Looking back to look forward: the historical determinants of rural

people’s health & wellbeing:

Data from a natural experiment

Janet McCalman (SPH) with

Ruth Morley (Paediatrics, RCH) & Gita Mishra (UCL)

The Melbourne Lying-In Hospital and Infirmary for the Diseases Peculiar to Women and Children in 1862.

Our aim: life courses in historical context 1857-1985

To reconstruct life-courses for individuals in a cohort born 1857-1900 in a charity hospital in Melbourne

To study associations with biological and social characteristics recorded at birth with causes of death, social destiny and family formation as recorded at death;

To locate those life-courses in time and place and identify the long-run effects of socio-economic change, medical intervention and social entitlements as far as the 1980s.

Midwifery Book

July-August 1886

Of the 8,584 traced 1281 (15%) died in first 28 days 3015 (35%) died 1-12 months 941 (11%) died 1-16 years 409 (5%) died 17-40 years 2938 (34%) died aged 40+ years 4296 (50%) died before age 1 year Australia: born 1871-1900: 11% died before age 1 year; 67% died aged 40+ years

Kaplan-Meier Survival Curves

LIH cohort born 1857-1900

Australia cohorts born 1901-10 born 1993

Age at death in adulthood, for males and females

0

5

10

15

20

25

30

16-20 20-30 30-40 40-50 50-60 60-70 70-80 >80

MalesFemales

It looks like the lack of difference in life expectancy is because females are slightly more likely to die before age 40. If they get to age 40 they do much better than males.

Infant Mortality in LIH Cohort, compared with Melbourne, Chicago and Denmark

0%

10%

20%

30%

40%

50%

60%

70%

1857-1865 1866-1870 1871-1875 1876-1880 1881-1885 1886-1890 1891-1895 1896-1900

Chicago

Denmark

Melbourne

Age at death by father’s occupation

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

unsupportedmother

unskilled or semi-skilled

skilled orprofessional

40+ years16-40 years1-16 years<1 year

Age of death by mother’s age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<20 yrs 20-30 yrs 30+ yrs

40+ years16-40 years1-16 years<1 year

Mean Birth

weight (lb)

Mum married No No Yes Yes Yes Yes Yes Yes Dad occupation - +/- - 1 2 3 4 5

Dad named No Yes Yes Yes Yes Yes Yes Yes

Father’s occupation 1 Unskilled 2 Semiskilled 3 Skilled manual 4 Skilled non-manual 5 Managerial / Professional

345 562 317 780 321 874 83 52

Mean birth weight by parents’ SES

Age at death by birth weight

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<2.5 kg 2.5 - 3 kg 3 - 3.5 kg 3.5+ kg

40+ years16-40 years1-16 years<1 year

Age at death by maternal country of birth

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

born overseas born Australia

40+ years16-40 years1-16 years<1 year

AGE GROUP AT DEATH, IN RELATION TO YEAR OF BIRTH

Year of birth N % (N) diedin infancy

(up to 1 year)

% (N) diedin childhood(from 1-16

years)

% (N)survived toadulthood(16+ years)

Year of birth1857-1865 803 51% (408) 18% (146) 31% (249)1866-1870 684 55% (376) 13% (90) 32% (218)1871-1875 952 61% (577) 11% (104) 28% (271)1876-1880 1019 56% (570) 10% (97) 35% (3521881-1885 1146 63% (722) 9% (102) 28% (322)1886-1890 960 59% (564) 9% (86) 32% (310)1891-1895 1015 43% (433) 9% (89) 49% (493)1896-1900 2005 32% (646) 11% (227) 56% (1132)

P value* <0.001 <0.001 <0.001Year of death was missing for 6/8584 subjects* by chi-squared

Per cent died <40

yrs

Per cent of Men and Women who died before 40 by material security in childhood

No father/ no occupation

Casual poor

Regular wages

Skilled-white collar

Food producers

Left columns - males

Right columns - females

Men’s survival by social location at death

1-casual, 2-regular semi-skilled, 3-skilled manual, 4-mixed, 5-comfortable, 7-rural, 8-asylum

North Melbourne

Northcote

Social location of men and women who died after 70 years of age Men Women

47% 46% 40% 41% 55% 52% 58% 51%

Social location of men and women who died before 51 years

Men Women

13% 16% 22% 18% 20% 18% 20% 20%

Men: survival time by number of children:

No children, 1-4 children, <4 children

Women: survival time by number of children

No children, 1-4 children, >4 children

Women’s Hospital Midwifery and Infirmary wings, 1890s

Men: mean age of death by social location at end of life

Men’s mean age of death by social location at end of life

Women: Mean age of death by social location at end of life

TB

0

1

2

3

4

5

6

7

8

9

1857-1867 1868-1878 1879-1889 1890-1900

malesfemales%

Year of birth

Coronary heart disease, among 2985 people living beyond age 40

Year of birth

Lung cancer and COPD, among 2985 people living beyond age 40

Year of birth

Lung cancer

COPD

%

Stroke, among 2985 people living beyond age 40

Year of birth

Age at death by sex

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male Female

40+ years

16-40 years

1-16 years<1 year

Age at death by mother’s marital status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Notsupported

Married andsupported

40+ years16-40 years1-16 years<1 year