Ilona Koupil

Ilona Koupil


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Works at Department of Public Health Sciences
Telephone 08-16 39 52
Visiting address Albanovägen 12 Plan 5
Room A 531
Postal address Institutionen för folkhälsovetenskap 114 19 Stockholm

About me

Principal position as a Professor of Health Equity Studies/Public Health Medicine at the Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University. Visiting Professor of Social Epidemiology, especially Children and Adolescents, at the Department of Public Health Sciences, Karolinska Institutet 2015-2019, Affiliate at the Department of Global Public Health, Karolinska Institutet, 2020-2021.

My background is in paediatrics and epidemiology and my main research interests include social and life course determinants of health, developmental origins of health and disease, and paediatric and perinatal epidemiology.

Most recently, I have been working as the principal investigator of the Uppsala Birth Cohort Multigenerational Study, and a co-investigator within the Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) Lund project and the Mothers and Their Children’s Health (MaTCH) study at the University of Queensland. I also coordinate the work of Swedish partners in the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project and in a project on Body size, Mental health and Inequalities (BMI).

I very much enjoy teaching and have extensive experience from teaching epidemiology and public health at universities in the United Kingdom, Czech Republic and Sweden. I have served as a member of the steering group for the Swedish Interdisciplinary Graduate School in Register-Based Research (SINGS) as well as a Nordic Course in Register based research: Key concepts and principles for design and critical interpretation of Nordic register-based studies.

Publications (selection):

Hossin MZ, Björk J, Koupil I. Early-life social and health determinats of adult socioeconoic position: associations ad trends across generations. J Epidemiol Community Health. 2020 May;74(5):412-420. doi: 10.1136/jech-2019-213209. 

Gao M, Allebeck P, Mishra GD, Koupil I. Developmental origins of endometriosis: a Swedish cohort study. J Epidemiol Community Health. 2019 Jan 19. pii: jech-2018-211811. doi: 10.1136/jech-2018-211811.

Gao M, Goodman A, Mishra G, Koupil I. Associations of birth characteristics with perimenopausal disorders: a prospective cohort study. J Dev Orig Health Dis. 2018 Oct 9:1-7. doi: 10.1017/S204017441800065X.

Holowko N, Jones M, Tooth L, Koupil I, Mishra GD. Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women's Health. Matern Child Health J. 2018;22:1713-1724. doi: 10.1007/s10995-018-2567-1.

Juárez SP, Goodman A, Koupil I. From cradle to grave: tracking socioeconomic inequalities in mortality in a cohort of 11 868 men and women born in Uppsala, Sweden, 1915-1929. J Epidemiol Community Health. 2016;70:569-75. doi: 10.1136/jech-2015-206547.

Chaparro MP, Koupil I. The impact of parental educational trajectories on their adult offspring's overweight/obesity status: a study of three generations of Swedish men and women. Soc Sci Med. 2014;120:199-207. doi: 10.1016/j.socscimed.2014.09.024.

Koupil I, Tooth L, Heshmati A, Mishra G. Social patterning of overeating, binge eating, compensatory behaviours and symptoms of bulimia nervosa in young adult women: results from the Australian Longitudinal Study on Women's Health. Public Health Nutr. 2016;19:3158-3168.

Goodman A, Heshmati A, Koupil I. Family history of education predicts eating disorders across multiple generations among 2 million Swedish males and females. PLoS One. 2014;9(8):e106475. doi: 10.1371/journal.pone.0106475.

Mishra GD, Chiesa F, Goodman A, De Stavola B, Koupil I. Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50-87 years: results from a Swedish birth cohort. Eur J Epidemiol. 2013;28:139-47. doi: 10.1007/s10654-013-9777-z

Goodman A, Koupil I, Lawson DW. Low fertility increases descendant socioeconomic position but reduces long-term fitness in a modern post-industrial society. Proc Biol Sci. 2012;279:4342-51.

De Stavola BL, Leon DA, Koupil I. Intergenerational correlations in size at birth and the contribution of environmental factors: The Uppsala Birth Cohort Multigenerational Study, Sweden, 1915-2002. Am J Epidemiol 2011;174:52-62.

Koupil I, Goodman A. Health Equity: A life course approach. Public Service Review: European Union 2011; 22:382-3.

Goodman A, Gisselmann M, Koupil I. Birth outcomes and early-life social characteristics predict unequal educational outcomes: consistency across Swedish cohorts born 1915-1929 and 1973-1980. Longitudinal and Life Course Studies 2010:1:317-338.

Manor O, Koupil I. Birth weight of infants and mortality in their parents and grandparents: the Uppsala Birth Cohort Study. Int J Epidemiol. 2010;39:1264-1276.

