Human development and ageing are lifelong processes, where earlier life conditions and events are interlinked with later life outcomes. Patterns of inequality within and among cohorts emerge over ...time as products of the interplay between institutional arrangements and individual life, often dependent on childhood or earlier life circumstances. The life conditions and experiences of older adults in Eastern and Western Europe differ significantly, but whether their cumulative effects on later life outcomes vary across these two regions has not been compared. We explore the effects of socioeconomic position, the experience of a period of hunger, the dispossession of assets, and discrimination suffered by parents in respondents’ life courses on later life health inequalities in Europe. Self-reported health, everyday activity limitations, and cognitive functioning are the main outcomes that provide an adequate overview of different health domains. We mainly use data from the seventh wave of the Survey of Health, Ageing, and Retirement in Europe (SHARE 2017) and restrict our sample to respondents aged 65 and older from 26 European countries (N=41,566). We find that older people in Eastern Europe fare worse in self-rated health and everyday activity limitations than Western Europeans, while Eastern Europeans indicate somewhat better outcomes in cognitive functioning. A disadvantaged socioeconomic position in childhood and adulthood has the strongest association with all health outcomes, followed by the experience of hunger over the life course for the whole of Europe. However, we do not find diverging associations between life-course factors and health outcomes in Eastern and Western Europe. We argue that self-reported health, everyday activity limitations and cognitive functioning have to be analysed within their own frameworks and cannot yield conclusions that are uniform for all health outcomes. Moreover, major generalisations either about Eastern or Western Europe must be treated with caution as the regions have very different historical as well as demographic developments and thus cannot be treated as uniform.
* This article belongs to a special issue on “Demographic Developments in Eastern and Western Europe Before and After the Transformation of Socialist Countries”.
In migration and health research, the healthy migrant effect has been a common finding, but it usually pertains to specific contexts only. Existing findings are inconsistent and inconclusive ...regarding the cognitive functioning of the (aging) foreign-origin population relative to the populations of their host and sending countries. Moreover, this comparison is an understudied design setting.
We analyze the outcomes and associations of cognitive functioning outcomes of the non-institutionalized middle-aged and older population, comparing the Russian-origin population in Estonia with Estonians in Estonia and Russians in Russia in a cross-sectional design. We aim to estimate the (long-term) effects of migration on cognitive functioning in later life, contextualizing the findings in previous research on the healthy migrant effect.
We use data from face-to-face interviews conducted within the SHARE Estonia (2010-2011) and SAGE Russia (2007-2010) surveys. Respondents aged 50+ living in urban areas were grouped by self-identified ethnicity, including 2,365 Estonians, 1,373 Russians in Estonia, and 2,339 Russians in Russia (total
= 6,077). Cognitive functioning was measured using a 25-percentile cut-off threshold for the results of two cognition outcomes - immediate recall and verbal fluency - and the odds of impairment were estimated using binary logistic regression.
Russian men and women living in Estonia have significantly higher odds of impairment in immediate recall than Estonian men and women, though they do not differ from Russians in Russia in the final adjusted models. The differences between all groups are non-significant if age at migration is considered. There are no significant differences between the groups in verbal fluency.
Contrary to the commonly found healthy migrant effect, the middle-aged and older foreign-origin population in Estonia fares initially worse than the native population in the immediate recall outcome, but does not differ from their sending country population, possibly due to Russia's higher mortality rate and therefore the selective survival of healthier people. Different results depending on the cognitive functioning outcome suggest that migration may affect temporary memory more than crystallized knowledge. However, there are no differences between the groups if defined based on age at migration, which suggests that the age profile differences explain most of the groups' differences in cognitive functioning.
Background: An expanding literature documents the childbearing patterns of migrants and their descendants in contemporary Europe. The existing evidence pertains mainly to the northern, western, and ...southern regions of the continent, while less is known about the fertility of migrants who have moved between the countries of Eastern Europe. Objective: The aim of this study is to examine the fertility patterns of first- and second-generation Russians in Estonia, relative to the sending and host populations. Methods: The study draws on the Estonian and Russian Generations and Gender Surveys. Proportional hazards models are estimated for the transitions to first, second, and third births. Results: Russian migrants in Estonia exhibit greater similarity to the sending population, with a lower propensity for having a second and third birth than the host population. This pattern extends to the descendants of migrants. However, mixed Estonian-Russian parentage, enrolment in Estonian-language schools, and residence among the host population are associated with the convergence of Russians' childbearing behaviour with the host-country patterns. The findings support the cultural maintenance and adaptation perspectives; selectivity was found to be less important. Contribution: The study focuses on a previously under-researched context and underscores the importance of contextual factors in shaping migrants' fertility patterns. It raises the possibility that, depending on the childbearing trends and levels among the sending and receiving populations, large-scale migration may reduce rather than increase aggregate fertility in the host country. With the advancement of the fertility transition in sending countries, this situation may become more common in Europe in the future.
