Fatherhood and Cardiovascular Health, Disease and Mortality: Associations from the Multi-Ethnic Study of Atherosclerosis

Introduction Emerging literature links fatherhood to men's health, but lacks comprehensive assessment of health outcomes, especially among multi-ethnic populations. Our objective was to evaluate the associations of fatherhood (age at onset and status) with cardiovascular health (CVH) scores, incident cardiovascular disease (CVD), CVD death and all-cause mortality, examining differences by race/ethnicity. Methods We included men from Multi-Ethnic Study of Atherosclerosis (MESA), prospective cohort study which enrolled adults aged 45 to 84 years without known CVD at baseline. CVH was defined using the American Heart Association Life's Essential 8 (LE8) scores (0-100), excluding sleep (CVH score). Results In this sample of 2,814 men, mean age at CVH assessment was 62.2 years, 82% were fathers, 24% self-identified as Black, 13% Chinese, 22% Hispanic, and 41% White. Fathers who were <20 and 20-24 years old at their oldest child's birth had worse overall CVH compared with fathers who were >35 years old (adjusted mean score 61.1 vs 64.7, p=0.01 and 61.0 vs 64.7, p<0.001 respectively). Fathers had worse overall CVH (adjusted mean score 63.2 vs 64.7, p=0.03) and more nicotine exposure (63.1 vs 66.6, p=0.04), than non-fathers. In age-adjusted models, fathers overall (hazard ratio [HR]=0.82; 95%CI, 0.69–0.98) and Black fathers (HR=0.73; 95%CI, 0.53–0.999) had a lower rate of all-cause mortality rate than non-fathers, but these associations were no longer significant in fully adjusted models. Conclusion Fatherhood is a social determinant of health and understanding its influence may provide opportunities to improve men's health, particularly among men of color.