Goodman A, Koupil I. Social and biological determinants of reproductive success in Swedish males and females born 1915-1929.  Evolution And Human Behavior 2009;30:329-341.

Koupil I. The Uppsala studies on developmental origins of health and disease. J Internal Medicine 2007;261:426-436.

Research grants (selection):

-              Swedish Research Council for Health, Working Life and Welfare (FORTE), Principle Investigator, "Developmental origins of women’s health": 2019-2022.

-              Swedish Research Council for Health, Working Life and Welfare (FORTE) & South African Medical Research Council (SAMRC), Principle Investigator in Sweden, "Body size, Mental health and Inequalities: A life course approach": 2017-2019.

-              EC Horizon 2020, Co-applicant/Partner, Project ID 635316 "ATHLOS Ageing Trajectories of Health: Longitudinal Opportunities and Synergies": 2015-2020.

-              Swedish Research Council (VR), Principle Investigator, "Methods in register-based research in Life course and social epidemiology": 2014-2019.

-              Swedish Research Council for Health, Working Life and Welfare (FORTE), Principle Investigator, "Social mobility and health among Swedish men and women born 1915-2010: life course and intergenerational effects across the twentieth century": 2014-2017.

-              Swedish Research Council (VR), Principle Investigator, "Intergenerational, early life, cognitive and social determinants of eating disorders": 2010-2013.

-              Swedish Research Council for Health, Working Life and Welfare (FAS/FORTE), Principle Investigator, "Developmental origins of health inequality – maternal influences, growth in early life, reproduction, and health in adulthood": 2008-2013.

-              Swedish Research Council (VR), Principle Investigator, "UBCoS Multigen: Supplementary data collection, development, maintenance and documentation of the database": 2008-2012.

-              Swedish Council for Working Life and Social Research (FAS), Principal Investigator, "Reproduction of health and health inequality across five generations": 2004-2007.


A selection from Stockholm University publication database
  • 2018. Gita D. Mishra (et al.). Longitudinal and life course studies 9 (3), 351-375

    MatCH (Mothers and their Children's Health) is a nationwide Australian study to investigate the links between the history of health, wellbeing and living conditions of mothers and the health and development of their children. MatCH builds on the Australian Longitudinal Study on Women's Health (ALSWH), which began in 1996 and has surveyed more than 58,000 women in four nationally representative age cohorts. MatCH focuses on the three youngest offspring of the cohort of ALSWH participants randomly sampled from all women in Australia born in 1973-78 (N=5780 children of N=3039 mothers). These women, who had completed up to seven postal or online surveys since 1996, were invited in 2016-17 to complete surveys about the health and development of their three youngest children aged under 13. The mothers reported on their children's health conditions and symptoms, diet, anthropometric measures, childcare, screen time, physical activity, temperament, behaviour, language development, motor development and health service utilisation, as well as household and environmental factors. These data are being linked with each child's records from official sources including the Australian Early Development Census (collected at age five to six), the National Assessment Program-Literacy and Numeracy (collected at age eight, 10, 12 and 14) and other external datasets. MatCH will combine 20 years of maternal data with all the information on her children, taking into account the family setting. MatCH offers an unprecedented opportunity to advance our understanding of the relationship between maternal health and wellbeing and child health and development.

  • 2017. M. Pia Chaparro (et al.). Scandinavian Journal of Public Health 45 (5), 511-519

    Aim: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. Methods: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/ obesity (body mass index (BMI) >= 25 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. Results: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. Conclusions: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

  • 2016. Ilona Koupil (et al.). Public Health Nutrition 19 (17), 3158-3168

    Objective To study social patterning of overeating and symptoms of disordered eating in a general population.

    Design A representative, population-based cohort study.

    Setting The Australian Longitudinal Study on Women’s Health (ALSWH), Survey 1 in 1996 and Survey 2 in 2000.

    Subjects Women (n 12 599) aged 18–23 years completed a questionnaire survey at baseline, of whom 6866 could be studied prospectively.

    Results Seventeen per cent of women reported episodes of overeating, 16 % reported binge eating and 10 % reported compensatory behaviours. Almost 4 % of women reported symptoms consistent with bulimia nervosa. Low education, not living with family, perceived financial difficulty (OR=1·8 and 1·3 for women with severe and some financial difficulty, respectively, compared with none) and European language other than English spoken at home (OR=1·5 for European compared with Australian/English) were associated with higher prevalence of binge eating. Furthermore, longitudinal analyses indicated increased risk of persistent binge eating among women with a history of being overweight in childhood, those residing in metropolitan Australia, women with higher BMI, smokers and binge drinkers.

