Association of Parenthood With Incident Heart Disease in United States’ Older Men and Women: A Longitudinal Analysis of Health and Retirement Study Data

Abstract

Objective: To examine the association of number of children birthed/fathered with incident heart disease, accounting for socioeconomic and lifestyle characteristics. Methods: We analyzed data from 24,923 adults 50 and older (55% women) in the Health and Retirement Study. Participants self-reported number of children and doctor-diagnosed incident heart disease. Cox proportional hazards models estimated heart disease risk. Results: Compared to women with one to two children, those with five or more had increased risk of heart disease (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = [1.03, 1.25]). Compared to men with one to two children, those with five or more had a marginally increased risk of heart disease (HR = 1.11, 95% CI = [0.99, 1.25]), but this association attenuated in models adjusting for socioeconomic and lifestyle variables. Compared to men with no children, those with five or more retained a borderline significant association in the fully adjusted model (HR = 1.15, 95% CI = [0.99, 1.35]). Discussion: Social and lifestyle pathways appear to link parenthood to cardiovascular health.

Keywords

number of children parity socioeconomic characteristics lifestyle characteristics cardiovascular disease risk

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References

Appelman

van Rijn

B. B.

ten Haaf

M. E.

Boersma

Peters

S. A.

(2015). Sex differences in cardiovascular disease risk factors and disease prevention. Atherosclerosis, 241, 211-218.

Arnold

A. M.

Psaty

B. M.

Kuller

L. H.

Burke

G. L.

Manolio

T. A.

Fried

L. P.

. . . Kronmal

R. A.

(2005). Incidence of cardiovascular disease in older Americans: The cardiovascular health study. Journal of the American Geriatrics Society, 53, 211-218.

Baldi

Costa

Foltran

Spada

Chiffi

Sacerdote

Gregori

(2013). Effect of educational attainment on incidence and mortality for ischemic heart and cerebrovascular diseases: A systematic review and trend estimation. International Journal of Cardiology, 168, 4959-4963.

Bellamy

Casas

J. P.

Hingorani

A. D.

Williams

D. J.

(2007). Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. British Medical Journal, 335(7627), Article 974.

Centers for Disease Control and Prevention. (2013). CDC health disparities & inequalities report—United States, 2013. Morbidity and Mortality Weekly Report, 62(Suppl. 3), 1-187.

Clark

A. M.

DesMeules

Luo

Duncan

A. S.

Wielgosz

(2009). Socioeconomic status and cardiovascular disease: Risks and implications for care. Nature Reviews Cardiology, 6, 712-722.

Cunningham

T. J.

Croft

J. B.

Liu

Eke

P. I.

Giles

W. H.

(2017). Vital signs: Racial disparities in age-specific mortality Among blacks or African Americans—United States, 1999–2015. Morbidity and Mortality Weekly Report, 66, 444-456.

de Kleijn

M. J. J.

van der Schouw

Y. T.

van der Graaf

. (1999). Reproductive history and cardiovascular disease risk in postmenopausal women: A review of the literature. Maturitas, 33, 7-36.

Feinglass

Lin

Thompson

Sudano

Dunlop

Song

Baker

D. W.

(2007). Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: Findings from the health and retirement study, 1992-2002. The Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 62, S209-S217.

10.

Fisher

G. G.

Ryan

L. H.

(2018). Overview of the health and retirement study and introduction to the special issue. Work, Aging and Retirement, 4, 1-9.

11.

Frejka

Westoff

C. F.

(2008). Religion, religiousness and fertility in the US and in Europe. European Journal of Population, 24, 5-31.

12.

Fryar

C. D.

Chen

(2012). Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999-2010 (NCHS Data Brief No. 103). Hyattsville, MD: National Center for Health Statistics.

13.

Gallagher

L. G.

Davis

L. B.

Ray

R. M.

Psaty

B. M.

Gao

D. L.

Checkoway

Thomas

D. B.

(2011). Reproductive history and mortality from cardiovascular disease among women textile workers in Shanghai, China. International Journal of Epidemiology, 40, 1510-1518.

