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Studies in low-fertility settings have consistently found positive relationships between parents' and children's fertility timing and family sizes, and these persist after accounting for socio-demographic factors. We explore intergenerational transmission of fertility in Great Britain, where socio-economic inequalities are larger and could play a greater role in explaining intergenerational continuities than in other settings. Using the 1970 British Cohort Study, a long-running longitudinal data set, we estimate parity-specific discrete-time event-history models to investigate the role of mother's family size and age at first birth in birth transitions. We find stronger evidence for transmission of birth timing and family size in transitions to first and third births than second births. Family size transmission affects daughters more than sons. Accounting for socio-economic and demographic characteristics does not explain these associations. Except for first births, transmission of fertility is equally likely across the socio-economic hierarchy, highlighting the importance of socialization and cultural preferences for fertility transmission, even in the relatively unequal British context.

This paper investigates the association between family formation and the labour market trajectories of immigrants' descendants over the life course. Using rich data from the Trajectories and Origins survey from France, we apply multilevel event history models to analyse the transitions in and out of employment for both men and women by parity. We account for unobserved co-determinants of childbearing and employment by applying a simultaneous-equations modelling. Our analysis shows that women's professional careers are negatively associated with childbirth. There are differences across descendant groups. The female descendants of Turkish immigrants are more likely to exit employment and less likely to re-enter employment following childbirth than women from other groups. The negative impact of childbearing on employment is slightly overestimated among women due to unobserved selection effects. Among men, the descendants of European immigrants are less likely to exit employment after having a child than other descendant groups. The study demonstrates the negative effect of childbearing on women's employment, which is pronounced for some minority groups suggesting the need for further policies to help women reconcile work with family life., (© 2024. The Author(s).)

This study investigates partnership changes and childbearing among immigrants and their descendants in the UK, France, and Germany. Our analysis of longitudinal data shows, first, significant diversity in family trajectories among immigrants and their descendants in Europe. Immigrants from other European countries and their descendants tend to cohabit prior to marriage, and their fertility in unions is often similar to that of the native population. In contrast, South Asians and Turkish populations exhibit marriage-centred family behaviour with elevated third-birth rates. Individuals of sub-Saharan African or Caribbean origin display higher rates of non-marital family transitions. Second, we observe some changes in partnership and childbearing patterns across migrant generations; these are stronger for fertility than for partnership patterns. Third, migration background is particularly associated with partnership patterns, whereas the destination country context influences childbearing patterns. We expect some patterns to persist across future migrant generations (e.g. preference for marriage vs cohabitation), whereas others are likely to vanish (e.g. large families).

Objectives: To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States (US). We also assess MMLE inequalities by sex and education., Methods: Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of 2 or more chronic diseases. Disability is defined using limitations in activities of daily living., Results: Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated., Discussion: Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

This paper examines childbearing in and outside of marriage as a manifestation of the Second Demographic Transition among immigrant populations in Switzerland. Based on full-population register data, we simultaneously analyse fertility and partnership changes at different stages of the migration process. Results from a multistate event history model show that most of the differences in family formation patterns between migrant groups and natives are in the sequencing of marriage and first birth among childless unmarried women. Out of wedlock family trajectories prove to be a common experience for European migrants, but a sustainable family pathway only among natives, as well as among immigrants from France, and Sub-Saharan Africa. Among married women, it is the risk of a third birth that marks the differences between groups; first and second birth rates are relatively similar across migrant groups. Distinguishing between the transition patterns of newly arrived immigrants and settled immigrants (characterised by various residence durations) support the disruption hypothesis among EU migrants and the interrelated life events hypothesis among non-EU groups. Family size and the partnership context of fertility highlight which family regime prevails in different population subgroups and the role that immigrants play in the Second Demographic Transition and family transformation in Europe., (© 2024. The Author(s).)

Multimorbidity is increasing globally as populations age. However, it is unclear how long individuals live with multimorbidity and how it varies by social and economic factors. We investigate this in South Africa, whose apartheid history further complicates race, socio-economic, and sex inequalities. We introduce the term 'multimorbid life expectancy' (MMLE) to describe the years lived with multimorbidity. Using data from the South African National Income Dynamics Study (2008-17) and incidence-based multistate Markov modelling, we find that females experience higher MMLE than males (17.3 vs 9.8 years), and this disparity is consistent across all race and education groups. MMLE is highest among Asian/Indian people and the post-secondary educated relative to other groups and lowest among African people. These findings suggest there are associations between structural inequalities and MMLE, highlighting the need for health-system and educational policies to be implemented in a way proportional to each group's level of need.

