Mikko Myrskylä's research while affiliated with University of Helsinki and other places
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Publications (183)
Objectives
To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States. We also assess MMLE inequalities by sex and education.
Methods
Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-...
Women’s labor force participation has increased in Western countries, but gender gaps remain, especially among parents. Using a novel comparative perspective, we assess women’s and men’s employment trajectories from midlife onward by parity and education. We provide insights into the gendered parenthood-employment gaps examining the long-term impli...
Period fertility has declined rapidly in Norway in the 2010s, reaching record lows. While there is a clear education-fertility dynamic, significant educational shifts have occurred and it’s unclear how much this contributed to recent fertility declines. To disentangle this, we utilize high-quality Norwegian register data and model yearly transition...
Adverse life events are major causes of declining health and well-being, but the effects vary across subpopulations. We analyze how the intersection of migration status and sex relates to two main adverse life events—job loss and divorce—thereby affecting individual health and well-being trajectories. Using data from the German Socio-Economic Panel...
Background
At the turn of 2021-2022, monthly birth rates declined in many higher-income countries. We explore how the rollout of COVID-19 vaccination was associated with this decline.Methods
Using an interrupted time series design, we evaluate the impact of the onset of the COVID-19 pandemic and the start of COVID-19 vaccination on seasonally-adjus...
Fertility declined sharply and unexpectedly in Finland in the 2010s across educational levels. Using Finnish register data, we calculated total fertility rates (TFRs) and the proportion of women expected to have a first birth in 2010–2019 for 153 educational groups—reflecting field and level—and estimated how the characteristics of a group predicte...
Drawing cohort profiles and cohort forecasts from grids of age–period data is common practice in demography. In this research note, we (1) show how demographic measures artificially fluctuate when calculated from the diagonals of age–period rates because of timing and cohort-size bias, (2) estimate the magnitude of these biases, and (3) illustrate...
STUDY QUESTION
Is maternal pre-pregnancy BMI associated with semen quality, testes volume, and reproductive hormone levels in sons?
SUMMARY ANSWER
Maternal pre-pregnancy BMI was associated with an altered reproductive hormone profile in young adult sons, characterized by higher levels of oestradiol, LH, and free androgen index (FAI) and lower leve...
A growing applied literature investigates the levels, trends, causes, and effects of lifespan variation. This work is typically based on measures that combine partial cohort histories into a synthetic cohort, most frequently in a period-life table, or focus on single (completed) cohort analysis. We introduce a new cohort-based method, the overlappi...
Background
Multimorbidity patterns in immigrants may differ from the native population due to their biological traits and experience in origin and receiving countries. This study addresses the descriptive patterns of multimorbidity by gender and immigration background and compares the prevalence of each multimorbidity pattern between immigrants and...
Background
Immigrants may experience a faster health decline than natives due to the deleterious impact of migration-related experiences on healthy ageing. Support from living arrangements where family members reside together is known to provide a buffering effect for such health deterioration. This study examines the role of living arrangements in...
Background
We aim to investigate to what extent gender inequality at the labor market explains higher depression risk for women than men among older US adults.
Methods
We analyze data for 35,699 US adults aged 50-70 years that participated in the Health and Retirement Study. We calculate the gender gap as the difference in the prevalence of elevat...
Background
This study aims to investigate regional disparities of quality of life (QoL) among older cancer survivors across European countries.
Methods
This is a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) project. European-level, regional and national QoL among cancer survivors were investigated using...
Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US li...
Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at...
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/m ³ ) are associated with school performance and how childhood family social position modifi...
The extension of late working life has been proposed as a potential remedy for the challenges of aging societies. For Germany, surprisingly little is known about trends and social inequalities in the length of late working life. We use data from the German Microcensus to estimate working life expectancy from age 55 onward for the 1941‒1955 birth co...
We aim to investigate to what extent gender inequality at the labor market explains higher depression risk for older US women compared to men. We analyze data from 35,699 US adults aged 50-80 years that participated in the Health and Retirement Study. The gender gap is calculated as the difference in prevalence in elevated depressive symptoms (scor...
