Graduation Year
2024
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Epidemiology and Biostatistics
Major Professor
Amy C. Alman, Ph.D.
Co-Major Professor
Russell S. Kirby, Ph.D.
Committee Member
Henian Chen, Ph.D.
Committee Member
Mary Ashley Cain, Ph.D.
Keywords
parity, age at childbirth, pregnancy, propensity score matching, lifespan
Abstract
Introduction: The associations between childbirth and future maternal cardiovascular disease (CVD) and mortality have been inconclusive. Limited studies have focused on the association between childbirth and HRQoL. Objective: We aimed to examine the long-term effects of parity and age at childbirth on women's CVD and mortality based on propensity score matching. Methods: This study used data from the Women’s Health Initiative study (1993-2022). We used propensity score matching to produce matched samples, then employed multilevel Cox proportional hazard models for hazard ratios (HRs) to estimate the associations of parity and age at childbirth with CVD and mortality. We used mixed-effects models to study the impact of parity and age at childbirth on HRQoL changes over time. Additionally, we conducted multiple mediation analyses to estimate the effects of potential mediators on the associations. Results: Compared to parity of 2, there were no significant associations between other parity levels and maternal CVD. The HRs (95% CIs) for the association of all-cause mortality with parity of 0, 1, 3, 4, and 5+ were 1.09(1.05-1.13), 1.11(1.06-1.16), 1.01(0.99-1.04), 1.00(0.97-1.03), and 1.00(0.96-1.03), respectively. Age at first childbirth of < 20 was associated with increased risks of CVD, mortality, and reduced HRQoL. Conclusions: Nulliparity was associated with increased mortality risk and shorter lifespan. Young age at first childbirth (< 20) was consistently associated with increased risks of CVD and mortality, shorter lifespan, and decreased HRQoL. Multiple mediation analyses suggested that premature menopause may play a pivotal role in reducing risks of CVD, mortality, and lower HRQoL associated with childbirth.
Scholar Commons Citation
Xing, Zailing, "Childbirth, Later-life Cardiovascular Disease, Mortality, and Health-Related Quality of Life in Postmenopausal Women" (2024). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/11214