Cognitively impaired adults without a partner are highly disadvantaged, as partners constitute an important source of caregiving and emotional support. With the application of innovative multistate models to the Health and Retirement Study, this paper is the first to estimate joint expectancies of cognitive and partnership status at age 50 by sex, race/ethnicity, and education in the United States. We find that women live a decade longer unpartnered than men. Women are also disadvantaged as they experience three more years as both cognitively impaired and unpartnered than men. Black women live over twice as long as cognitively impaired and unpartnered compared with White women. Lower-educated men and women live around three and five years longer, respectively, as cognitively impaired and unpartnered than more highly educated men and women. This study addresses a novel facet of partnership and cognitive status dynamics and examines their variations by key socio-demographic factors.

Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships., (Copyright © 2024 The Authors.)

Background: Air pollution is associated with several adverse health outcomes. However, heterogeneity in the size of effect estimates between cohort studies for long-term exposures exist and pollutants like SO 2 and mental/behavioural health outcomes are little studied. This study examines the association between long-term exposure to multiple ambient air pollutants and all-cause and cause-specific mortality from both physical and mental illnesses., Methods: We used individual-level administrative data from the Scottish-Longitudinal-Study (SLS) on 202,237 individuals aged 17 and older, followed between 2002 and 2017. The SLS dataset was linked to annual concentrations of NO 2 , SO 2 , and particulate-matter (PM10, PM2.5) pollution at 1 km 2 spatial resolution using the individuals' residential postcode. We applied survival analysis to assess the association between air pollution and all-cause, cardiovascular, respiratory, cancer, mental/behavioural disorders/suicides, and other-causes mortality., Results: Higher all-cause mortality was associated with increasing concentrations of PM2.5, PM10, NO 2 , and SO 2 pollutants. NO 2, PM10, and PM2.5 were also associated with cardiovascular, respiratory, cancer and other-causes mortality. For example, the mortality hazard from respiratory diseases was 1.062 (95%CI = 1.028-1.096), 1.025 (95%CI = 1.005-1.045), and 1.013 (95%CI = 1.007-1.020) per 1 μg/m 3 increase in PM2.5, PM10 and NO 2 pollutants, respectively. In contrast, mortality from mental and behavioural disorders was associated with 1 μg/m 3 higher exposure to SO 2 pollutant (HR = 1.042; 95%CI = 1.015-1.069)., Conclusion: This study revealed an association between long-term (16-years) exposure to ambient air pollution and all-cause and cause-specific mortality. The results suggest that policies and interventions to enhance air quality would reduce the mortality hazard from cardio-respiratory, cancer, and mental/behavioural disorders in the long-term., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

We study the interrelationships between partnership and fertility trajectories of immigrant women and female descendants of immigrants using the UK Household Longitudinal Study. We propose a novel multistate event history approach to analyse the outcomes of unpartnered, cohabiting, and married women. We find that the partnership and fertility behaviours of immigrants and descendants from European and Western countries are similar to those of native women: many cohabit first and then have children and/or marry. Those from countries with conservative family behaviours (e.g. South Asian countries) marry first and then have children. Women from the Caribbean show the weakest link between partnership changes and fertility: some have births outside unions; some form a union and have children thereafter. Family patterns have remained relatively stable across migrant generations and birth cohorts, although marriage is being postponed in all groups. Our findings on immigrants support the socialization hypothesis, whereas those on descendants are in line with the minority subculture hypothesis.

Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population., (Copyright © 2023 The Authors.)

Background: Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data to investigate the spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnicity in the United-Kingdom (UK)., Methods: Longitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009-2019) were utilized and were linked to yearly concentrations of NO 2 , SO 2 , and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals' health (Likert scale: 1-5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health., Results: Higher concentrations of NO 2 , SO 2 , PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO 2 and SO 2 pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO 2 , SO 2 , PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals., Conclusion: Using longitudinal data on individuals' health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals' health, especially for ethnic minorities who are affected the most., (© 2023. The Author(s).)

