Attained socioeconomic position is associated with drug-related deaths, but whether social characteristics in childhood predict drug-related mortality remains unclear. We estimated differences in drug-related mortality between ages 16 and 41 by parental education, household income, and household type. We used administrative data on all Finnish residents born 1982-2004 (N = 1 446 548). Underlying and contributory causes of drug-related mortality (1997-2023) were drawn from Causes of Death Register records and parental education, household income and household type (age 15) were derived from administrative records. Differences in drug-related mortality by childhood social characteristics and their co-occurrence were estimated using sex-stratified Cox regression. Birth cohort differences were estimated using Kaplan-Meier failure curves. The drug-related mortality rate per 100 000 person-years for men (21.9, 95% CI: 21.1-22.8) was over 3× higher than that of women (5.7, 5.3-6.2). Among both men and women, respectively, lower parental education (basic: HR 1.86, 1.63-2.11; HR 1.78, 1.37-2.32) and non-nuclear household type (single-parent households: HR 2.10, 1.89-2.33; HR 3.06, 2.46-3.79) independently predicted higher mortality hazards net of all predictors, whereas the estimates for household income greatly attenuated. Interaction analyses between parental education and household type suggested larger relative increases in mortality hazards by lower parental education among individuals from non-nuclear families. Mortality differences were consistently observed across birth cohorts. Childhood household type and parental education independently predicted subsequent drug-related mortality among men and women. Children of lower educated parents from non-nuclear families had the highest excess risk.

BACKGROUND:Parental death has well-established adverse effects on the mental health of children and adolescents, but evidence on adults is scarce. Also, the role of siblings has not been assessed before, even though siblings might be an important source of support during parental death. METHODS:We conducted a national cohort study to examine psychotropic medication purchases (antidepressants, anxiolytics, hypnotics and sedatives) before and after parental death and assessed differences by sibship size and sex of the offspring. We estimated annual probabilities of psychotropic medication purchases for 6 years surrounding parental death and compared men and women experiencing parental death from 2006 to 2016 at ages 35-55 years to a synthetic control group not experiencing parental deaths. RESULTS:We showed increased psychotropic medication purchases in the year before and after parental death. These associations were strongest for those with no or fewer siblings and among women. For example, after mother's death, we observed an increase of 6.8 (95% CI 5.8 to 7.8) percentage points (pp) in psychotropic medication prevalence for women with no siblings in contrast to women whose mother did not die. For women with 1, 2 or 3 siblings, the respective differences were 6.1 (95% CI 5.5 to 6.8), 4.7 (95% CI 4.0 to 5.4) and 3.9 (95% CI 3.0 to 4.8) pp increases. The associations were also stronger after maternal than paternal death. CONCLUSIONS:The findings may indicate that the burden of parental death is less substantial when several siblings are present. The more pronounced association among women may reflect gendered differences in treatment-seeking.

The COVID-19 pandemic offers opportunities to study effects of in-utero and early life exposure to environmental changes. However, inferences from such studies may be flawed if the pandemic has changed the socioeconomic composition of parents. Analysing over 77.9 million live births from 15 countries, we estimate changes in the socioeconomic composition of the cohort born between December 2020 and December 2021 using interrupted time series analysis. We find that, compared with their counterfactual compositions, the December 2020-December 2021 birth cohort has a higher proportion of babies born to socioeconomically advantaged parents in Austria, England, Finland, the Netherlands, Scotland, Spain, Wales, and the United States while we observe the opposite change for Brazil, Colombia, Ecuador, and Mexico. These changes in cohort composition may cause between-cohort differences in life course outcomes that are influenced by parental socioeconomic circumstances even if early life exposure to the pandemic had no direct effect on this birth cohort.

