Study of mortality associated with exposure to the Holocaust is relevant for better understanding the effects of man-made massive killings on survivors. Previous studies did not investigate long- term cause-specific mortality of Holocaust survivors. We compared mortality rates of Israelis born in European countries controlled by the Nazis to Israelis of European descent without this exposure. Records of 22,671 people (5,042 survivors, 45% women) from the population-based Jerusalem Perinatal Study (1964-1976) were linked to the Population Registry updated through 2016. Cox models were used with two-sided tests of statistical significance. Risk of all-cause mortality was higher in the exposed women (hazard ratio (HR) = 1.15; 95% confidence interval (CI): 1.05, 1.27) as compared to unexposed. No association was found between the exposure and male all-cause mortality. In both sexes, the survivors had higher cancer-specific mortality (HR=1.17; CI: 1.01, 1.35 in women and HR=1.14; CI: 1.01, 1.28 in men). The exposed men also had excess mortality due to coronary heart disease (HR=1.39; CI: 1.09, 1.77) and lower mortality due to other known causes combined (HR=0.86; CI: 0.75, 0.99). In summary, Holocaust experience was associated with excess of all-cause and cancer-specific female and cancer- and coronary heart disease -specific male mortality.
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