The probability of having multiple chronic conditions simultaneously, or multimorbidity, tends to increase with age. Immigrants face a particularly high risk of unhealthy ageing. This study investigates the immigrant-native disparities in the speed of age-related chronic disease accumulation, focusing on the number of chronic health conditions; and...
Women’s labor force participation has increased remarkably in western countries, but important gender gaps still remain, especially among parents. This paper uses a novel comparative perspective assessing women’s and men’s mid-life employment trajectories by parity and education. We provide new insight into the gendered parenthood penalty by analyz...
Discrete-time multistate life tables are attractive because they are easier to understand and apply in comparison with their continuous-time counterparts. While such models are based on a discrete time grid, it is often useful to calculate derived magnitudes (e.g. state occupation times), under assumptions which posit that transitions take place at...
Background:
US racial-ethnic mortality disparities are well documented and central to debates on social inequalities in health. Standard measures, such as life expectancy or years of life lost, are based on synthetic populations and do not account for the real underlying populations experiencing the inequalities.
Methods:
We analyze US mortality...
Cognitively impaired adults without a partner are highly disadvantaged, as partners constitute an important source of caregiving and emotional support. With the application of innovative multistate models to the Health and Retirement Study, this paper is the first to estimate joint expectancies of cognitive and partnership status at age 50 by sex,...
Background
It remains unclear how pre-existing depression, anxiety, and diabetes of different durations are associated with the risk of pancreatic cancer, its clinical characteristics, treatment modalities, and subsequent survival.
Methods
From a register-based random sample of Finns residing in Finland at the end of the period 1987–2007, 6492 pat...
Same-sex couples increasingly often live in legally recognized unions and have children as a couple. The accessibility of parenthood, however, depends on intersecting contextual and couple-level characteristics. Using Finnish register data on female same-sex couples who registered their partnership in 2006–2015, during which important legal reforms...
Background
Advanced maternal age at birth is considered a risk factor for adverse birth outcomes. A recent study applying a sibling design has shown, however, that the association might be confounded by unobserved maternal characteristics.
Methods
Using total population register data on all live singleton births during the period 1999–2012 in Denm...
Background
Medically assisted reproduction (MAR) can negatively impact women’s mental health, particularly when the treatments do not result in a live birth. While the number of women relying on MAR to conceive has grown rapidly, our knowledge about the mental health effects before, during, and after treatment is limited.
Objective
To understand t...
Fertility declined sharply and unexpectedly in Finland in the 2010s. Using detailed Finnish register data, we calculated total fertility rates (TFRs) and the proportion of women expected to have a first birth (TFRp1) in 2010–2019 for 153 fields of education and estimated how the characteristics of each field predicted its fertility decline. As educ...
The Brazilian period total fertility rate (PTFR) dropped to 1.8 in 2010 (1.5 among those with high education). Due to shifts in fertility timing, the PTFR may provide a misleading picture of fertility levels. The consequences of these changes for the cohort total fertility rate (CTFR)—a measure free from tempo distortions—and for educational differ...
Background:
More recent birth cohorts are at a higher depression risk than cohorts born in the early 20th century. We aimed to investigate to what extent changes in alcohol consumption, smoking, physical activity, and obesity contribute to these birth cohort variations.
Methods:
We analyzed panel data from US adults born 1916-1966 enrolled in th...
Young adulthood is a dynamic and demographically dense stage in the life course. This poses a challenge for research on the socioeconomic consequences of parenthood timing, which most often focuses on women. We chart the dynamics of delayed parenthood and its implications for educational and labor market trajectories for young adult women and men u...
Although preterm birth is the leading cause of perinatal morbidity and mortality in advanced economies, evidence about the consequences of prematurity in later life is limited. Using Swedish registers for cohorts born 1982–94 (N = 1,087,750), we examine the effects of preterm birth on school grades at age 16 using sibling fixed effects models. We f...
Health and mortality in the United States rank poorly by international standards, despite the nation s robust economic and technological standing. In 2010, life expectancy at birth in the United States, at 78.8 years, was 1.0 year lower than the average of 27 European Union countries (Eurostat, 2021; University of California, Berkeley and Max Planc...