BACKGROUND:Previous evidence on season-of-birth differences in atopic diseases is partially mixed, and the etiology behind them is not well understood. For example, outdoor temperature may be an important modifier of the association but has been previously neglected. METHODS:We assess how the month of birth is associated with medication use for atopic diseases at ages 0-15 and how outdoor temperatures after birth modify these associations for 0.55 million Finns born during 1995-2004. We used Finnish register data on purchases of medications used for allergic rhinitis, eczema, asthma, and food allergies. We predicted month-of-birth associations with medication use using extensive controls for observed and unobserved confounders and assessed effect modification by 3-month mean outdoor temperature after birth. RESULTS:Approximately half of the children had at least one purchase of medication used for atopic diseases. For children born in spring or summer, the probability of medication use was moderately lower than for children born in the autumn or winter. Among children born in the autumn or winter, exposure to the coldest outdoor temperatures in the first 3 months of life was associated with a nearly 10-percentage-point increase in the risk for medication use compared with the warmest temperatures. CONCLUSIONS:Behind the moderate overall associations between month of birth and childhood atopic diseases, there was notable variation by environmental conditions after birth, with cold weather after birth being particularly harmful. Future studies should assess what specific exposures do the outdoor temperatures affect, and in turn how they affect the development of atopic diseases.

BACKGROUND:Little is known about how alcohol policies experienced in adolescence are associated with later health. We assess whether the age of exposure to stricter alcohol policies is associated with later alcohol-attributable hospitalizations and mortality. We take advantage of an alcohol advertising ban and alcohol tax increases introduced in 1975-1977 with relatively stable alcohol policies before and after. METHODS:We used Finnish register data on birth cohorts 1950-1964 (1,175,878 individuals) to assess cohort-wise hazard ratios for the first incidence of alcohol-attributable hospitalization and mortality, and mortality due to external and other causes at ages 21-54 years. RESULTS:Men who were aged 19-25 at the time of the restrictive reform had similar risks for alcohol-attributable hospitalization and mortality to the reference group of those aged 18-legal drinking age-at the time of reform. For those underage at the time, hospitalization and mortality rates were incrementally smaller cohort by cohort. For example, men who were 17 at the time of the reform had lower hazard ratios of alcohol-attributable hospitalization: 0.91 (95% confidence interval: 0.87, 0.95) as did those who were 13 (0.85; 95% confidence interval: 0.81, 0.89). The findings were similar for external-cause mortality, and similar yet more uncertain for women. In contrast, mortality from other causes declined continuously from cohort to cohort. CONCLUSIONS:Our findings are consistent with the hypothesis that stricter alcohol policies in adolescence reduce harmful alcohol consumption patterns extending into adulthood and manifesting as lower alcohol-related harm to health.

The association between having older siblings and decreased risk for atopic symptoms is well-established. This has been interpreted as evidence for the microbiota hypothesis, i.e. that increased early-childhood microbial exposure caused by siblings protects from immune hypersensitivities. However, possible confounders of the association have received little attention. We used register data on Finnish cohorts born in 1995-2004 (N = 559,077) to assess medication purchases for atopic diseases: antihistamines, eczema medication, asthma medication and Epinephrine. We modelled the probability of atopic medication purchases at ages 0-15 by birth order controlling for important observed confounders and all unobserved genetic and environmental characteristics shared by siblings in a within-family fixed effects model. We further studied medication purchases among first-borns according to the age difference with younger siblings to assess whether having younger siblings in early childhood is beneficial. Having older siblings was associated with a lower probability of atopic medication purchases. Compared to first-borns, the probability was 10-20% lower among second-borns, 20-40% lower among third-borns, and 30-70% lower among subsequent children, depending on medication type. Confounding accounted for up to 75% of these differences, particularly for asthma and eczema medication, but significant differences by birth order remained across all medication types. Among first-borns, a smaller age difference with younger siblings was related to a lower likelihood of atopic medication use. Our results, based on designs that account for unobserved confounding, show that exposure to siblings in early childhood, protects from atopic diseases, and thus strongly support the microbiota hypothesis.

Fathers tend to achieve higher earnings than childless men, but there is limited evidence on the associations between fatherhood timing and men's later earnings. Using a longitudinal census-based sample of Finnish men, including a subsample of brothers, we investigated fatherhood timing and men's midlife earnings using both between- and within-family models. Earnings around age 50 were lower among adolescent and young fathers than for men who became fathers at ages 25-29 or later, but these associations became negligible after accounting for measured confounders and unobserved familial confounding. Overall, our findings highlight the important roles of selection into early childbearing and into childlessness. At the population level, early fatherhood was associated with clear negative distributional shifts in fathers' midlife earnings. However, among all men, any influence of fatherhood timing on men's midlife earnings distribution paled in comparison with that of childlessness.