    Conclusions Overeating, binge eating and symptoms of bulimia nervosa are common among young Australian women and cluster with binge drinking. Perceived financial stress appears to increase the risk of binge eating and bulimia nervosa. It is unclear whether women of European origin and those with a history of childhood overweight carry higher risk of binge eating because of genetic or cultural reasons.

  • 2014. Anna Goodman, Amy Frances Heshmati, Ilona Koupil. PLoS ONE 9 (8), e106475

    Purpose 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.

  • 2013. Gita Devi Mishra (et al.). European Journal of Epidemiology 28 (2), 139-147

    Both child and adult socio-economic position (SEP) predict adult mortality, but little is known about the variation in the impact of SEP across the life course. The Uppsala Birth Cohort Study is a representative birth cohort born 1915–1929 in Uppsala, Sweden. For the 5,138 males and 5,069 females alive in 1980, SEP was available at birth; in adulthood (age 31–45); and in later life (age 51–65). Follow-up for mortality (all-cause, and circulatory disease) was from 1980 to 2002. To test which life course model best described the association between SEP and mortality, we compared the fit of a series of nested Cox proportional hazards regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. For all-cause mortality in both genders, the sensitive period model best described the influence of SEP across the life course with a heightened effect in later adult life (males: Hazard Ratio (95 % CI) for advantaged SEP: 0.89 (0.81–0.97) at birth, 0.90 (0.81–0.98) in adulthood, 0.74 (0.67–0.82) in later life; females: 0.87 (0.78–0.98), 0.95 (0.86–1.06), 0.73 (0.64–0.83)). The effect of SEP on circulatory diseases mortality in males was cumulative (HR: 0.84 (0.80–0.87) per unit time in advantaged SEP). For circulatory disease mortality among females, a sensitive period model was selected due to SEP in later adult life (HR: 0.64 (0.52–0.80)). These findings suggest that reducing inequality throughout the life course might reduce all-cause and circulatory disease mortality.

  • 2012. Anna Goodman, Ilona Koupil, David W. Lawson. Proceedings of the Royal Society of London. Biological Sciences 279 (1746), 4342-4351

    Adaptive accounts of modern low human fertility argue that small family size maximizes the inheritance of socioeconomic resources across generations and may consequently increase long-term fitness. This study explores the long-term impacts of fertility and socioeconomic position (SEP) on multiple dimensions of descendant success in a unique Swedish cohort of 14 000 individuals born during 1915-1929. We show that low fertility and high SEP predict increased descendant socioeconomic success across four generations. Furthermore, these effects are multiplicative, with the greatest benefits of low fertility observed when SEP is high. Low fertility and high SEP do not, however, predict increased descendant reproductive success. Our results are therefore consistent with the idea that modern fertility limitation represents a strategic response to the local costs of rearing socioeconomically competitive offspring, but contradict adaptive models suggesting that it maximizes long-term fitness. This indicates a conflict in modern societies between behaviours promoting socioeconomic versus biological success. This study also makes a methodological contribution, demonstrating that the number of offspring strongly predicts long-term fitness and thereby validating use of fertility data to estimate current selective pressures in modern populations. Finally, our findings highlight that differences in fertility and SEP can have important long-term effects on the persistence of social inequalities across generations.

  • 2020. Yu-Tzu Wu (et al.). The Lancet Public Health 5 (7), e386-e394

    BACKGROUND: The rapid growth of the size of the older population is having a substantial effect on health and social care services in many societies across the world. Maintaining health and functioning in older age is a key public health issue but few studies have examined factors associated with inequalities in trajectories of health and functioning across countries. The aim of this study was to investigate trajectories of healthy ageing in older men and women (aged ≥45 years) and the effect of education and wealth on these trajectories.

    METHODS: This population-based study is based on eight longitudinal cohorts from Australia, the USA, Japan, South Korea, Mexico, and Europe harmonised by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. We selected these studies from the repository of 17 ageing studies in the ATHLOS consortium because they reported at least three waves of collected data. We used multilevel modelling to investigate the effect of education and wealth on trajectories of healthy ageing scores, which incorporated 41 items of physical and cognitive functioning with a range between 0 (poor) and 100 (good), after adjustment for age, sex, and cohort study.

    FINDINGS: We used data from 141 214 participants, with a mean age of 62·9 years (SD 10·1) and an age range of 45-106 years, of whom 76 484 (54·2%) were women. The earliest year of baseline data was 1992 and the most recent last follow-up year was 2015. Education and wealth affected baseline scores of healthy ageing but had little effect on the rate of decrease in healthy ageing score thereafter. Compared with those with primary education or less, participants with tertiary education had higher baseline scores (adjusted difference in score of 10·54 points, 95% CI 10·31-10·77). The adjusted difference in healthy ageing score between lowest and highest quintiles of wealth was 8·98 points (95% CI 8·74-9·22). Among the eight cohorts, the strongest inequality gradient for both education and wealth was found in the Health Retirement Study from the USA.

