Duke University Population Research Institute and Center for Population Health and Aging, Duke University, Durham, NC, United States of America.
Department of Sociology and Duke University Population Research Institute and Center for Population Health and Aging, Duke University, Durham, NC, United States of America.
PLoS One. 2024 Sep 19;19(9):e0310629. doi: 10.1371/journal.pone.0310629. eCollection 2024.
Population health research finds women's mortality risk associated with childlessness, low parity (one child), and high parity (6+ children) in a U-shaped pattern, although U.S. studies are inconsistent overall and by race/ethnicity. Parity, however, is contingent on women's biophysiological likelihood of (in)fecundity as well as voluntary control practices that limit fertility. No studies have empirically examined infecundity differentials among women and their potential contribution to the parity-post-reproductive mortality relationship or the race/ethnic-related mortality gap. We examine 7,322 non-Hispanic Black and White women, born 1920-1941, in the Health and Retirement Study, using zero-inflation methods to estimate infecundity risk and parity by race/ethnicity. We estimate proportional hazards models [t0 1992/1998, t1 2018] to examine associations of infecundity risk, parity, early-life-course health and social statuses, and post-reproductive statuses with all-cause mortality. We find Black women's infecundity probability to be twice that of White women and their expected parity 40% higher. Infecundity risk increases mortality risk for all women, but parity-post-reproductive mortality associations differ by race/ethnicity. White women with one and 5+ children (U-shaped curve) have increased mortality risk, adjusting for infecundity risk and early-life factors; further adjustment for post-reproductive health and social status attenuates all parity-related mortality risk. Black women's parity-post-reproductive mortality associations are not statistically significant. Black women's post-reproductive mortality risk is anchored in earlier-life conditions that elevate infecundity risk. Results suggest a need to focus upstream to better elucidate race/ethnic-related social determinants of reproductive health, infecundity, parity, and mortality.
人口健康研究发现，女性的死亡率与不孕、低生育（一个孩子）和高生育（6 个以上孩子）呈 U 形模式相关，尽管美国的研究总体上以及按种族/族裔存在不一致。然而，生育力取决于女性的生物生理生育能力以及限制生育的自愿控制实践。没有研究从实证角度考察女性之间的不孕差异及其对生育后死亡率与种族/族裔相关死亡率差距的潜在贡献。我们研究了健康与退休研究中的 7322 名非西班牙裔黑人和白人女性，出生于 1920 年至 1941 年，使用零膨胀方法按种族/族裔估计不孕风险和生育力。我们使用比例风险模型[t0 1992/1998，t1 2018]来检验不孕风险、生育力、生命早期健康和社会地位以及生育后状况与全因死亡率之间的关联。我们发现，黑人女性的不孕概率是白人女性的两倍，她们的预期生育力高出 40%。不孕风险增加了所有女性的死亡率风险，但生育后死亡率与种族/族裔的关联存在差异。对于有一个孩子和 5 个以上孩子的白人女性（U 形曲线），在调整不孕风险和生命早期因素后，死亡率风险增加；进一步调整生育后健康和社会地位会降低所有与生育力相关的死亡率风险。黑人女性生育后死亡率与生育力的关联不具有统计学意义。黑人女性生育后死亡率的风险源于生命早期的条件，这些条件增加了不孕风险。结果表明，需要关注上游因素，以更好地阐明与生殖健康、不孕、生育力和死亡率相关的种族/族裔的社会决定因素。
