Is there an association between fatherhood and cardiovascular outcomes?

By Tarun Sai LomteReviewed by Lily Ramsey, LLMMay 31 2024

In a recent study published in AJPM Focus, researchers evaluated associations between fatherhood and cardiovascular health (CVH), disease (CVD), and mortality.

Study: Fatherhood and Cardiovascular Health, Disease and Mortality: Associations from the Multi-Ethnic Study of Atherosclerosis. Image Credit: Halfpoint/Shutterstock.com

Background

CVD is the leading cause of death among males. In 2021, males in the United States (US) had a six-year shorter life expectancy than females. This discrepancy was highly significant among ethnic and racial minorities.

CVH declines from late adolescence in males through their 30s, when most become fathers. Further, fatherhood transition is associated with negative and positive changes in CVH.

Fatherhood has been linked to higher cardiovascular disease (CVD) rates among Chinese males, while the opposite is observed in White individuals, indicating racial and cultural disparities.

Additionally, evidence suggests that fatherhood is associated with a lower risk of all-cause mortality. However, previous studies on fatherhood, CVD, cardiovascular health (CVH), and mortality have not thoroughly evaluated CVH or included diverse ethnic and racial populations.

About the study

In the present study, researchers evaluated associations between fatherhood and CVD, CVH, and mortality across a racially and ethnically diverse sample.

They used data from the multiethnic study of atherosclerosis, which comprised non-CVD individuals aged 45–84. Black, Hispanic, White, and Chinese individuals were recruited between 2000 and 2002 in the US.

All males who had data for CVH and comorbidities and completed the family history interview were included in this study, while females were excluded.

Males were classified as non-fathers or fathers based on interview data. Father’s age at the birth of the first child, i.e., the onset of fatherhood, was determined.

CVH was evaluated using the Life’s Essential eight framework. It comprised metrics for blood pressure, lipids, glucose levels, weight, healthy sleep, nicotine avoidance, physical activity, and diet. Sleep data were unavailable; thus, data on seven metrics were used. A CVH score was calculated for each metric, and a mean total CVH score was estimated.

Covariates included age, marital status, race/ethnicity, education, family income, depressive symptoms, alcohol intake, and serum testosterone.

Participants were followed up for medical events at 9–12-month intervals for 18 years. The associations of fatherhood status with all-cause mortality, incident CVD events, and CVD death were assessed using Cox proportional hazard regression models.

Findings

Overall, 2,814 males aged 62.2, on average, were included. Of these, 41% were White, 22% were Hispanic, 13% were Chinese, and 24% were Black.

Fathers were more likely to have a gross family income of $50,000 or higher but were less likely to be White, have depressive symptoms, and have a higher education than non-fathers. On average, participants became fathers at 27.6 years. There were significant differences in the age of fatherhood onset by race/ethnicity.

The overall CVH and nicotine exposure were worse among fathers than non-fathers. However, White fathers showed much worse CVH than White non-fathers. Further, nicotine exposure was higher among individuals who were aged < 20 at fatherhood onset compared to those who were aged > 35.

Individuals aged 20–24 years at fatherhood onset had poorer CVH, blood sugar levels, body mass index (BMI), and nicotine exposure than those who were aged > 35.

Black or Hispanic subjects aged < 20 or 20–24 at fatherhood onset had poorer CVH than those who were aged > 35.

Overall, 608 CVD events, 214 CVD deaths, and 854 deaths from other causes occurred during a median follow-up of 17.6 years. Fathers aged <20 at fatherhood onset showed an increased all-cause mortality rate compared to those aged >35 in age-adjusted models.

In fully adjusted models, there were no associations between fatherhood onset age and all-cause mortality, CVD events, and CVD death.

Further, fathers had a lower all-cause mortality rate than non-fathers in models adjusted for age but not in fully adjusted models. There was evidence of statistical interactions between race/ethnicity and fatherhood on all-cause mortality, which was attenuated after adjustment.

Moreover, no interactions between race/ethnicity and fatherhood were evident for CVD events or death. Further, Black fathers had a lower all-cause mortality rate than Black non-fathers in models adjusted for age; however, this was attenuated when adjusted for all covariates.

Finally, there were no differences in CVD, CVD mortality, and all-cause mortality between fathers and non-fathers who were White, Chinese, or Hispanic.

Conclusions

In sum, the study observed poor CVH and increased nicotine exposure among fathers. Males, particularly Black and Hispanic persons, with younger fatherhood onset ages (< 25 years) had worse CVH than those with older onset ages (> 35 years).

Further, an interaction was found between race/ethnicity and fatherhood for all-cause mortality. Overall, fatherhood might be an important health determinant, and understanding its impact may help improve males’ health.