Joe William, Prakash Atma, Ahluwalia Komal, Kim Rockli, Subramanian S V
Institute of Economic Growth, New Delhi, India.
Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea.
J Glob Health. 2025 May 5;15:04136. doi: 10.7189/jogh.15.04136.
Twin births present unique challenges for child survival, particularly in low- and middle-income countries. Despite the high burden of global child mortality, there has been no comprehensive assessment of twin births and deaths in India. We analysed the trends and patterns in twin births and deaths in India between 1993 and 2021, examining mortality risks across different phases of early childhood, including the late neonatal phase.
We analysed data on 659 175 births from five rounds of India's National Family Health Survey (NFHS) (1992-93 to 2019-21). We calculated age-specific mortality rates using a synthetic cohort life table approach for early neonatal (0-7 days), late neonatal (8-28 days), post-neonatal (29 days to 11 months), and child (12-59 months) periods. The analysis employed logistic regression models (both adjusted and unadjusted) to estimate phase-specific mortality risks and coarsened exact matching to establish causal relationships while adjusting for demographic and socioeconomic covariates.
Twinning rates in India increased from 0.9% in 1992-93 to 1.5% in 2019-21. Despite this small share in births, twins accounted for 7.7% of under-five deaths in 2019-21. Twin under-five mortality rate was 179.8 (95% confidence interval (CI) = 162.2, 197.4) per 1000 live births in 2019-21, declining from 447.5 (95% CI = 405.6, 489.3) in 1992-93. Twins faced 7.5 times higher risk of early neonatal death and 10 times higher risk of late neonatal death compared to singletons. Twins from the poorest wealth quintile experienced 9.8 (95% CI = 8.43, 11.44) times higher early neonatal mortality risk compared to those from the highest quintile. The coarsened exact matching analysis confirmed twin birth as an independent risk factor for neonatal and infant mortality.
Despite general improvements in child survival, twin mortality rates continue to be high, particularly during the neonatal period. The persistent socioeconomic gradient in twin survival necessitates strengthening health care delivery for vulnerable populations. Establishing twin registries and including twin mortality in global monitoring frameworks could accelerate progress toward achieving Sustainable Development Goal targets for child survival.
双胞胎出生给儿童生存带来了独特挑战，在低收入和中等收入国家尤其如此。尽管全球儿童死亡率负担沉重，但印度尚未对双胞胎出生和死亡情况进行全面评估。我们分析了1993年至2021年印度双胞胎出生和死亡的趋势及模式，研究了幼儿期不同阶段（包括晚新生儿期）的死亡风险。
我们分析了来自印度五轮全国家庭健康调查（NFHS）（1992 - 93年至2019 - 21年）的659175例出生数据。我们使用合成队列生命表方法计算了早期新生儿期（0 - 7天）、晚新生儿期（8 - 28天）、新生儿后期（29天至11个月）和儿童期（12 - 59个月）的年龄别死亡率。该分析采用逻辑回归模型（调整和未调整）来估计各阶段的死亡风险，并使用粗化精确匹配在调整人口和社会经济协变量的同时建立因果关系。
印度的双胞胎出生率从1992 - 93年的0.9%上升至2019 - 21年的1.5%。尽管在出生总数中占比小，但双胞胎在2019 - 21年的五岁以下儿童死亡中占7.7%。2019 - 21年，每1000例活产双胞胎的五岁以下死亡率为179.8（95%置信区间（CI） = 162.2，197.4），低于1992 - 93年的447.5（95% CI = 405.6，489.3）。与单胎相比，双胞胎面临的早期新生儿死亡风险高7.5倍，晚新生儿死亡风险高10倍。最贫困财富五分位数组的双胞胎早期新生儿死亡风险比最高五分位数组的高9.8（95% CI = 8.43，11.44）倍。粗化精确匹配分析证实双胞胎出生是新生儿和婴儿死亡的独立风险因素。
尽管儿童生存总体有所改善，但双胞胎死亡率仍然很高，尤其是在新生儿期。双胞胎生存中持续存在的社会经济梯度要求加强对弱势群体的医疗服务。建立双胞胎登记处并将双胞胎死亡率纳入全球监测框架可以加速实现儿童生存可持续发展目标的进展。