Background Minimum legal drinking age (MLDA) is an effective policy tool in preventing youth drinking and shortterm alcohol-attributable harm, but studies concerning long-term associations are scarce. Methods In this register-based, national cohort study, we assessed alcohol-attributable morbidity and mortality of cohorts born in 1944-54 in Finland. Data were from the 1970 census, the Care Register for Healthcare (maintained by the Finnish Institute of Health and Welfare), and the Cause-of-Death Register (maintained by Statistics Finland). As MLDA was lowered from 21 years to 18 years in 1969, these cohorts were effectively allowed to buy alcohol from different ages (18-21 years). We used survival analysis to compare their alcohol-attributable mortality and hospitalisations with a 36-year follow-up. Findings Compared with the first cohort (1951) allowed to buy alcohol from age 18, the hazard ratios (HRs) for alcohol-attributable morbidity and mortality were lower in cohorts who could not buy alcohol until age 20 or 21 years. For alcohol-attributable morbidity in those aged 21 years when the reform took place, HR was 0 center dot 89 (95% CI 0 center dot 86-0 center dot 93) for men and 0 center dot 87 (0 center dot 81-0 center dot 94) for women versus those aged 17 years. For alcohol-attributable mortality, HR was 0 center dot 86 (0 center dot 79-0 center dot 93) for men and 0 center dot 78 (0 center dot 66-0 center dot 92) for women aged 21 years when the reform took place. The outcomes of the later-born 1952-54 cohorts did not differ from the 1951 cohort. Interpretation Earlier cohorts had consistently lower alcohol-attributable mortality and morbidity; however, other simultaneous increases in alcohol availability probably contributed to increased alcohol-related harm among the younger cohorts. Overall, differences between cohorts born only a few years apart highlight late adolescence as a crucial period for the establishment of lifelong patterns of alcohol use and suggest that higher MLDA could be protective for health beyond young adulthood. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Abstract Background In some high-income contexts, the COVID-19 pandemic was associated with improved birth outcomes, which was hypothesised to be caused by a positive effect of the pandemic on maternal health. Conversely, an improvement in birth outcomes may have been driven by pandemic-induced compositional changes in parental characteristics, which are associated with health outcomes at birth. Research on this consequence of the COVID-19 pandemic is critical for understanding pandemic-induced changes in population health (inequalities) and planning of public service provision. Methods We analysed population-wide data on birth outcomes and parental sociodemographic characteristics from Finland collected between January 2015 and December 2021 (n = 336,000). The total effect of pandemic-induced compositional changes on birth weight and preterm birth rate was estimated by segmented regression models using three conception cohorts: a) conceived prior to May 2019, b) conceived between June 2019 and February 2020 (to account for in-utero exposure to the pandemic), and c) conceived during the pandemic between March 2020 and February 2021 (to prevent selection bias). Preliminary Results Adjusting for secular trends and seasonality, and accounting for in-utero exposure to the pandemic, the estimated effect of parental compositional change on average birth weight was 36.5 grams [95%CI: 24.8; 48.3]. Correspondingly, this compositional change was associated with a 16.2% [95%CI: 8.8%; 23%] lower risk of preterm birth for babies conceived during the pandemic. Conclusions Pandemic-induced changes in parental composition drove the modest increase in birth weight and substantial reduction in preterm births for babies conceived during the pandemic. Should the postponed pregnancies among population groups at risk for worse birth outcomes eventually realise post-COVID-19, health care and educational systems may need to prepare for cohort-specific variations in service demand. Key messages • Improvement in birth weight and preterm birth rate among babies conceived during the COVID-19 pandemic were driven by pandemic-induced changes in parental composition. • Further research using natural experimental designs on this compositional change and health outcomes can inform future public service provision.