In the 2010s, fertility has declined in the Nordic countries, most strikingly in Finland, and first births drive the decline. It remains unclear whether this decline results from decreased fertility within unions, changing union dynamics, or both. Thus, we investigated changes in the union-first birth dynamics from 2000 through 2018 in Finland usin...
Drawing cohort profiles and cohort forecasts from grids of age-period data is common practice in demography. In this research note, we: (1) estimate the bias in the cohort TFR and life expectancies calculated from such data, and (2) demonstrate that cohort Lee-Carter forecasts drawn from an age-period grid have implausible prediction intervals, esp...
Objectives
Reductions in US cardiovascular (CVD) mortality have stagnated. While other high life expectancy countries (HLC) have also recently experienced a stall, the stagnation in CVD mortality in the US appeared earlier and has been more pronounced. The reasons for the stall are unknown. We analyze cross-national variations in mortality trends t...
The relationship between levels of social and economic inequality and demographic changes remains poorly documented, particularly for fertility. Covering a period from 1986 to 2018, this paper documents a positive country‐level association between income inequality and the dispersion of first birth schedules among women from 88 countries of the Glo...
Background
The first few weeks’ post-imprisonment are associated with high mortality, particularly among individuals with a history of substance use. Excess risk may vary by societal context due to a range of penal systems and substance use patterns. Using data on Finnish individuals who had sought treatment for substance use, we studied the associ...
Objective:
To compare risks of adverse birth outcomes among pregnancies conceived with and without medically assisted reproduction treatments.
Methods:
Birth certificates were used to study birth outcomes of all neonates born in Utah from 2009 through 2017. Of the 469,919 deliveries, 52.8% (N=248,013) were included in the sample, with 5.2% of th...
Background
The increasing number and proportion of children born after medically assisted reproduction (MAR) has raised concerns and motivated research about the impact of MAR on the well-being and development of children.
Objective
We summarize existing studies on the well-being and development of children conceived through MAR.
Materials and me...
The extension of late working life has been proposed as a potential remedy for the challenges of aging societies. For Germany, surprisingly little is known about trends and social inequalities in the length of late working life. Here, we use data from the German Microcensus to estimate working life expectancy from age 55 onwards for the 1941-1955 b...
Background
Some birth cohorts experience a larger burden of depression than others. We hypothesize that lifestyle, i.e. BMI, alcohol consumption, smoking and physical activity, are potential drivers of these generational differences.
Methods
We analyzed data from US adults aged 50-80 years enrolled in the Health and Retirement Study (N = 163,760 p...
Although the children of first-generation immigrants tend to have better health than the native population, the health advantage of the children of immigrant families deteriorates over generations. It is, however, poorly understood where on the generational health assimilation spectrum children with one immigrant and one native parent (i.e., exogam...
Background:
The US rural disadvantage in life expectancy (LE) relative to urban areas has grown over time. We measured the contribution of cardiovascular disease (CVD), drug-overdose deaths (DODs) and other major causes of death to LE trends in rural and urban counties and the rural-urban LE gap.
Methods:
Counterfactual life tables and cause-of-...
With historically similar patterns of high and stable cohort fertility and high levels of gender equality, the Nordic countries of Sweden, Finland, Norway, Denmark, and Iceland are seen as forerunners in demographic behavior. Furthermore, Nordic fertility trends have strongly influenced fertility theories. However, the period fertility decline that...
Methods and data sources for the manuscript “Optimal vaccination age varies across countries”, which elaborates on the findings by Goldstein, Cassidy, and Wachter (2021).
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 81 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. We find that over 20.5 million years of life have been lost to C...
When did mortality first start to decline, and among whom? We build a large, new data set with more than 30,000 scholars covering the sixteenth to the early twentieth century to analyze the timing of the mortality decline and the heterogeneity in life expectancy gains among scholars in the Holy Roman Empire. The large sample size, well-defined entr...
Background
The COVID-19 pandemic poses the risk of overburdening health care systems, and in particular intensive care units (ICUs). Non-pharmaceutical interventions (NPIs), ranging from wearing masks to (partial) lockdowns have been implemented as mitigation measures around the globe. However, especially severe NPIs are used with great caution due...
Background: Understanding how widely COVID-19 has spread is critical information for monitoring the pandemic. The actual number of infections potentially exceeds the number of confirmed cases.
