Birth distance influential factors: a multilevel recurrent events approach

Area of Science:

• Reproductive Health
• Biostatistics
• Sociology

Background:

• Birth spacing patterns are influenced by various factors, often overlooked in previous research.
• Existing studies frequently omit the correlations between birth events within families and between different healthcare centers.
• Understanding these correlations is crucial for accurate analysis of birth distance patterns.

Purpose of the Study:

• To identify key factors influencing birth distance patterns.
• To incorporate correlations within families and between healthcare centers in the analysis.
• To evaluate the suitability of a multilevel recurrent event model for birth distance data.

Main Methods:

• Data were collected from 480 families across four healthcare centers in Hamedan City, Iran.
• Families with at least one successful birth were included, with 1115 birth events analyzed.
• A multilevel recurrent event approach was employed to analyze birth distance patterns.

Main Results:

• Mothers' employment status was a significant factor affecting birth distance (P=0.018).
• Healthcare center (cluster) effects were significant (P=0.038), indicating socio-economic influences on birth spacing.
• Other potential variables did not significantly affect birth distances and were excluded from the final model.

Conclusions:

• The multilevel recurrent event model provides a superior fit for birth distance data due to its ability to account for frailty and center effects.
• Socio-economic factors and mothers' job status are significant determinants of birth spacing.
• Alternative models like Cox and standard frailty models may yield misleading results for this type of data.