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Birth characteristics and all-cause mortality: a sibling analysis using the Uppsala birth cohort multigenerational
S Juárez1, A Goodman1, B De Stavola2
11Centre for Health Equity Studies (CHESS),Stockholm University/Karolinska Institute,Stockholm,Sweden.
Insights
Perinatal health significantly impacts long-term survival. Improving birth outcomes, like birth weight and gestational age, is crucial for public health and reducing mortality risks throughout life.
Area of Science:
- Perinatal epidemiology
- Public health research
- Longitudinal cohort studies
Background:
- Understanding the long-term impact of perinatal health on mortality is essential for public health policy.
- Maternal socioeconomic factors may confound the relationship between birth outcomes and mortality.
- Previous studies have not fully elucidated age-specific mortality risks associated with perinatal factors.
Purpose of the Study:
- To investigate the association between perinatal health indicators (birth weight, gestational age) and all-cause mortality across different age intervals.
- To assess the influence of maternal socioeconomic characteristics and potential confounding factors.
- To provide evidence supporting interventions focused on improving birth outcomes.
Main Methods:
- Cohort study of 12,564 singletons born 1915-1929 at Uppsala University Hospital.
- Cox regression models used to estimate age-varying hazard ratios for mortality.
- Within-family analyses conducted to control for maternal confounding factors.
Main Results:
- Associations between perinatal factors and mortality varied significantly by age, affecting infancy, childhood, and early adulthood.
- Low birth weight showed a persistent elevated mortality risk up to age 44 (HR 2.82 to 1.51).
- Within-family analyses confirmed the observed associations, indicating minimal residual confounding by maternal characteristics.
Conclusions:
- Perinatal health has a lasting impact on all-cause mortality across the lifespan.
- Investments in maternal health and improved birth outcomes are vital for enhancing population health.
- Public health policies should prioritize interventions targeting perinatal factors to reduce long-term mortality.
Abstract:
This paper investigates the association between perinatal health and all-cause mortality for specific age intervals, assessing the contribution of maternal socioeconomic characteristics and the presence of maternal-level confounding. Our study is based on a cohort of 12,564 singletons born between 1915 and 1929 at the Uppsala University Hospital. We fitted Cox regression models to estimate age-varying hazard ratios of all-cause mortality for absolute and relative birth weight and for gestational age. We found that associations with mortality vary by age and according to the measure under scrutiny, with effects being concentrated in infancy, childhood or early adult life. For example, the effect of low birth weight was greatest in the first year of life and then continued up to 44 years of age (HR between 2.82 and 1.51). These associations were confirmed in within-family analyses, which provided no evidence of residual confounding by maternal characteristics. Our findings support the interpretation that policies oriented towards improving population health should invest in birth outcomes and hence in maternal health.
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