Development: We develop a demographic scaling model to estimate COVID-19 infections, based on minimal data requirements: COVID-19-related deaths, infection...
COVerAGE-DB is an open-access database including cumulative counts of confirmed COVID-19 cases, deaths, and tests by age and sex. Original data and sources are provided alongside data and measures in age-harmonized formats. The database is still in development, and at this writing, it includes 87 countries, and 195 subnational areas. Cumulative cou...
The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use dat...
Background:
Accumulating evidence suggests risk of cognitive impairment is declining in high-income countries. Much of this research uses longitudinal surveys in which learning over repeated tests may bias results. We analyze trends in cognitive impairment in the United States, accounting for prior test experience and selective mortality.
Methods...
Educational differences in female cohort fertility vary strongly across high-income countries and over time, but knowledge about how educational fertility differentials play out at the sub-national regional level is limited. Examining these sub-national regional patterns might improve our understanding of national patterns, as regionally varying co...
![Fig. 2 State space of the model of Hardy et al. [15]](publication/343293177/figure/fig2/AS:920122663391234@1596385746828/State-space-of-the-model-of-Hardy-et-al-15_Q320.jpg)
Background:
Markov models are a key tool for calculating expected time spent in a state, such as active life expectancy and disabled life expectancy. In reality, individuals often enter and exit states recurrently, but standard analytical approaches are not able to describe this dynamic. We develop an analytical matrix approach to calculating the...
The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how th...
For a long time, high‐income countries tended to report a negative association between female educational attainment and childbearing. Belgium was among the first countries that seemed to witness the emergence of a positive educational gradient in female fertility. It has been argued that—alongside other contextual correlates—this trend reflects th...
Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 42 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. As of June 13th 2020, YLL in heavily affected countries are 2 to...
Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 42 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. As of June 13th 2020, YLL in heavily affected countries are 2 to...
The ongoing period fertility decline in the Nordic countries is particularly strong in Finland, where the total fertility rate (TFR) reached an all-time low of 1.41 in 2018. We analyse the decrease in Finland's TFR in 2010–17, and assess its consequences for cohort fertility using complementary approaches. Decomposition of this fertility decline sh...
Background
The total number of COVID-19 infections is critical information for decision makers when assessing the progress of the pandemic, its implications, and policy options. Despite efforts to carefully monitor the COVID-19 pandemic, the reported number of confirmed cases is likely to underestimate the actual number of infections. We aim to est...
Background:
Life course epidemiology suggests that early life circumstances affect adult mortality, but most of the evidence is based on cohorts born in the beginning of the 20th century. It remains unclear whether and how the influences of early life circumstances on mortality have changed in later birth cohorts.
Methods:
Analyses rely on 10% r...
The population-level case fatality rate (CFR) associated with COVID-19 varies substantially, both across countries and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COV...
After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held...
Prior studies have analyzed the burden of cognitive impairment, but often use potentially biased prevalence-based methods or measure only years lived with impairment, without estimating other relevant metrics. We use the Health and Retirement Study (1998–2014; n = 29,304) and the preferred incidence-based Markov-chain models to assess three key mea...
The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how th...
Objectives: Little is known about the length of working life, even though it is a key indicator for policy-makers. In this paper, we study how the length of working life at age 50has developed in the U.S. from a cohort perspective.
Methods: We use a large longitudinal sample of U.S. Social Security register data that covers close to 1.7 million in...
Study question:
Does the risk of low birth weight and premature birth increase with age among mothers who conceive through medically assisted reproduction (MAR)?
Summary answer:
Among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+).
What is known already:
T...
This study investigates spatial variation in fertility in Europe. We analyse spatial variation in total fertility rates using small‐scale geographical data from 21 European countries for 2010 and investigate the role economic, sociocultural, and spatial factors play in regional fertility levels. We compare the performance of conventional ordinary l...
(Abstracted from Lancet 2019;393:1225–1232)
Medically assisted reproduction—that is, reproduction brought about through treatments such as ovulation induction, artificial insemination, in vitro fertilization (IVF), or intracytoplasmic sperm injection with fresh or frozen embryo transfer—has resulted in the birth of more than 5 million children. Alt...