Objectives: Evidence suggests long-term exposure to fine particulate matter air pollution (PM2.5) is associated with a higher risk of cognitive impairment, especially among older adults. This study examines the relationship between PM2.5 exposure and cognitive function in China's aging population., Methods: We used longitudinal data from the China Health and Retirement Longitudinal Study (2011-2015) linked with historical PM2.5 concentrations (2000-2015) from remotely sensed satellite data. Growth curve models were applied to estimate associations between PM2.5 exposure (measured in intensity, duration, and a joint variable of intensity with duration for cumulative exposure) and cognitive function., Results: Relative to the lowest exposure group, exposure in the second group of PM2.5 intensity (35-50 μg/m3) is associated with poorer cognitive function, but higher levels of PM2.5 appear to be associated with better cognitive function, indicating a U-shaped association. Similar patterns are seen for fully adjusted models of PM2.5 duration: the second group (13-60 months) is associated with worse cognitive function than the first group (0-12 months), but coefficients are nonsignificant in longer duration groups. Joint analysis of PM2.5 intensity with duration suggests that duration may play a more detrimental role in cognitive function than intensity. However, we do not find a statistically significant association between PM2.5 exposure and the rate of cognitive decline., Discussion: Our findings are mixed and suggest that some categories of higher and longer exposure to PM2.5 are associated with poorer cognitive function, while that exposures do not hasten cognitive decline. However, more work is necessary to disentangle PM2.5 exposure from individuals' background characteristics, particularly those jointly associated with cognitive function and urban living., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America.)

While there is a large literature investigating migrant marriage or fertility, little research has examined how childbearing and partnerships are interrelated. In this paper, we investigate how childbearing and partnership trajectories evolve and interact over the life course for immigrants and their descendants and how the relationship varies by migrant origin. We apply multichannel sequence analysis to rich longitudinal survey data from France and find significant differences in family-related behaviour between immigrants, their descendants, and the native French. Immigrants' family behaviour is characterized by stronger association between marriage and childbearing than in the native population. However, there are significant differences across migrant groups. Turkish immigrants exhibit the most conservative family pathways. By contrast, the family behaviour of European immigrants is similar to that of the native population. The study also demonstrates that the family behaviour of some descendant groups has gradually become indistinguishable from that of the native French, whereas for other groups significant differences in family behaviour persist. Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2022.2049856 .

Objective: This study was carried out to determine the knowledge levels of nurses working in Family Health Centers (FHCs) about childhood autism. Methods: This study is a descriptive and cross-sectional study. The sample of the study consisted of 361 nurses working in FHCs in the province with the highest child population rate in Turkey. Data were obtained using the personal information form and the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. Results: The findings show that the mean score for the KCAHW questionnaire was 10.95 ± 3.7. Gender, education level, previous employment in a mental health clinic, the presence of a person with autism in their environment or family, their previous participation in any autism-related education program, and knowledge of the autism screening and follow-up program conducted by the Ministry of Health significantly affected the scores that were obtained from the KCAHW questionnaire ( p  < 0.05). Conclusion: Educational practices that will increase the knowledge and awareness of nurses about autism can contribute to the diagnosis of children with autism at an earlier age., Competing Interests: No potential conflict of interest was reported by the authors., (© The British Society of Developmental Disabilities 2022.)