14.

GBD 2016 Causes of Death Collaborators. (2017). Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the global burden of disease study 2016. The Lancet, 390, 1151-1210.

15.

Green

Beral

Moser

(1988). Mortality in women in relation to their childbearing history. British Medical Journal, 297, 391-395.

16.

Grundy

Read

(2015). Pathways from fertility history to later life health: Results from analyses of the English longitudinal study of ageing. Demographic Research, 32, 107-146.

17.

Hardy

Lawlor

D. A.

Black

Mishra

G. D.

Kuh

(2009). Age at birth of first child and coronary heart disease risk factors at age 53 years in men and women: British birth cohort study. Journal of Epidemiology & Community Health, 63, 99-105.

18.

Health and Retirement Study, ([RAND HRS Longitudinal File 2014]) public use dataset. Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). Ann Arbor, MI, (2016).

19.

Health and Retirement Study, ([RAND HRS Fat Files 1992-1996,2014]) public use dataset. Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). Ann Arbor, MI, (2011-2016).

20.

Heeringa

S. G.

Connor

J. H.

(1995). Technical description of the health and retirement study sample design. Ann Arbor: Institute for Social Research, University of Michigan.

21.

Juster

F. T.

Suzman

(1995). An overview of the health and retirement study. Journal of Human Resources, 30, S7-S56.

22.

Krieger

(1990). Racial and gender discrimination: Risk factors for high blood pressure? Social Science & Medicine, 30, 1273-1281.

23.

Krieger

Rowley

D. L.

Herman

A. A.

Avery

Phillips

M. T.

(1993). Racism, sexism, and social class: Implications for studies of health, disease, and well-being. American Journal of Preventive Medicine, 9(6 Suppl), 82-122.

24.

Kurian

A. K.

Cardarelli

K. M.

(2007). Racial and ethnic differences in cardiovascular disease risk factors: A systematic review. Ethnicity & Disease, 17, 143-152.

25.

Lawlor

D. A.

Emberson

J. R.

Ebrahim

Whincup

P. H.

Wannamethee

S. G.

Walker

Smith

G. D.

(2003). Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with Child-rearing? Findings from the British women’s heart and health study and the British regional heart study. Circulation, 107, 1260-1264.

26.

Lloyd-Jones

Adams

Carnethon

De Simone

Ferguson

T. B.

Flegal

, . . . American Heart Association Statistics Committee Stroke Statistics Subcommittee. (2009). Heart disease and stroke statistics—2009 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation, 119(3), e21-e181.

27.

Magnus

M. C.

Iliodromiti

Lawlor

D. A.

Catov

J. M.

Nelson

S. M.

Fraser

(2017). Number of offspring and cardiovascular disease risk in men and women. Epidemiology, 28, 880-888.

28.

McDonald

S. D.

Malinowski

Zhou

Yusuf

Devereaux

P. J.

(2008). Cardiovascular sequelae of preeclampsia/eclampsia: A systematic review and meta-analyses. American Heart Journal, 156, 918-930.

29.

Mensah

G. A.

Mokdad

A. H.

Ford

E. S.

Greenlund

K. J.

Croft

J. B.

(2005). State of disparities in cardiovascular health in the United States. Circulation, 111, 1233-1241.

30.

Mishra

G. D.

Anderson

Schoenaker

D. A.

Adami

H. O.

Avis

N. E.

Brown

. . . Weiderpass

(2013). InterLACE: A new international collaboration for a life course approach to women’s reproductive health and chronic disease events. Maturitas, 74, 235-240.

31.

Mozaffarian

Benjamin

Arnett

Blaha

Cushman

. . .Turner

(2016). Heart disease and stroke statistics—2016 update: A report from the American heart association. Circulation, 133(4), e38-e360.

32.

National Heart, Lung, and Blood Institute. (2017). Coronary heart disease. Retrieved from https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease

33.

