Abstract
Do early-life effects of investments in public health persist to the oldest-old ages? This article answers this question by using the primary care reform in rural Sweden that between 1890 and 1917 led to the establishment of local health districts, together with openings of hospitals and recruitments of medical personnel, as a natural experiment in early-life environmental conditions. The initiatives undertaken within these districts targeted control of infectious diseases, including various isolation and disinfection measures. This study applies a difference-in-differences method combined with propensity score matching to register-based individual-level data for Sweden from 1968 to 2012 and to multisource, purposely collected data on the reform implementation. Providing pioneering evidence for such a distal relationship (ages 78–95), this study finds that treatment through primary care in the year of birth leads to a significant reduction in all-cause mortality (4 % to 6%) and mortality from cardiovascular diseases (5 % to 6 %) and to an increase in average incomes (2 % to 3 %). The effects are universal and somewhat stronger among individuals from poor socioeconomic backgrounds and at higher baseline levels of disease burden.
Highlights
Introduction and Previous ResearchThe oldest-old (80+) represent the fastest growing age group in developed countries and are projected to account for one in five older persons by 2050 globally (United Nations 2015)
I find that due to the reform, individuals treated in the year of birth attained decreases in all-cause mortality risk at approximately 4.1 % to 6.0 %, roughly equivalent to 0.5–0.7 additional years spent alive
Because I have the data for the number of infants at the parish level for each cohort and the number of individuals who survived to age 78, I estimate the impact of the reform on the absolute and relative cohort sizes
Summary
Introduction and Previous ResearchThe oldest-old (80+) represent the fastest growing age group in developed countries and are projected to account for one in five older persons by 2050 globally (United Nations 2015). V. Lazuka challenges related to rising costs in health and social care (Bengtsson 2010; Wise 2010). Lazuka challenges related to rising costs in health and social care (Bengtsson 2010; Wise 2010) For these reasons, identifying the factors that lead to long-term survival and prosperity is increasingly important. Originating from Barker (1991, 1994), the epidemiological literature has developed the concepts of developmental plasticity and critical periods linking particular environments and events in early life to the development of chronic diseases as a person ages. A response by Barbi and Vaupel (2005) argued that cohort effects are modest compared with period effects, more recently coming from medical advancements benefiting the elderly. As Fogel (1994) argued, huge social investments around the turn of the twentieth century—under focus in this study—should inevitably yield large payoffs via cohort mechanisms through the end of the century
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
