Long-term physical health outcomes and mortality in offspring of female child Holocaust survivors

Aim: Higher chronic physical morbidity has been reported in Holocaust survivors. Despite evidence of potential intergenerational effects, data on their offspring’s physical health remain limited. This exploratory study aimed to compare outcomes of cancer, diabetes, stroke, end-stage renal disease, bariatric surgery utilization, multi-morbidity, and mortality between offspring of female child Holocaust survivors and their counterparts, using national registry data. Subject and methods: This cohort study compared offspring (born 1960–1990) of Jewish female Holocaust survivors born during 1940–1945 in European countries that were under the Nazi regime (exposed) and same-age offspring of same-age European-origin Jewish women unexposed to the Holocaust. The dataset was cross-linked with national disease, procedure, and mortality registries. Multivariable logistic regression and proportional hazards models were adjusted for birth cohort and sex. Results: Exposed individuals (N = 20,193; 51% male) were older than unexposed individuals (N = 23,938; 51% male) (p < 0.001). Following adjustment, bariatric surgery utilization was found to be higher in the exposed overall (odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.07–1.43) and in women (OR = 1.22, 95% CI 1.01–1.47). Cancer incidence in exposed women was marginally higher as well (OR = 1.11, 95% CI 0.99–1.24). No differences were found in other outcomes. For those who died during follow-up (exposed: N = 553, 2.7%; unexposed: N = 647, 2.7%), no differences were observed in median age at death (37–38 years), mortality risk, or causes of death. Conclusion: The signals for higher utilization of bariatric surgery (obesity proxy) and borderline increased cancer risk among exposed women detected in this study should be interpreted cautiously and primarily as hypothesis-generating, and followed up by further research.