While previous studies have emphasised the role of individual factors in understanding multimorbidity disparities, few have investigated contextual factors such as air pollution (AP). We first use cross-sectional latent class analysis (LCA) to assess the associations between PM2.5 exposure and multimorbidity disease clusters, and then estimate the associations between PM2.5 exposure and the development of multimorbidity longitudinally using growth curve modelling (GCM) among adults aged 45-85 in China. The results of LCA modelling suggest four latent classes representing three multimorbidity patterns (respiratory, musculoskeletal, cardio-metabolic) and one healthy pattern. The analysis shows that a 1 μg/m3 increase in cumulative exposure to PM2.5 is associated with a higher likelihood of belonging to respiratory, musculoskeletal or cardio-metabolic clusters: 2.4% (95% CI: 1.02, 1.03), 1.5% (95% CI: 1.01, 1.02) and 3.3% (95% CI: 1.03, 1.04), respectively. The GCM models show that there is a u-shaped association between PM2.5 exposure and multimorbidity, indicating that both lower and higher PM2.5 exposure is associated with increased multimorbidity levels. Higher multimorbidity in areas of low AP is explained by clustering of musculoskeletal diseases, whereas higher AP is associated with cardio-metabolic disease clusters. The study shows how multimorbidity clusters vary contextually and that PM2.5 exposure is more detrimental to health among older adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Hu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study investigates partnership transitions of young adults born between 1974 and 1990 in England and Wales. These cohorts were affected by the expansion of higher education, increasing gender equality, and ideational changes, but faced increased economic precarity caused by the economic and housing crisis. Given these changes, it is likely that the partnership experiences of young adults including marriage, cohabitation, separation, and repartnering have also undergone considerable changes. We apply competing risks event history analysis to combined data from the British Household Panel Survey and the UK Household Longitudinal Study to determine how birth cohort, gender, socio-economic background, and educational attainment influence partnership changes. We study the transition into and out of first cohabitation and marriage and repartnering between age 16 and 27. Cohabitation has become a universal form of first union among young adults born in the late 1970s and 1980s regardless of their socio-economic background or educational level, but their first unions do not last long. While cohabiters are equally likely to marry or separate in the oldest cohort (1974-1979), cohabiting unions are very likely to end in separation among the two youngest cohorts (1980-1984 and 1985-1990). Consequently, repartnering has become common; those in the youngest cohort repartner rather quickly suggesting that an increasing number of individuals experience multiple partnerships. Highly educated young adults have higher rates of entry into first cohabitation than their lower educated counterparts across all cohorts. However, we do not find differences in cohabitation outcomes by socio-economic background and educational level indicating that the main changes have taken place across birth cohorts. The results also suggest that there is a convergence in partnership experiences among young men and women. The increased prevalence of sliding into and out of cohabitation could indicate significant changes in the meaning young people attach to first partnerships., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Recent studies suggest an association between ambient air pollution and mental well-being, though evidence is mostly fragmented and inconclusive. Research also suffers from methodological limitations related to study design and moderating effect of key demographics (e.g., ethnicity). This study examines the effect of air pollution on reported mental well-being in United Kingdom (UK) using spatial-temporal (between-within) longitudinal design and assesses the moderating effect of ethnicity., Methods: Data for 60,146 adult individuals (age:16+) with 349,748 repeated responses across 10-data collection waves (2009-2019) from "Understanding-Society: The-UK-Household-Longitudinal-Study" were linked to annual concentrations of NO2, SO2, PM10, and PM2.5 pollutants using the individuals' place of residence, given at the local-authority and at the finer Lower-Super-Output-Areas (LSOAs) levels; allowing for analysis at two geographical scales across time. The association between air pollution and mental well-being (assessed through general-health-questionnaire-GHQ12) and its modification by ethnicity and being non-UK born was assessed using multilevel mixed-effect logit models., Results: Higher odds of poor mental well-being was observed with every 10μg/m3 increase in NO2, SO2, PM10 and PM2.5 pollutants at both LSOAs and local-authority levels. Decomposing air pollution into spatial-temporal (between-within) effects showed significant between, but not within effects; thus, residing in more polluted local-authorities/LSOAs have higher impact on poor mental well-being than the air pollution variation across time within each geographical area. Analysis by ethnicity revealed higher odds of poor mental well-being with increasing concentrations of SO2, PM10, and PM2.5 only for Pakistani/Bangladeshi, other-ethnicities and non-UK born individuals compared to British-white and natives, but not for other ethnic groups., Conclusion: Using longitudinal individual-level and contextual-linked data, this study highlights the negative effect of air pollution on individuals' mental well-being. Environmental policies to reduce air pollution emissions can eventually improve the mental well-being of people in UK. However, there is inconclusive evidence on the moderating effect of ethnicity., Competing Interests: The authors declare that they have no conflict of interest

Introduction: The COVID-19 pandemic dramatically disrupts health care for patients with chronic diseases including chronic spontaneous urticaria (CSU). As of now, it is unknown if the effects of the pandemic in CSU are different than in other chronic diseases. We also do not know, if different groups of CSU patients, for example female and male patients, are affected differently., Aim: To understand how CSU patients and subgroups are affected by the COVID-19 pandemic in their disease activity and control and treatment, using psoriasis as control., Patients and Methods: We analyzed 399 patients (450 visits) with CSU or psoriasis assessed during August 2019, i.e. before the pandemic, or August 2020, i.e. during the pandemic, for changes in disease activity, disease control, and the treatment they used, and how these changes are linked to age, gender, and disease duration., Results: Male but not female patients with CSU had markedly increased disease activity during the pandemic. CSU patients' age or disease duration were not linked to changes. Male and female patients with psoriasis showed similar increases in disease activity and decreases in disease control. The rate of omalizumab treatment, during the pandemic, was unchanged in male patients and increased in female patients with CSU. The efficacy of omalizumab treatment, during the pandemic, was reduced in male patients but not female patients with CSU., Conclusion: Male but not female CSU patients, during the COVID-19 pandemic, show loss of disease control linked to loss of omalizumab efficacy. The reasons for this need to be investigated., Competing Interests: MM is or recently was a speaker and/or advisor for and/or has received research funding from Allakos, Amgen, Aralez, ArgenX, AstraZeneca, Celldex, Centogene, CSL Behring, FAES, Genentech, GIInnovation, Gilead, Innate Pharma, Kyowa Kirin, Leo Pharma, Lilly, Menarini, Moxie, Novartis, Roche, Sanofi/Regeneron, Third HarmonicBio, UCB, and Uriach. RE recently was a speaker for Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past collaboration with one of the authors MM., (Copyright © 2021 Kulu, Atasoy, Özyurt, Maurer, Avcı, Akkuş and Ertaş.)