    INTERPRETATION: The apparent difference in baseline healthy ageing scores between those with high versus low education levels and wealth suggests that cumulative disadvantage due to low education and wealth might have largely deteriorated health conditions in early life stages, leading to persistent differences throughout older age, but no further increase in ageing disparity after age 70 years. Future research should adopt a lifecourse approach to investigate mechanisms of health inequalities across education and wealth in different societies.

    FUNDING: European Union Horizon 2020 Research and Innovation Programme.

  • 2020. Muhammad Zakir Hossin, Jonas Björk, Ilona Koupil. Journal of Epidemiology and Community Health 74 (5), 412-420

    Background Social and biological circumstances at birth are established predictors of adult socioeconomic position (SEP). This study aims to assess the trends in these associations across two generations and examine the effects of parental early-life characteristics on descendants' adult SEP.

    Methods We studied men and women born in the Uppsala University Hospital 1915-1929 (G1) and their offspring born 1932-1960 (G2). Data were collected in archives and routine registers. Adult SEP was assessed as an aggregate measure combining education and occupation. The exposures were family SEP, mother's marital status, mother's parity, mother's age, standardised birth weight, gestational length and birth multiplicity. Linear regression was used to examine the associations across generations.

    Results The difference in adult SEP between low and high family SEP at birth was 15.8 (95% CI: 13.3 to 18.3) percentage points smaller in G2 compared with G1, although a considerable difference was still evident in G2. The associations of adult SEP with small birth weight for gestational age, post-term birth and high parity were stable between the generations: the generational differences in adjusted coefficients were 1.5 (95% CI: -1.1 to 4.1), 0.6 (-1.7 to 2.9) and 1.8 (-0.2 to 3.8) percentage points, respectively. The association between grandparental and grandchildren's SEPs was largely explained by parental socioeconomic conditions. Father's preterm birth was independently associated with offspring's SEP.

    Conclusion The stability of the associations between early-life biological disadvantages and adult SEP and the persistent, although attenuated, association between early-life and adult SEPs necessitates increased policy attention to both social and health conditions at birth.

  • 2020. Menghan Gao (et al.). American Journal of Obstetrics and Gynecology 223 (3), 415.e1-415.e16

    Background  Endometriosis is a common gynecologic condition affecting women of reproductive age. It has been linked with greater rates of depression and anxiety in small, cross-sectional, and clinical studies. Other studies have reported that women with endometriosis have increased risk of bipolar disorder. These reports suggest that psychiatric disorders might be more common among women with endometriosis, contributing to increased burden of mental ill-health in this population of women. However, this hypothesis has not been adequately studied.

    Objectives  In this population-based study, we investigated the overall psychiatric comorbidity among women with endometriosis, and the role of familial liability.

    Study Design  Several Swedish national registers were linked and used to follow all women born in Sweden in 1973–1990 for diagnosed psychiatric disorders and endometriosis from age 14 years until year 2016. Sibling comparison analyses were performed in a subsample of 173,650 families.

    Results  After adjustment for birth characteristics and education, women with endometriosis had an increased risk of being later diagnosed with depressive-, anxiety and stress-related disorders, alcohol/drug dependence, and attention-deficit hyperactivity disorder compared with the general population and with their sisters without endometriosis. The adjusted hazard ratios ranged from 1.56 (95% confidence interval, 1.29–1.88) for depressive disorders to 1.98 (95% confidence interval, 1.34–2.93) for attention-deficit hyperactivity disorder in the sibling analysis. Also, women with previous affective psychotic disorders, depressive-, anxiety and stress-related disorders, eating disorders, personality disorders, and attention-deficit hyperactivity disorder were more likely to be later diagnosed with endometriosis. The adjusted hazard ratios ranged from 1.51 (95% confidence interval, 1.30–1.76) for depressive disorders to 1.93 (95% confidence interval, 1.47–2.52) for personality disorders.

    Conclusion  These findings reveal a high degree of comorbidity between endometriosis and many psychiatric disorders that was not entirely explained by shared familial confounding. Clinical practice may consider psychosocial support to women with endometriosis and treating them from a multidisciplinary perspective.

  • 2019. Johan Sundström (et al.). Upsala Journal of Medical Sciences 124 (1), 21-28

    We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

Show all publications by Ilona Koupil at Stockholm University

Last updated: September 2, 2021

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