The role of children and their socioeconomic resources for the risk of hospitalisation and mortality - a nationwide register-based study of the total Swedish population over the age 70

Background: Previous studies have shown that mortality in old age is associated with both number of children and their socioeconomic resources. The underlying mechanisms are unclear, as well as when during the process of health deterioration the advantage of parents over non-parents arises. This study aims to examine how the number of children and their socioeconomic resources are associated with different health outcomes among their parents, namely the hazard for i) first hospitalisation, ii) re-admission, iii) mortality after first hospitalisation, and iv) overall mortality. Method: This longitudinal cohort study includes all individuals born 1920-1940 who were living in Sweden at age 70years (890,544 individuals). Individuals were linked to their offspring and spouse using administrative registers and followed for up to 25years. Associations were estimated using multivariable Cox models adjusted for index persons' education and income, marital status, their partners' education, and age at first birth. Results: In this study, having children was associated with reduced mortality risk of their parents, but not with the risk of being hospitalised, which increased as number of children increased. A higher education of children was protective for all parental outcomes independent of number of children and their financial resources. In fact, income of the children was only weakly associated with the health of their parents. Conclusions: The benefit of having children compared to childlessness for health in old age seems to arise once individuals have become ill rather than before. Children's education is important for parental health and mortality, in fact more important than the number of children itself in this Swedish cohort.De två första författarna delar förstaförfattarskapet.