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American Journal of Epidemiology Advance Access originally published online on July 9, 2009
American Journal of Epidemiology 2009 170(5):566-575; doi:10.1093/aje/kwp166
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Association of Higher Parental and Grandparental Education and Higher School Grades With Risk of Hospitalization for Eating Disorders in Females

The Uppsala Birth Cohort Multigenerational Study

Jennie Ahrén-Moonga, Richard Silverwood, Britt af Klinteberg and Ilona Koupil

Correspondence to Dr. Jennie Ahrén-Moonga, CHESS, Karolinska Institutet/Stockholm University, Sveavägen 160, 106 91 Stockholm, Sweden (e-mail: jennie.ahren-moonga{at}chess.su.se).

Received for publication February 23, 2009. Accepted for publication May 19, 2009.

Eating disorders are a leading cause of disease burden among young women. This study investigated associations of social characteristics of parents and grandparents, sibling position, and school performance with incidence of eating disorders. The authors studied Swedish females born in 1952–1989 (n = 13,376), third-generation descendants of a cohort born in Uppsala in 1915–1929. Data on grandparental and parental social characteristics, sibling position, school grades, hospitalizations, emigrations, and deaths were obtained by register linkages. Associations with incidence of hospitalization for eating disorders were studied with multivariable Cox regression, adjusted for age and study period. Overall incidence of hospitalization for eating disorders was 32.0/100,000 person-years. Women with more highly educated parents and maternal grandparents were at higher risk (hazard ratio for maternal grandmother with higher education relative to elementary education = 6.5, 95% confidence interval: 2.2, 19.3, adjusted for parental education). Independent of family social characteristics, women with the highest school grades had a higher risk of eating disorders (hazard ratio = 7.7, 95% confidence interval: 2.5, 24.1 for high compared with low grades in Swedish, adjusted for parental education). Thus, higher parental and grandparental education and higher school grades may increase risk of hospitalization for eating disorders in female offspring, possibly because of high internal and external demands.

anorexia nervosa; eating disorders; education; family; parents; siblings; social class

Abbreviations: ICD, International Classification of Diseases; UBCos, Uppsala Birth Cohort


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