This study estimates cumulative infection rates from Covid-19 in Great Britain by local authority districts (LADs) and council areas (CAs) and investigates spatial patterns in infection rates. We propose a model-based approach to calculate cumulative infection rates from data on observed and expected deaths from Covid-19. Our analysis of mortality data shows that 7% of people in Great Britain were infected by Covid-19 by the last third of June 2020. It is unlikely that the infection rate was lower than 4% or higher than 15%. Secondly, England had higher infection rates than Scotland and especially Wales, although the differences between countries were not large. Thirdly, we observed a substantial variation in virus infection rates in Great Britain by geographical units. Estimated infection rates were highest in the capital city of London where between 11 and 12% of the population might have been infected and also in other major urban regions, while the lowest were in small towns and rural areas. Finally, spatial regression analysis showed that the virus infection rates increased with the increasing population density of the area and the level of deprivation. The results suggest that people from lower socioeconomic groups in urban areas (including those with minority backgrounds) were most affected by the spread of coronavirus from March to June., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Air-pollution and weather exposure beyond certain thresholds have serious effects on public health. Yet, there is lack of information on wider aspects including the role of some effect modifiers and the interaction between air-pollution and weather. This article aims at a comprehensive review and narrative summary of literature on the association of air-pollution and weather with mortality and hospital admissions; and to highlight literature gaps that require further research., Methods: We conducted a scoping literature review. The search on two databases (PubMed and Web-of-Science) from 2012 to 2020 using three conceptual categories of "environmental factors", "health outcomes", and "Geographical region" revealed a total of 951 records. The narrative synthesis included all original studies with time-series, cohort, or case cross-over design; with ambient air-pollution and/or weather exposure; and mortality and/or hospital admission outcomes., Results: The final review included 112 articles from which 70 involved mortality, 30 hospital admission, and 12 studies included both outcomes. Air-pollution was shown to act consistently as risk factor for all-causes, cardiovascular, respiratory, cerebrovascular and cancer mortality and hospital admissions. Hot and cold temperature was a risk factor for wide range of cardiovascular, respiratory, and psychiatric illness; yet, in few studies, the increase in temperature reduced the risk of hospital admissions for pulmonary embolism, angina pectoris, chest, and ischemic heart diseases. The role of effect modification in the included studies was investigated in terms of gender, age, and season but not in terms of ethnicity., Conclusion: Air-pollution and weather exposure beyond certain thresholds affect human health negatively. Effect modification of important socio-demographics such as ethnicity and the interaction between air-pollution and weather is often missed in the literature. Our findings highlight the need of further research in the area of health behaviour and mortality in relation to air-pollution and weather, to guide effective environmental health precautionary measures planning., Competing Interests: The authors declare that they have no conflict of interest.

The effects of COVID-19 are likely to be socially stratified. Disease control measures introduced during the COVID-19 pandemic mean that people spend much more time in their immediate households, due to lockdowns, the need to self-isolate, and school and workplace closures. This has elevated the importance of certain household-level characteristics for individuals' current and future wellbeing. The multi-dimensional poverty and health inequalities literature suggests that poor health and socio-economic conditions cluster in the general population, which may exacerbate societal inequalities over time. This study investigates how COVID-19-related health- and socio-economic vulnerabilities co-occur at the household level, and how they are distributed across household types and geographical areas in the United Kingdom. Using a nationally representative cross-sectional study of UK households and individuals and applying principal components analysis, we derived summary measures representing different dimensions of household vulnerabilities critical during the COVID-19 epidemic: health, employment, housing, financial and digital. Our analysis highlights four key findings. First, although COVID-19-related health risks are concentrated in retirement-age households, a substantial proportion of working-age households also face these risks. Second, different types of households exhibit different vulnerabilities, with working-age households more likely to face financial and housing precarities, and retirement-age households health and digital vulnerabilities. Third, there are area-level differences in the distribution of household-level vulnerabilities across England and the constituent countries of the United Kingdom. Fourth, in many households, different dimensions of vulnerabilities intersect; this is especially prevalent among working-age households. The findings imply that the short- and long-term consequences of the COVID-19 crisis are likely to significantly vary by household type. Policy measures that aim to mitigate the health and socio-economic consequences of the COVID-19 pandemic should consider how vulnerabilities cluster and interact with one another both within individuals and different household types, and how these may exacerbate already existing inequalities., Competing Interests: We declare no conflicts of interest., (© 2020 The Author(s).)

