University of Oulu

Mikkonen HM, Salonen MK, Häkkinen A, Osmond C, Eriksson JG, Kajantie E. Cardiovascular disease in people born to unmarried mothers in two historical periods: The Helsinki Birth Cohort Study 1934–1944. Scandinavian Journal of Public Health. 2022;50(5):613-621. doi:10.1177/14034948211019792

Cardiovascular disease in people born to unmarried mothers in two historical periods : the Helsinki Birth Cohort Study 1934–1944

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Author: Mikkonen, H. Maiju1,2,3; Salonen, Minna K.1,4; Häkkinen, Antti3;
Organizations: 1Finnish Institute for Health and Welfare, Finland
2Faculty of Medicine, University of Helsinki, Finland
3Economic and Social History, University of Helsinki, Finland
4Folkhälsan Research Centre, Finland
5MRC Lifecourse Epidemiology Unit, University of Southampton, UK
6Department of General Practice and Primary Health Care, University of Helsinki, Finland
7Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore
8Department of Obstetrics and Gynaecology, and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
9Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Finland
10PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Finland
11Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: SAGE Publications, 2021
Publish Date: 2021-08-20


Aims: Socio-economic conditions in early life are important contributors to cardiovascular disease — the leading cause of mortality globally — in later life. We studied coronary heart disease (CHD) and stroke in adulthood among people born out of wedlock in two historical periods: before and during World War II in Finland.

Methods: We compared offspring born out of wedlock before (1934–1939) and during (1940–1944) World War II with the offspring of married mothers in the Helsinki Birth Cohort Study. The war affected the position of unmarried mothers in society. We followed the study subjects from 1971 to 2014 and identified deaths and hospital admissions from CHD and stroke. Data were analysed using a Cox regression, adjusting for other childhood and adulthood socio-economic circumstances.

Results: The rate of out-of-wedlock births was 240/4052 (5.9%) before World War II and 397/9197 (4.3%) during World War II. Among those born before World War II, out-of-wedlock birth was associated with an increased risk of stroke (hazard ratio (HR)=1.44; 95% confidence interval (CI) 1.00–2.07) and CHD (HR=1.37; 95% CI 1.02–1.86). Among those born out of wedlock during World War II, the risks of stroke (HR=0.89; 95% CI 0.58–1.36) and CHD (HR=0.70; 95% CI 0.48=1.03) were similar to those observed for the offspring of married mothers. The p-values for interaction of unmarried×World War II were (p=0.015) for stroke and (p=0.003) for CHD.

Conclusions: In a society in which marriage is normative, being born out of wedlock is an important predictor of lifelong health disadvantage. However, this may change rapidly when societal circumstances change, such as during a war.

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Series: Scandinavian journal of public health
ISSN: 1403-4948
ISSN-E: 1651-1905
ISSN-L: 1403-4948
Volume: 50
Issue: 5
Pages: 613 - 621
DOI: 10.1177/14034948211019792
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: Academy of Finland (274794, 315680 to E.K., 129369, 129907, 135072, 129255, 126775 to J.G.E.); The Diabetes Research Foundation (to J.G.E. and E.K.); Eemil Aaltonen Foundation (to H.M.M.); European Commission Horizon 2020 Framework Programme (733280 RECAP Research on Children and Adults Born Preterm to E.K., 633595 DynaHealth to J.G.E.); European Commission within the 7th Framework Programme (278603 DORIAN to J.G.E.); Finnish Cultural Foundation (to M.M.); Finnish Foundation for Cardiovascular Research (to J.G.E.); Finnish Foundation for Paediatric Research (to E.K.); Finnish Special Governmental Subsidy for Health Sciences (to J.G.E.); Finska Läkaresällskapet (to J.G.E.); Juho Vainio Foundation (to J.G.E., E.K. and H.M.M.); Liv och Hälsa (to J.G.E.); Ministry of Education and Culture Doctoral Programs for Public Health (to H.M.M.); Novo Nordisk Foundation (to E.K.); Samfundet Folkhälsan (to J.G.E.); Signe and Ane Gyllenberg Foundation (to J.G.E., E.K. and H.M.M.); Sigrid Jusélius Foundation (to E.K.); University of Helsinki Doctoral School in Health Sciences (to H.M.M.); Yrjö Jahnsson Foundation (to J.G.E., E.K. and H.M.M.).
EU Grant Number: (633595) DYNAHEALTH - Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging
Copyright information: © Author(s) 2021. CC BY 4.0.