ABSTRACT

This paper investigates the association between advanced maternal age and under-5 mortality and morbidity in Turkey, and is the first such study in the country to use a sibling comparison model to analyze this phenomenon. The study is based on data obtained from the 2013 Turkey Demographic and Health Survey, and analyzes the association of advanced maternal age with: (1) under-five mortality, using Cox proportional hazard models and their stratified versions to compare sibling groups born to the same mother in the 1978–2013 period, and (2) under-five morbidity; specifically, being born with low birth weight, stunting, underweight, and wasting based on between- and within-sibling groups models for the 2008–2013 period. Overall, our findings suggest that the hazard of under-5 mortality increases as maternal age increases. We conclude that period effects have failed to reverse the impeding effects of advanced maternal age on child mortality. Between-sibling group models indicate a positive but close to null association between advanced maternal age and child morbidity in general, although these positive associations vanish once we apply within-sibling group models. This result can be partially attributed to our controlling for unobserved characteristics specific to sibling groups, in addition to other methodological differences.

摘要

本文调查了土耳其高龄产妇与 5 岁以下儿童死亡率和发病率之间的关联，并且是该国首次使用同胞比较模型来分析这一现象的此类研究。该研究基于 2013 年土耳其人口与健康调查获得的数据，分析了高龄产妇与以下因素的关联：(1) 五岁以下儿童死亡率，使用 Cox 比例风险模型及其分层版本来比较出生于1978-2013 年期间是同一个母亲，并且 (2) 五岁以下儿童发病；具体而言，根据 2008 年至 2013 年期间的兄弟姐妹组间和兄弟姐妹组内模型，出生时出生体重低、发育迟缓、体重不足和消瘦。总体而言，我们的研究结果表明，随着母亲年龄的增加，5 岁以下儿童死亡的风险也会增加。我们得出的结论是，周期效应未能扭转高龄产妇对儿童死亡率的阻碍作用。兄弟姐妹组模型表明高龄产妇和儿童发病率之间存在正相关但接近于零，尽管一旦我们应用兄弟姐妹组模型，这些正相关就会消失。除了其他方法论差异之外，这一结果可以部分归因于我们控制了特定于兄弟姐妹群体的未观察到的特征。