This study investigates the magnitude and persistence of elevated post-separation residential mobility (i.e. residential instability) in five countries (Australia, Belgium, Germany, the Netherlands, and the UK) with similar levels of economic development, but different welfare provisions and housing markets. While many studies examine residential changes related to separation in selected individual countries, only very few have compared patterns across countries. Using longitudinal data and applying Poisson regression models, we study the risk of a move of separated men and women compared with cohabiting and married individuals. We use time since separation to distinguish between moves due to separation and moves of separated individuals. Our analysis shows that separated men and women are significantly more likely to move than cohabiting and married individuals. The risk of a residential change is the highest shortly after separation, and it decreases with duration since separation. However, the magnitude of this decline varies by country. In Belgium, mobility rates remain elevated for a long period after separation, whereas in the Netherlands, post-separation residential instability appears brief, with mobility rates declining rapidly. The results suggest that housing markets are likely to shape the residential mobility of separated individuals. In countries, where mortgages are easy to access and affordable rental properties are widespread, separated individuals can rapidly adjust their housing to new family circumstances; in contrast, in countries with limited access to homeownership and small social rental markets, separated individuals experience a prolonged period of residential instability., Competing Interests: Conflict of interestHill Kulu is a member of advisory board of EJP. The authors declare that there are no further conflicts of interest., (© The Author(s) 2020.)

This study aimed to estimate the prevalence of three measures of multimorbidity among people aged 50 years or older in England. Beside the basic measure of two or more diseases within a person, we added a measure of three or more affected body systems (complex multimorbidity) and a measure of 10 or more functional limitations. We found that the three health outcomes became more prevalent between 2002 and 2015. They were more common among females than males and were becoming more common among younger age groups. While in 2002, the prevalence of basic multimorbidity overcame 50% from the 70-74 age group upwards, in 2015 it crossed the same threshold in the 65-69 age group. The distribution of multimorbidity and multiple functional limitations were stratified by the amount of household wealth. Multiple functional limitations reflected the largest differences between the most and the least affluent groups (5.9-fold in 2014/2015), followed by the measure of complex multimorbidity (2.8-fold in 2014/2015) and basic multimorbidity (1.9-fold) in 2014/2015.While age acted as a levelling factor for the wealth differences in basic multimorbidity, it had no such effect on the two other outcomes. Our study observed social polarization among multimorbid ageing population in England where complex multimorbidity and multiple functional limitations increase faster and reflect stronger inequality than basic multimorbidity., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study investigates the formation of endogamous and exogamous marriages among immigrants and their descendants in the United Kingdom. We apply event history analysis to data from the Understanding Society study and use multiple imputation to determine the type of marriage for individuals with missing information on the origin of their spouse. The analysis shows, first, significant differences among immigrants and their descendants in the likelihood of marrying within and outside their ethnic groups. While immigrants from European countries have relatively high exogamous marriage rates, South Asians exhibit a high likelihood of marrying a partner from their own ethnic group; Caribbean people hold an intermediate position. Second, the descendants of immigrants have lower endogamous and higher exogamous marriage rates than their parents; however, for some ethnic groups, particularly South Asians, the differences across generations are small, suggesting that changes in marriage patterns have been slower than expected.

Background: Previous research shows that mortality varies significantly by residential context; however, the nature of this variation is unclear. Some studies report higher mortality levels in urban compared to rural areas, whereas others suggest elevated mortality in rural areas or a complex U-shaped relationship. Further, the extent to which compositional factors explain urban-rural mortality variation, the extent to which contextual factors play a role and whether and how the patterns vary by gender also remain unclear. This study investigates urban-rural mortality variation in England and Wales and the causes of this variation., Method: The study applies survival analysis to the Office for National Statistics Longitudinal Study; the population aged 20 and older in 2001 is followed for 10 years., Results and Conclusions: The analysis demonstrates a clear urban-rural mortality gradient, with the risk of dying increasing with each level of urbanisation. The exceptions are those living in areas adjacent to London, who consistently exhibit lower mortality than anticipated. Once the models are adjusted to individuals' socio-economic characteristics, the variation across the urban-rural continuum reduces substantially, although the gradient persists suggesting contextual effects. Females are found to be influenced more by their surrounding environment and males by their socio-economic position, although both experience lower mortality in rural compared to urban areas., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The aim of this study is to investigate spatial mobility over time. Research on 'new mobilities' suggests increasing movement of individuals, technology, and information. By contrast, studies of internal migration report declining spatial mobility in recent decades. Using longitudinal register data from Sweden, we calculate annual order-specific migration rates to investigate the spatial mobility of young adults over the last three decades. We standardize mobility rates for educational enrolment, educational level, family status, and place of residence to determine how much changes in individuals' life domains explain changes in mobility. Young adults' migration rates increased significantly in the 1990s; although all order-specific migration rates increased, first migration rates increased the most. Changes in population composition, particularly increased enrolment in higher education, accounted for much of the elevated spatial mobility in the 1990s. The analysis supports neither ever increasing mobility nor a long-term rise in rootedness among young adults in Sweden.