To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) ...infants according to international and national charts in Europe.
We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models.
SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR95% confidence interval (CI)=6.1 5.6–6.7) and infants reclassified by international charts from SGA to AGA (2.7 2.3–3.1), but decreased for those reclassified from AGA to LGA (0.6 0.4–0.7). Results were similar for stillbirth and neonatal death.
Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth.
InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.
Previous research has shown considerable variation in the relationship between women's educational attainment and second births in contemporary Europe. A negative association is found in some ...countries, while a positive or non-negative relationship is reported in others. Existing studies come mainly from single-country perspectives, which renders the results not strictly comparable. We investigate the association between women's and their partners' educational attainment and transition to second births comparatively in regions and sub-regions of Europe. The data come from the 2005 and 2011 waves of the EU Statistics on Income and Living Conditions (EU-SILC). We estimate separate discrete-time event history models for regions and sub-regions and multilevel models for all EU-SILC countries. Northern Europe exhibits a positive association between women's and their partners' education and second childbearing. Western Europe features a positive relationship among partners but demonstrates a U-shaped pattern among women. This pattern occurs due to German-speaking countries where women's educational attainment appears inversely related to second births. A negative relationship between women's education and second childbearing also prevails in Eastern Europe; in some sub-regions it extends to male partners. Except for in Eastern Europe, the time-squeeze adds to the positive effect of women's high education. In Northern Europe it enables highly educated women to wholly catch up with their counterparts with medium and low education as regards the proportion having second births. In Southern Europe, by contrast, the educational gradient turns negative following the consideration of the time-squeeze effect. We conclude that the relationship between educational attainment and second births varies not only by individual country but also by larger geographical area in Europe. Although smaller in scale than among women, the variation also extends to male partners.
Ethnically mixed partnerships are often regarded as the ultimate evidence of the integration of migrants and their descendants into their host society. A common finding in the literature is an ...increase in the occurrence of mixed partnerships across migrant generations. This study investigates the formation of minority--majority partnerships in Estonia, with special attention to the variation associated with the migrants' generation and their exposure to the majority population. The study uses pooled data from the Estonian Family and Fertility Survey (FFS) and the Estonian Generations and Gender Survey (GGS), and estimates proportional hazards models. The experience of second-generation migrants indicates a stalling trend in the incidence of mixed partnerships between the majority population and migrant groups, which is rooted in contextual features. Apart from residential proximity, the study shows the salience of early acquisition of the host society language. Our results for the majority population highlight the role of international migration, which exposes host populations to mixed partnership formation. The results lend support to the view that the integration of migrant populations through mixed partnering is a lengthy process that stretches across several generations. A linguistically divided school system and residential segregation contribute to the pillarization of society.
Extensive scholarly literature documents the decline in marriage and increase in nonmarital cohabitation and divorce across regions and countries of Europe, but we know less about the extent to which ...these new family behaviours that have emerged in host societies are adopted by migrants. The aim of this study is to examine partnership transitions among the migrants and their descendants in Estonia, who mainly originate from the European part of Russia. By investigating an East European context, the study contributes to a more comprehensive account of migrant populations in different socio-economic and cultural settings. The study is based on the Estonian Generations and Gender Survey (2004/2005) and the Estonian Family and Fertility Survey (1994/1997), and employs proportional hazards models. The results show that new family formation patterns, associated with the Second Demographic Transition, are less prevalent among migrants. The difference between migrants and native Estonians is most pronounced in the mode of partnership formation and outcomes of cohabiting unions, whereas the results pertaining to union dissolution reveal a less systematic difference between population groups. Reflecting the relatively slow integration, the second-generation migrants exhibit partnership behaviour that differs from that of the native population. The observed differences between migrants and the native population appear largely similar for both men and women. The results lend support to socialisation, cultural maintenance, and adaptation hypotheses, and underscore the importance of contextual factors. The analysis reveals disruption effects of migration on partnership processes.
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 (39-40 weeks), 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.
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.
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.
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 39 weeks GA may provide a useful preterm birth prevention paradigm.
While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to ...evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States.
This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26-31 weeks GA), moderate preterm (32-36 weeks GA), near term (37-38 weeks GA), term (39-41 weeks GA) and post-term (42+ weeks GA) births, using Spearman's rank tests.
High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries' overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births.
Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.
Entering employment and achieving a stable position in the labour market are considered important preconditions for childbearing. The researchers investigate how work experience and career ...development are related to the timing of parenthood in two diverse contexts in Estonia, state socialism and the market economy, and how it varies by gender and nativity. The data used come from the Estonian Health Interview Survey 2006-2007. They estimate piecewise constant event history models to analyse the transition to first birth. Their results suggest that in the market economy work experience became more important in the decision to enter parenthood. In the market economy the importance of work experience to entering parenthood became more similar for women and men. Non-native-origin men and women's timing of parenthood appears to have become detached from their career developments. The article discusses mechanisms that may underlie the observed patterns.
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