BACKGROUND:Low birth weight (BW) is associated with lower cognitive functioning, but less is known of these associations across the full range of the BW distribution and its components. We analyzed how BW, birth length (BL) and birth ponderal index (BPI, kg/m3) are associated with school performance and how childhood family social position modifies these associations. METHODS:Medical birth records of all Finnish children born in 1987-1997 were linked to school performance records at 16 years of age (N = 642,425). We used population averaged and within-siblings fixed-effects linear regression models. RESULTS:BL showed a linear and BW a curvilinear association with school performance whereas for BPI the association was weak. The strongest association was found for BL explaining 0.08% of the variation in school performance in boys and 0.14% in girls. Demographic, gestational and social factors partly explained these associations. Similar but weaker associations were found within sibships. The association of BL with school performance was stronger at lower levels of family social position. CONCLUSION:BL shows a linear association with school performance and can explain more school performance variation than BW. At the population level, BL can offer useful information on intrauterine environmental factors relevant for cognitive performance. IMPACT:Birth length is linearly associated with school performance in late adolescence and explains a larger proportion of school performance variation than birth weight. The association between birth length and school performance is stronger in families with lower socio-economic position. At the population level, birth length can offer information on the intrauterine environment relevant for later cognitive performance.

BACKGROUND AND AIMS:Alcohol use during pregnancy remains an important risk factor for adverse birth outcomes, but little is known regarding how alcohol prices affect pregnancy outcomes on the population level. We assess the associations between decreased alcohol prices with birth outcomes and abortions.DESIGN:Using national registers, we used interrupted time-series modelling to compare outcomes of pregnancies conceived before and after a tax cut, resulting in 33% mean decrease of off-premise alcohol prices on 1 March 2004. We also addressed possible heterogeneity of the associations by maternal age and household income.SETTING:Finland.PARTICIPANTS:All registered pregnancies starting 2 years before and 1 year after the alcohol price cut (analysis sample consisted of 169 735 live births and 32 441 abortions).MEASUREMENTS:The outcomes were birth weight, gestational age, the probability of low birth weight (< 2500 g at birth), preterm birth (< 37 weeks of gestation), any congenital malformations and share of registered abortions of pregnancies.FINDINGS:On the population level, lowered alcohol prices were associated with an increase in abortions immediately after the price cut [+0.84 percentage points; 95% confidence interval (CI) = 0.2, 1.4]. For birth outcomes, negative associations were observed among women in the lowest income quintile; for example, increased probabilities of low birth weight (+1.5 percentage points; 95% CI = 0.4, 2.6) and preterm birth (+1.98 percentage points; 95% CI = 0.8, 3.2). All changes were strongest immediately after the price cut and attenuated during the course of the following year.CONCLUSIONS:Lowered alcohol prices in Finland were associated with a short-term increase in adverse birth outcomes among low-income mothers and an overall increase in abortions.

Abstract Background Ageing populations and decreasing family size suggest more persons might need to take care of their aging parents for longer periods and eventually cope with the loss of their parents with fewer siblings. However, little is known about how number of siblings or specific causes of death, such as dementia, may moderate the burden of impending parental death and coping with parental loss. Methods Using Finnish population registers, we assess annual psychotropic medication use among adult offspring around the time of parental death. We use deaths that occurred in Finland during 2004 to 2016 and assess medication use up to two years before and after parental death with generalized estimation equations while controlling for sociodemographic factors. We assess whether sibship size moderates medication use and whether the associations differ by parental causes of death (e.g. dementia, neoplasms or cardiovascular diseases) that convey information about the abruptness of death and care burden prior to death. Results Before and after parental death, psychotropic medication use increased more among individuals with fewer siblings. The differences were largest in the first year after parental death, e.g., the increase in medication prevalence was 2.8% (95% CI: 2.5; 3.1) among only children, 2.2% (2.0; 2.2) with those with one to two siblings and 1.1% (0.4; 1.8) with those with three or more siblings. There were little differences between causes of death. Our results are preliminary and based on a 10% subsample of deaths in Finland (n = 110,000). Conclusions Parental death was associated with an increase in adult offspring psychotropic medication use that was larger among those with fewer siblings. Decreases in sibship sizes may significantly increase the care burden on offspring caring for their aging parents. Yet, more studies are needed to establish how sibling characteristics moderate these associations. Key messages • There is a clear increase in adult offspring psychotropic medication use in the event of a parental death, yet there was little variation according to cause of death. • Having more siblings was associated with a smaller and belated increase in psychotropic medication use in the event of parental death, which could be interpreted as sharing the burden.