Associations of paternal age with offspring under-five mortality and perinatal outcomes: a cohort study using claims data in Taiwan
Journal
BMJ Public Health
Journal Volume
2
Journal Issue
2
Start Page
e001113
ISSN
2753-4294
Date Issued
2024-11
Author(s)
Abstract
Background
The causal relationship between advanced paternal age and offspring health is unclear, owing to familial confounders. This study examined the association of paternal age with offspring’s under-five mortality and perinatal outcomes, using sibling comparison analyses to account for familial confounding factors. Methods A nationwide birth cohort study was designed based on Taiwan’s single-payer compulsory National Health Insurance programme. Individuals born between 2001 and 2015 were included, resulting in 2454 104 live-born singletons. Among them, 1513 222 individuals had full sibling(s) who were included in the sibling-comparison analyses. Logistic regression analyses were used to evaluate the main study cohort whereas conditional logistic regressions were used in the sibling-comparison analyses. Results In the main cohort, paternal age categories showed a U-shaped relationship with offspring’s under-five mortality in the crude analysis, which attenuated towards the null hypothesis after accounting for the measured potential confounders. There was an increased risk of premature birth (gestational age <37 weeks), low birth weight (<2500 g), large for gestational age (90th percentile) and low 5 min Apgar Score (<7) in individuals with a paternal age of >35 years. Sibling-comparison analyses that accounted for unmeasured familial time-invariant confounders showed that younger siblings with older paternal age had a lower risk of under-five mortality, low birth weight, small for gestational age (10th percentile), congenital defects and low 5 min Apgar Score, and a higher risk of premature birth and large for gestational age. Conclusions Children with older fathers had lower risks of under-five mortality, low birth weight, small for gestational age, congenital defects and low 5 min Apgar Score.
The causal relationship between advanced paternal age and offspring health is unclear, owing to familial confounders. This study examined the association of paternal age with offspring’s under-five mortality and perinatal outcomes, using sibling comparison analyses to account for familial confounding factors. Methods A nationwide birth cohort study was designed based on Taiwan’s single-payer compulsory National Health Insurance programme. Individuals born between 2001 and 2015 were included, resulting in 2454 104 live-born singletons. Among them, 1513 222 individuals had full sibling(s) who were included in the sibling-comparison analyses. Logistic regression analyses were used to evaluate the main study cohort whereas conditional logistic regressions were used in the sibling-comparison analyses. Results In the main cohort, paternal age categories showed a U-shaped relationship with offspring’s under-five mortality in the crude analysis, which attenuated towards the null hypothesis after accounting for the measured potential confounders. There was an increased risk of premature birth (gestational age <37 weeks), low birth weight (<2500 g), large for gestational age (90th percentile) and low 5 min Apgar Score (<7) in individuals with a paternal age of >35 years. Sibling-comparison analyses that accounted for unmeasured familial time-invariant confounders showed that younger siblings with older paternal age had a lower risk of under-five mortality, low birth weight, small for gestational age (10th percentile), congenital defects and low 5 min Apgar Score, and a higher risk of premature birth and large for gestational age. Conclusions Children with older fathers had lower risks of under-five mortality, low birth weight, small for gestational age, congenital defects and low 5 min Apgar Score.
SDGs
Publisher
BMJ
Type
journal article