title: Family history of education predicts eating disorders across multiple generations among 2 million Swedish males and females.
abstract: OBJECTIVE
  To investigate which facets of parent and grandparent socio-economic position (SEP) are associated with eating disorders (ED), and how this varies by ED subtype and over time.
  
  
  METHODS
  Total-population cohort study of 1,040,165 females and 1,098,188 males born 1973-1998 in Sweden, and followed for inpatient or outpatient ED diagnoses until 2010. Proportional hazards models estimated associations with parental education, income and social class, and with grandparental education and income.
  
  
  RESULTS
  15,747 females and 1051 males in our sample received an ED diagnosis, with rates increasing in both sexes over time. ED incidence in females was independently predicted by greater educational level among the father, mother and maternal grandparents, but parent social class and parental income showed little or no independent effect. The associations with education were equally strong for anorexia nervosa, bulimia nervosa and ED not-otherwise-specified, and had increased over time. Among males, an apparently similar pattern was seen with respect to anorexia nervosa, but non-anorexia ED showed no association with parental education and an inverse association with parental income.
  
  
  CONCLUSIONS
  Family history of education predicts ED in gender- and disorder-specific ways, and in females the effect is observed across multiple generations. Particularly given that these effects may have grown stronger in more recent cohorts, these findings highlight the need for further research to clarify the underlying mechanisms and identify promising targets for prevention. Speculatively, one such mechanism may involve greater internal and external demands for academic success in highly educated families.
authors.affiliation: CHESS, Centre for Health Equity Studies, Karolinska Institutet, Stockholm University, Stockholm, Sweden; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Goodman
authors.affiliation: CHESS, Centre for Health Equity Studies, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
authors.forename: Amy
authors.initials: A
authors.lastname: Heshmati
authors.affiliation: CHESS, Centre for Health Equity Studies, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
authors.forename: Ilona
authors.initials: I
authors.lastname: Koupil
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D052018:Bulimia Nervosa / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D010290:Parents / Q000193:education* / Q000523:psychology; D012307:Risk Factors; D012923:Social Class; D013548:Sweden / Q000453:epidemiology