Parity-related mortality: shape of association among middle-aged and elderly men and women
Parity-related mortality: shape of association among middle-aged and elderly men and women
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DOI：
10.1007/s10654-008-9310-y
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发表时间：
2009-01-01
影响因子：
13.6
通讯作者：
Manor, Orly
中科院分区：
文献类型：
--
作者：
Jaffe, Dena H.;Neumark, Yehuda D.;Manor, Orly
生育与中年妇女的死亡率有关，而对男子和老年人的这一关系知之甚少。使用基于人口普查的以色列纵向死亡率研究（ILMS）II（1995-2004），我们试图研究男性和女性，中年和老年人之间的产次-死亡率关系。在我们的研究队列中，71，733名已婚男性和62，822名已婚女性的基线年龄为45-89岁，报告了19，437例死亡。采用考克斯比例风险回归模型，根据年龄、出身、教育程度和房间数量逐步调整，评估不同胎次的死亡率差异。分别对中年（45-64岁）和老年（65-89岁）男性和女性进行分析。我们观察到，即使在调整人口和社会经济变量后，所有个体的产次和死亡率之间也存在非线性关系。例如，在完全调整的模型中，未经生育的中年妇女经历了最高的死亡风险（风险比[HR] = 1.57，95%置信区间[CI] 1.24，1.98），其次是有一个孩子的人（HR = 1.29，95% CI 1.10，1.51）。这些结果在未经产的老年女性中有所减弱（HR = 1.25，95% CI 1.11，1.41）。低产次和高产次对男女死亡率的不利影响表明，这可能是一个与怀孕无关的途径，可能是由生物和心理社会因素以及其他生活方式特征介导的，这些因素对老年人有长期影响。需要进一步研究，以检查特定死亡原因对产次的影响。
Parity is associated with mortality among middle-aged women, while substantially less is known about this relationship for men and the elderly. Using the census-based Israel Longitudinal Mortality Study (ILMS) II (1995-2004) we sought to examine the parity-mortality relationship among men and women, middle-aged and elderly. In our study cohort of 71,733 married men and 62,822 married women ages 45-89 years at baseline, 19,437 deaths were reported. Mortality differentials by parity were assessed using Cox proportional hazard regression models adjusted stepwise for age, origin, education and number of rooms. Analyzes were carried out for middle-aged (45-64 years) and elderly (65-89 years) men and women separately. We observed a non-linear relationship between parity and mortality for all individuals even after adjustment for demographic and socio-economic variables. In fully adjusted models, for example, nulliparous middle-aged women experienced the highest mortality risks (hazard ratios [HR] = 1.57, 95% confidence intervals [CI] 1.24, 1.98) followed by those with one child (HR = 1.29, 95% CI 1.10, 1.51). These results were attenuated somewhat for nulliparous older women (HR = 1.25, 95% CI 1.11, 1.41). The detrimental effects of low and high parity on mortality among both men and women suggest a non pregnancy-related pathway that is likely mediated by biological and psychosocial factors and other lifestyle characteristics that have long-term consequences into older ages. Further research is warranted to examine the effects of parity by specific cause of death.