Work in progress

Intergenerational Inequality in Child Mortality in the Netherlands, 1833-1913.

In historical the Netherlands, child mortality was distributed unequally between families and this inequality persisted across generations. Using family reconstitution data for the province of Zeeland (LINKS) I show that parents with elevated sibling child mortality had increased risk of deaths among their own children. Intergenerationally high risk of child death can partially be attributed to SES. Inequalities accumulate as parents that grew up in high mortality, low-SES families with low adulthood SES had the highest under-five mortality among their children. Intergenerational transmission is found even for a period when child mortality had declined strongly.

An Age Old Advantage? Families’ exceptional longevity in the absence of a socioeconomic gradient in health, Sweden, 1880-2015

Average lifespan has increased strongly in the past decades, but the benefits have not been distributed equally. In recent decades, social characteristics have become increasingly important predictors of life expectancy in Sweden (Bengtsson et al., 2020). Inequalities in lifespan cluster in families: in some families, living to high ages can almost be counted on (van den Berg et al., 2023); in other families, premature mortality is common. Establishing the degree of intergenerational persistence of survival in families provides a tool to show overall survival inequalities that goes beyond quantifying inequalities related to socioeconomic status (SES) alone. Despite its potential role in demonstrating developments in broad inequalities in health and survival, between-family inequalities in lifespan over time have poorly been quantified. Using contemporary Swedish national register data covering the period 1967-today linked to historical population data for a region in Southern Sweden (SEDD), we show that even before the rise of the modern social gradient in health, descendants from long-lived ancestors (top 10% survivors of their birth cohort) have a survival advantage in comparison to the population. After the second world war, both men and women in white collar occupations live longer than individuals in blue collar occupations. The family-shared survival advantage persists over time even after taking into account individual socioeconomic status. Analyses by birth cohort show that there is a diminished relation between parental survival into extremely high ages and children’s mortality for the birth cohort 1869-1880. In the heyday of the smoking epidemic, the correlation between the family-shared survival advantage and cause-specific respiratory and circulatory mortlaity was smaller than previously and after smoking became less common. Higher socioeconomic status groups have a quick reversal from high respiratory mortality with falling rates from the 1980ies, whereas having parents who belong to the longest lived of their cohort only correlates with lower offspring respiratory mortality from the 2000s.

Overall, we find that mortality concentrates in families in patterns that go beyond the influence of just socioeconomic status. It does so across the demographic transition so that both in populations with much higher mortality than today and in contemporary populations there is a strong family component to survival, even after taking socioeconomic factors into account. Families thus provide an important lens into the larger socioeconomic inequalities in survival and health.

A Healthy Marriage? Emerging Marital Status Differences in Mortality in Scania, 1815 – 2015. Chapter, with Martin Dribe. Pre-print. In press.

Married people tend to have better health and live longer than the single and the widowed. When they do fall ill, they are more likely to recover and do so more quickly. Differences in health and mortality by marital status are not exclusively a modern phenomenon, but existed also in historical societies, including Sweden. However, the long-term change in the mortality differentials by marital status, and its interaction with gender and social class, has not been systematically addressed in the literature. In this chapter, we explore these issues for the city of Landskrona and the rural parishes in its hinterland. We focus on period changes and the different patterns by gender and social class. The development in marital status differences in mortality are related to societal transformation and the changing marriage patterns, especially increased frequency of divorce and the postponement of widowhood to later ages.

The development of maternal and infant health 1905-2000. Chapter, with Lazuka & Quaranta. Pre-print. In press.

In this chapter, we analyse the development of maternal and infant health in five rural parishes and the city of Landskrona in Scania, Sweden, in the last 110 years. We address the overall development of maternal and infant health using a range of indicators. We take a closer look at changes in care for pregnant women and infants, and developments in medical developments available to women around childbirth in Sweden and in the town of Landskrona specifically. Around the turn of the 20th century, maternal and infant mortality were very low in Scania from an international perspective. Yet, a dramatic further reduction took place in the 20th century. Before 1930, most women were assisted in childbirth by midwives, whereas later birth increasingly took place in maternity wards and, later, in hospitals. Medical interventions around childbirth became more feasible with time as infections could be treated using antibiotics from the 1930ies onwards. Similarly, bacterial infections among infants became less deadly with the arrival of antibiotics. We relate the development of maternal and infant health to the institutions and medical innovations available in the area, such as the expansion of hospital facilities, availability of antibiotics and the opening of maternity wards and neonatal intensive care units. We estimate the magnitude of the impact of these interventions on health using time series analysis.