Ness

Schotland

Flegal

Shofer

F. S.

(1994). Reproductive history and coronary heart disease risk in women. Epidemiologic Reviews, 16, 298-314.

34.

Ness

R. B.

Cobb

Harris

D’Agostino

R. B.

(1995). Does number of children increase the rate of coronary heart disease in men? Epidemiology, 6, 442-445.

35.

Ness

R. B.

Harris

Cobb

Flegal

K. M.

Kelsey

J. L.

Balanger

. . . D’Agostino

R. B.

(1993). Number of pregnancies and the subsequent risk of cardiovascular disease. New England Journal of Medicine, 328, 1528-1533.

36.

Newman

A. B.

Brach

J. S.

(2001). Gender gap in longevity and disability in older persons. Epidemiologic Reviews, 23, 343-350.

37.

Ofstedal

M. B.

Weir

D. R.

(2011). Recruitment and retention of minority participants in the health and retirement study. Gerontologist, 51(Suppl. 1), S8-S20.

38.

Oksanen

Kivimaki

Pentti

Virtanen

Klaukka

Vahtera

(2010). Self-report as an indicator of incident disease. Annals of Epidemiology, 20, 547-554.

39.

Parikh

N. I.

Cnattingius

Dickman

P. W.

Mittleman

M. A.

Ludvigsson

J. F.

Ingelsson

(2010). Parity and risk of later-life maternal cardiovascular disease. American Heart Journal, 159, 215-221.e6.

40.

Peters

S. A.

Yang

Guo

Chen

Bian

Millwood

I. Y.

, . . . China Kadoorie Biobank Collaboration Group. (2017). Parenthood and the risk of cardiovascular diseases among 0.5 million men and women: Findings from the China Kadoorie Biobank. International Journal of Epidemiology, 46, 180-189.

41.

Philipov

Berghammer

(2007). Religion and fertility ideals, intentions and behaviour: a comparative study of European countries. Vienna yearbook of population research, 5. 271-305.

42.

Rich-Edwards

J. W.

Fraser

Lawlor

D. A.

Catov

J. M.

(2014). Pregnancy characteristics and women’s future cardiovascular health: An underused opportunity to improve women’s health? Epidemiologic Reviews, 36, 57-70.

43.

Rindfuss

Morgan

Offutt

(1996). Education and the changing age pattern of American fertility: 1963-1989. Demography, 33, 277-290.

44.

Rosendaal

N. T. A.

Alvarado

Y. Y.

Velez

M. P.

da Camara

Pirkle

C. M.

(2017). Adolescent childbirth is associated with greater Framingham Risk Scores for cardiovascular disease among participants of the IMIAS (International Mobility in Aging Study). Journal of the American Heart Association, 6(11), Article e007058.

45.

Ruijter

Haitjema

Asselbergs

Pasterkemp

(2015). Sex matters to the heart: A special issue dedicated to the impact of sex related differences of cardiovascular disease. Atherosclerosis, 241, 205-207.

46.

Sattar

Greer

I. A.

(2002). Pregnancy complications and maternal cardiovascular risk: Opportunities for intervention and screening? British Medical Journal, 325, 157-160.

47.

Simons

L. A.

Simons

Friedlander

McCallum

(2012). Childbearing history and late-life mortality: The Dubbo study of Australian elderly. Age and Ageing, 41, 523-528.

48.

Smedley

B. D.

Stith

A. Y.

Nelson

A. R.

(2013). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.

49.

Sonnega

Faul

J. D.

Ofstedal

M. B.

Langa

K. M.

Phillips

Weir

D. R.

(2014). Cohort profile: The health and retirement study (HRS). International Journal of Epidemiology, 43, 576-585.

50.

Weng

H. H.

Bastian

L. A.

Taylor

D. H.

Moser

B. K.

Ostbye

(2004). Number of children associated with obesity in middle-aged women and men: Results from the health and retirement study. Journal of Women’s Health, 13, 85-91.