Background: This paper examines cause-specific mortality by partnership status. Although non-marital cohabitation has spread rapidly in industrialised countries, only a few studies have investigated mortality by partnership status and no recent study has investigated cause-specific mortality by partnership status., Methods: We use data from the Office for National Statistics Longitudinal Study and apply competing risks survival models., Results: The simultaneous analysis shows that married individuals have lower mortality than non-married from circulatory, respiratory, digestive, alcohol and accident related causes of deaths, but not from cancer. The analysis by partnership status reveals that once we distinguish premarital and postmarital cohabitants from other non-married groups, the differences between partnered and non-partnered individuals become even more pronounced for all causes of death; this is largely due to similar cause-specific mortality levels between married and cohabiting individuals., Conclusions: With declining marriage rates and the spread of cohabitation and separation, a distinction between partnered and non-partnered individuals is critical to understanding whether and how having a partner shapes the individuals' health behaviour and mortality. The cause-specific analysis supports both the importance of selection into partnership and the protective effect of living with someone together., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This paper investigates the effects of marital and non-marital separation on individuals' housing tenure in England and Wales. We apply competing risks event history models to data from the British Household Panel Survey and the UK Household Longitudinal Study to analyse the risk of a residential move to different tenure types, for single, married, cohabiting, and separated men and women. Separated individuals are more likely to move and experience a tenure change than those who are single or in a relationship. Among separated people, private renting is the most common outcome of a move; however, women are also likely to move to social renting, whereas men tend to move to homeownership. This pattern persists when we account for time since separation and order of move, indicating a potential long-term effect of separation on housing tenure. This long-term effect is especially pertinent to separated women who cannot afford homeownership.

This study investigates the effect of marital and nonmarital separation on individuals' residential and housing trajectories. Using rich data from the British Household Panel Survey (BHPS) and applying multilevel competing-risks event history models, we analyze the risk of a move of single, married, cohabiting, and separated men and women to different housing types. We distinguish moves due to separation from moves of separated people and account for unobserved codeterminants of moving and separation risks. Our analysis shows that many individuals move due to separation, as expected, but that the likelihood of moving is also relatively high among separated individuals. We find that separation has a long-term effect on individuals' residential careers. Separated women exhibit high moving risks regardless of whether they moved out of the joint home upon separation, whereas separated men who did not move out upon separation are less likely to move. Interestingly, separated women are most likely to move to terraced houses, whereas separated men are equally likely to move to flats (apartments) and terraced (row) houses, suggesting that family structure shapes moving patterns of separated individuals.

This article investigates the relationship between partnership status and mortality in England and Wales. Using data from the Office for National Statistics Longitudinal Study for the period between 2001 and 2011, we examine whether married people have lower mortality levels than unmarried individuals; whether individuals who cohabit have mortality levels similar to those of married or single persons; and how much the fact that married couples live with someone rather than alone explains their low mortality. Our analysis shows first that married individuals have lower mortality than unmarried persons. Second, men and women in premarital unions exhibit mortality levels similar to those of married men and women, whereas mortality levels are elevated for post-marital cohabitants. Third, controlling for household size and the presence of children reduces mortality differences between married and unmarried non-partnered individuals, but significant differences persist. The study supports both protection and selection theory. The increase in mortality differences by age between never-married cohabitants and married couples is likely a sign of the long-term accumulation of health and wealth benefits of marriage. Similar mortality levels of cohabiting and married couples at younger ages suggest that healthier individuals are more likely to find a partner.

