeconomic position, but also according to the time period and the country under study. Our review also shows how many different strategies have been used to examine the influence of socioeconomic factors on perinatal health. Conclusion: Danish register data is an invaluable source of information on socioeconomic differences in perinatal health. Danish registers continue to provide excellent opportunities for research and surveillance in this area. [ABSTRACT FROM PUBLISHER]

Abstract Children exposed to socioeconomic adversity have elevated levels of psychological difficulties immediately and long-term. However, few studies have examined the consequences of long-term patterns of dynamic trajectories of family income. The Danish National Birth Cohort (DNBC) is a longitudinal, population-based birth cohort study (1996–2002). Data on household poverty from the year before birth until the child was 10 years of age (n = 12 measures) were obtained from the National Danish Registries and modeled using semiparametric group-based modeling. Child mental health symptoms were measured at 11 years using mother and child-reported Strengths and Difficulties Questionnaires (n = 40 192), and the child-reported Stress in Childhood (SiC) scale (n = 46 284). Four categories of family socioeconomic position were identified: 1) No poverty (83.5%); 2) Intermittent poverty, representing families who alternate between being above and below the poverty cut-off (8.6%); 3) Poverty during the perinatal period (4.9%); and 4) Chronic poverty (3.0%). Controlling for several early life characteristics of the family, mother and child, intermittent poverty vs. no poverty was consistently associated with child psychological difficulties (any problem: RR = 1.38, 95% CI: 1.16–1.64; conduct problems: RR = 1.38, 95% CI: 1.16–1.64; and stress: RR = 1.07, 95% CI: 1.02–1.12). An association was also found between perinatal poverty and children's symptoms of hyperactivity/inattention (RR = 1.28, 95% CI = 1.03; 1.59). We found no associations between chronic poverty and any of the outcome measures when adjusting for early life risk factors. Children growing up in households characterized by financial instability have elevated levels of psychosocial symptoms, especially externalizing behaviors, as well as stress in early adolescence. Highlights • Intermittent child poverty associated with later externalizing symptoms and stress. • Perinatal period poverty associated with later hyperactivity/inattention. • Social policies should aim to ensure long-term income stability for families. [ABSTRACT FROM AUTHOR]

Abstract: This study examines the joint and separate contribution of social class in early and adult life to differences in health and physical function in middle-aged men. We use data from the Metropolit project which includes men born in 1953 in Copenhagen and a study of middle-aged Danish twins (MADT). In total 6292 Metropolit participants in a follow-up survey on health in 2004 were included in the study together with 2198 male twins of which 1294 were part of a male twin pair (N =647 pairs). Logistic regression was used to investigate the association between social class in early and adult life, respectively and health in midlife, measured as limitations in running 100m, poor dental status, poor self-rated health, and fatigue. In both datasets, men with low childhood or adult social class had a higher risk of being unable to run 100m, having poor dental status, having poor self-rated health and fatigue than men from the highest social classes. When childhood and adult social class were mutually adjusted, the estimates for both measures were attenuated. Adjustment for living without a partner, body mass index (BMI) and smoking in midlife, which were also related to the four outcomes, had marginal effects on the estimates for childhood social class, but attenuated the effect of adult social class somewhat. Among male twin pairs discordant on adult social class, the twin in the lowest class seemed to be unable to run 100m, rate own health poorer and being fatigued more often than the high class co-twin, while there seemed to be no twin pair difference in dental status. This suggests that the associations of adult social class with functional limitations, poor self-rated health and fatigue may partly be due to causal effects related to adult social class exposures, while social class differences in dental status might be consistent with an effect of factors mainly operating early in life. [Copyright &y& Elsevier]