Background
Previous research has shown that certain living arrangements, such as living alone, are associated with worse health at older ages. We assessed the association between living arrangements and hospital care use among middle-aged and older adults, and investigated to what extent observed and unobserved individual characteristics explain th...
Evidence for nation-states suggests that the long-standing negative relationship between fertility and economic development might turn positive at high levels of development. The robustness of the reversal continues to be debated. We add to this discussion from a novel angle by considering whether such a reversal could also occur at the sub-nationa...
Becoming a father, particularly for the first time, is a central transition in men's lives, and whether this transition takes place early or later in life may have important ramifications on the whole later life course. Previous research has shown that men who father their first child early in life have poorer later-life health than men who postpon...
A critical question in life-course research is whether the relationship between a risk factor and mortality strengthens, weakens, or remains constant with age. The objective of this paper is to shed light on the importance of measurement scale in examining this question. Many studies address this question solely on the multiplicative (relative) sca...
The increasing number of children conceived through medically assisted reproduction (MAR, including IVF/ICSI, intrauterine insemination and ovulation induction) has led to concerns about the potential negative effects of fertility treatments on children's psychosocial health. Some studies suggest that MAR children might be at higher risk of develop...
Background: Children born after medically assisted reproduction are at higher risk of adverse birth outcomes than are children conceived naturally. We aimed to establish the extent to which this excess risk should be attributed to harmful effects of treatment or to pre-existing parental characteristics that confound the association. Methods: We use...
Under the pressure of population aging the Italian pension system has undergone reforms to increase labor force participation and retirement age, and, thus, the length of working life. However, how the duration of working life has developed in recent years is not well understood. This paper is the first to analyze trends in working life expectancy...
Background:
The estimated effect of unemployment on depression may be biased by time-varying, intermediate, and time-constant confounding. One of the few methods that can account for these sources of bias is the parametric g-formula, but until now this method has required that all relevant confounders be measured.
Methods:
We combine the g-formu...
While there has been considerable debate about extending the length of working life, relatively little is known about this issue. We use data from the Spanish Continuous Working Life Sample for 2004–2013 to calculate period working life tables, which in turn allows us to assess the impact of the financial crisis on working life expectancy in Spain....
Significance
Information on cohort fertility is critical for the understanding of population dynamics, but only in historical settings can it be calculated without forecasting. Several forecasting methods exist, but their strengths and weaknesses have not been evaluated. Relying on the Human Fertility Database, the largest high-quality fertility da...
Background
Based on existing studies, there is no conclusive evidence as to whether and why paternal age matters for birth outcomes.
Methods
We used Finnish population registers on 106 652 children born 1987–2000. We first document the unadjusted association between paternal age and the risk of low birth weight (LBW; <2500 g) and preterm birth (<3...
Education is negatively associated with most major causes of death. Prior work ignores the premise that cause-specific hazards are interdependent and that both education and mortality depend on cognitive ability. We analyse Swedish men aged 18–63, focusing on months lost due to specific causes—which solves the interdependence problem—and use a stru...
The level of education and other adult socioeconomic characteristics of men are known to associate with their fertility, but early-life socioeconomic characteristics may also be related. We studied how men’s adult and early-life socioeconomic characteristics are associated with their eventual fertility and whether the differences therein by educati...
Introduction
This study aimed to investigate how depression and diabetes history, both short-term and long-term, before the diagnosis of pancreatic cancer are associated with cancer risk and survival outcomes.
Methods
Data from a linked registered-based 11% random sample of the population residing in Finland are used. The study cohort consists of...
Existing studies provide contradictory evidence concerning the association between child health and advanced maternal age. A potential explanation for the lack of consensus on this issue is changes over time in the costs and benefits of giving birth at an advanced age. This is the first study to investigate secular changes in the characteristics of...
Citations
... In addition, mothers with higher education are more likely to give birth to another child than mothers with primary education in the 2010s (Comolli et al. 2021), i.e., around the time when our sample gives birth. The fertility-decline in the 2010s in Finland seem to be related to the economic uncertainty women experience in different educational fields (Hellstrand et al. 2022). ...