Recent research has found a migrant mortality advantage among immigrants relative to the UK-born population living in England and Wales. However, while all-cause mortality is useful to show differences in mortality between immigrants and the host population, it can mask variation in mortality patterns from specific causes of death. This study analyses differences in the causes of death among immigrants living in England and Wales. We extend previous research by applying competing-risks survival analysis to study a large-scale longitudinal dataset from 1971 to 2012 to directly compare causes of death. We confirm low all-cause mortality among nearly all immigrants, except immigrants from Scotland, Northern Ireland and the Republic of Ireland (who have high mortality). In most cases, low all-cause mortality among immigrants is driven by lower mortality from chronic diseases (in nearly all cases by lower cancer mortality and in some cases by lower mortality from cardiovascular diseases (CVD)). This low all-cause mortality often coexists with low respiratory disease mortality and among non-western immigrants, coexists with high mortality from infectious diseases; however, these two causes of death contribute little to mortality among immigrants. For men, CVD is the leading cause of death (particularly among South Asians). For women, cancer is the leading cause of death (except among South Asians, for whom CVD is also the leading cause). Differences in CVD mortality over time remain constant between immigrants relative to UK-born, but immigrant cancer patterns shows signs of some convergence to the cancer mortality among the UK-born (though cancer mortality is still low among immigrants by age 80). The study provides the most up-to-date, reliable UK-based analysis of immigrant mortality., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Previous research shows low mortality for most immigrants compared to natives in host countries. This advantage is often attributed to health selection processes in migration and to protective health behaviours. Little research has examined the role of data quality, especially the registration of moves. Registration errors relating to moves between origin and host countries can mismatch deaths and risk populations, leading to denominator bias and an under-estimation of migrant mortality (data artefact). The paper investigates the mortality of immigrants in England and Wales from 1971 to 2001 using the Office for National Statistics Longitudinal Study (ONS LS), a 1% sample of the population of England and Wales. We apply parametric survival models to study the mortality of 450,000 individuals. We conduct sensitivity analysis to assess the impact of entry and exit uncertainty on immigrant mortality rates. The analysis shows that most international migrants have lower mortality than natives in England and Wales. Differences largely persist when we adjust models to entry and exit uncertainty and they become pronounced once we control for individual socioeconomic characteristics. This study supports low mortality among immigrants and shows that results are not a data artefact., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This study examines fertility variation by residential context in Britain. While there is a large literature on fertility trends and determinants in industrialised countries, to date longitudinal research on spatial fertility variation has been restricted to the Nordic countries. We study fertility variation across regions of different sizes, and within urban regions by distinguishing between central cities and suburbs. We use vital statistics and longitudinal data and apply event history analysis. We investigate the extent to which the socio-economic characteristics of couples and selective migrations explain fertility variation between residential contexts, and the extent to which contextual factors potentially play a role. Our analysis shows that fertility levels decline as the size of an urban area increases; within urban regions suburbs have significantly higher fertility levels than city centres. Differences in fertility by residential context persist when we control for the effect of population composition and selective migrations., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Previous studies have shown that the risk of divorce is low during the first months of marriage; it then increases, reaches a maximum, and thereafter begins to decline. Some researchers consider this pattern consistent with the notion of a "seven-year itch," while others argue that the rising-falling pattern of divorce risk is a consequence of misspecification of longitudinal models because of omitted covariates or unobserved heterogeneity. The aim of this study is to investigate the causes of the rising-falling pattern of divorce risk. Using register data from Finland and applying multilevel hazard models, the analysis supports the rising-falling pattern of divorce by marriage duration: the risk of marital dissolution increases, reaches its peak, and then gradually declines. This pattern persists when I control for the sociodemographic characteristics of women and their partners. The inclusion of unobserved heterogeneity in the model leads to some changes in the shape of the baseline risk; however, the rising-falling pattern of the divorce risk persists.

Research has examined the effect of family changes on housing transitions and childbearing patterns within various housing types. Although most research has investigated how an event in one domain of family life depends on the current state in another domain, the interplay between them has been little studied. This study examines the interrelationships between childbearing decisions and housing transitions. We use rich longitudinal register data from Finland and apply multilevel event history analysis to allow for multiple births and housing changes over the life course. We investigate the timing of fertility decisions and housing choices with respect to each other. We model childbearing and housing transitions jointly to control for time-invariant unobserved characteristics of women, which may simultaneously influence their fertility behavior and housing choices, and we show how joint modeling leads to a deeper understanding of the interplay between the two domains of family life.

This paper examines the effect of migration and residential mobility on union dissolution among married and cohabiting couples. Moving is a stressful life event, and a large, multidisciplinary literature has shown that family migration often benefits one partner (usually the man) more than the other Even so, no study to date has examined the possible impact of within-nation geographical mobility on union dissolution. We base our longitudinal analysis on retrospective event-history data from Austria. Our results show that couples who move frequently have a significantly higher risk of union dissolution, and we suggest a variety of mechanisms that may explain this.