... Life expectancy · Germany · International comparison Bundesgesundheitsblatt -Gesundheitsforschung -Gesundheitsschutz [6]. Dieser Befund sollte jedoch mit Vorsicht interpretiert werden, da die vorliegende Analyse auf Periodendaten und nicht auf Kohortendaten basiert [27]. Des Weiteren war der in der Vergangenheit in vielen Altersgruppen verzeichnete Vorsprung Deutschlands gegenüber Dänemark bei den Frauen stärker ausgeprägt als bei den Männern. ...
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... The slowdown of future growth in life expectancy that is most pronounced in the high-income super-region has already been observed and debated in the UK and the USA in the 5-10 years preceding the COVID-19 pandemic. 23,24 Increasing or stalled mortality trends have been observed both in midlife (deaths of despair due to suicide, drugs, and alcohol) and older age groups. [23][24][25] Population growth will slow considerably by 2050 at the global level but will remain high in some of the poorest regions of the world. ...
Reference: PIIS0140673624006858
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... Older immigrants have poorer physical, mental and social health than the general elderly population and rate their health as worse than older people in their host country (Khan et al., 2015). In a study analyzing data from 25 European countries, it is stated that older immigrants under the age of 75 have more chronic diseases than natives (Jang et al., 2023). In a study conducted in Norway, it is stated that the health and functional capacity of older immigrants are lower than those born in Norway (Qureshi et al., 2022). ...
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... The results of this study have important implications for public health and social policy. Regarding public health, the current study showed that a higher proportion of people work over time, which agrees with previous studies from Germany (Dudel et al. 2021;Heller et al. 2022;Tetzlaff et al. 2022). Increased work participation may have beneficial effects for the economy and for some aspects of people's health, but the relationship is not straightforward and depends on various factors, such as the quality and conditions of work and the Content courtesy of Springer Nature, terms of use apply. ...
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... The random variable η is a vector whose entries are the times to absorption (i.e., death) from each of the transient states. More sophisticated analyses can be written using Markov chains with rewards to account for fractional years lived by those who die (Caswell and van Daalen 2021;Schneider, Myrskylä, and van Raalte 2023), but will not change any of the analyses reported here. ...
... Studies investigating specific comorbidities and stage at diagnosis are scarce for cancers other than breast and colorectal cancers [7]. Nevertheless, patients with newly diagnosed T2D or hyperinsulinemia have been recommended for pancreatic and liver cancer screening since the presence of pre-existing disease may mask other diseases and thus lead to late cancer presentation [10]. Such recommendations for screening are supported by our findings. ...
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... Studies have shown that the relationship between the incidence of PTB and maternal age follows a "U-shaped" pattern, with a higher occurrence rate of PTB in younger and older pregnant women [20][21][22], the lowest occurrence rate of PTB in pregnant women aged 30-34 years (5.7%), and the highest occurrence rate of PTB in pregnant women aged 40 years or older (7.8%) [21]. In China, there is an increasing trend in the proportion of older maternal age (≥35 years), rising from 10.6% in 2016 to 16.7% in 2017 and 15.9% in 2018 [3]. ...
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... Alternatively, documented declines in the average ideal number of children in Finland could reflect period changes in fertility ideals during the Great Recession and the recovery period that followed. Recent studies from the Nordic countries found a more pronounced fertility decline in the 2010s among men and women with weaker labour market attachment (i.e., unemployed or with low earnings) (Ohlsson-Wijk and Andersson, 2022), the low educated (Comolli et al., 2021), and women in educational fields characterized by higher economic uncertainty (Hellstrand, Nisén and Myrskylä, 2022). Thus, declining fertility ideals during the 2010s might be related to the increased economic uncertainty associated with the Great Recession, not ideational changes. ...
... Next, we describe this general process in greater detail in the context of panel data and long-term causal effects. Our approach shares similarities with the methods employed by Bijlsma & Wilson (2019) and Nisén et al. (2022), who utilized ML-based generalized linear models with backdoor adjustment and bootstrapping to estimate the causal determinants of fertility and the consequences of delayed parenthood. Here we present a theoretical framework for SCM-based causal inference using panel data that is more broadly applicable. ...
