Skip to main content

Parity-related mortality: shape of association among middle-aged and elderly men and women


Parity is associated with mortality among middle-aged women, while substantially less is known about this relationship for men and the elderly. Using the census-based Israel Longitudinal Mortality Study (ILMS) II (1995–2004) we sought to examine the parity–mortality relationship among men and women, middle-aged and elderly. In our study cohort of 71,733 married men and 62,822 married women ages 45–89 years at baseline, 19,437 deaths were reported. Mortality differentials by parity were assessed using Cox proportional hazard regression models adjusted stepwise for age, origin, education and number of rooms. Analyzes were carried out for middle-aged (45–64 years) and elderly (65–89 years) men and women separately. We observed a non-linear relationship between parity and mortality for all individuals even after adjustment for demographic and socio-economic variables. In fully adjusted models, for example, nulliparous middle-aged women experienced the highest mortality risks (hazard ratios [HR] = 1.57, 95% confidence intervals [CI] 1.24, 1.98) followed by those with one child (HR = 1.29, 95% CI 1.10, 1.51). These results were attenuated somewhat for nulliparous older women (HR = 1.25, 95% CI 1.11, 1.41). The detrimental effects of low and high parity on mortality among both men and women suggest a non pregnancy-related pathway that is likely mediated by biological and psychosocial factors and other lifestyle characteristics that have long-term consequences into older ages. Further research is warranted to examine the effects of parity by specific cause of death.

This is a preview of subscription content, access via your institution.

Fig. 1



Confidence interval


Cardiovascular disease


Hazard ratio


Israel Longitudinal Mortality Study


Socio-economic position


  1. 1.

    Grundy E, Tomassini C. Fertility history and health in later life: a record linkage study in England and Wales. Soc Sci Med. 2005;61:217–28. doi:10.1016/j.socscimed.2004.11.046.

    Article  PubMed  Google Scholar 

  2. 2.

    Silvera SAN, Miller AB, Rohan TE. Hormonal and reproductive factors and pancreatic cancer risk: a prospective cohort study. Pancreas. 2005;30:369–74. doi:10.1097/

    Article  Google Scholar 

  3. 3.

    Ness RB, Harris T, Cobb J, Flegal KM, Kelsey JL, Balanger A, et al. Number of pregnancies and the subsequent risk of cardiovascular disease. N Engl J Med. 1993;328:1528–33. doi:10.1056/NEJM199305273282104.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Ross CE, Mirowsky J. Family relationships, social support and subjective life expectancy. J Health Soc Behav. 2002;43:469–89. doi:10.2307/3090238.

    Article  PubMed  Google Scholar 

  5. 5.

    Merriam-Webster’s Online Dictionary. Accessed June 7, 2007.

  6. 6.

    Kotler P, Wingard DL. The effect of occupational, marital and parental roles on mortality: the Alameda County Study. Am J Public Health. 1989;79:607–12. doi:10.2105/AJPH.79.5.607.

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Lund R, Due P, Modvig J, Holstein BE, Damsgaard MT, Andersen PK. Cohabitation and marital status as predictors of mortality—an eight year follow-up study. Soc Sci Med. 2002;55:673–9. doi:10.1016/S0277-9536(01)00219-2.

    Article  PubMed  Google Scholar 

  8. 8.

    Manor O, Eisenbach Z, Israeli A, Friedlander Y. Mortality differentials among women: the Israel Longitudinal Mortality Study. Soc Sci Med. 2000;51:1175–88. doi:10.1016/S0277-9536(00)00024-1.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Koski-Rahikkala H, Pouta A, Pietilainen K, Hartikainen AL. Does parity affect mortality among parous women? J Epidemiol Community Health. 2006;60:968–73. doi:10.1136/jech.2005.044735.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Dekker JM, Schouten EG. Number of pregnancies and risk of cardiovascular disease. N Engl J Med. 1993;329:1893–4. doi:10.1056/NEJM199312163292515. letter.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Kvale G, Heuch I, Nilssen S. Parity in relation to mortality and cancer incidence: a prospective study of Norwegian women. Int J Epidemiol. 1994;23:691–9. doi:10.1093/ije/23.4.691.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Hinkula M, Kauppila A, Nayha S, Pukkala E. Cause-specific mortality of grand multiparous women in Finland. Am J Epidemiol. 2006;163:367–73. doi:10.1093/aje/kwj048.

    Article  PubMed  Google Scholar 

  13. 13.

    Kravdal O. Children, family and cancer survival in Norway. Int J Cancer. 2003;105:261–6. doi:10.1002/ijc.11071.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Kravdal O, Hansen S. The importance of childbearing for Hodgkin’s disease: new evidence from incidence and mortality models. Int J Epidemiol. 1996;25:737–43. doi:10.1093/ije/25.4.737.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Lund E. Number of children and death from hormone-dependent cancers. Int J Cancer. 1990;46:998–1000. doi:10.1002/ijc.2910460608.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Jacobsen BK, Vollset SE, Kvale G. Do reproductive factors influence colorectal cancer survival? J Clin Epidemiol. 1995;48:1119–22. doi:10.1016/0895-4356(95)00009-S.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Kune GA, Kune S, Watson LF. The effect of family history of cancer, religion, parity and migrant status on survival in colorectal cancer. The Melbourne colorectal cancer study. Eur J Cancer. 1992;28A:1484–7. doi:10.1016/0959-8049(92)90549-H.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Kravdal O. Is the relationship between childbearing and cancer incidence due to biology or lifestyle? Examples of the importance of using data on men. Int J Epidemiol. 1995;24:477–84. doi:10.1093/ije/24.3.477.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Hibbard JH, Pope CR. Effect of domestic and occupational roles on morbidity and mortality. Soc Sci Med. 1991;32:805–11. doi:10.1016/0277-9536(91)90306-W.

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Kobrin FE, Hendershot G. Do family ties reduce mortality? Evidence from the United States 1966–68. J Marriage Fam. 1977;39:737–45. doi:10.2307/350478.

    Article  Google Scholar 

  21. 21.

    Kritz-Silverstein D, Barrett-Connor E, Wingard DL. The relationship between multiparity and lipoprotein levels in older women. J Clin Epidemiol. 1992;45:761–7. doi:10.1016/0895-4356(92)90053-P.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Lewis CE, Funkhouser E, Raczynski JM, Sidney S, Bild DE, Howard BV. Adverse effect of pregnancy on high density lipoprotein (HDL) cholesterol in young adult women. The CARDIA Study. Coronary artery risk development in young adults. Am J Epidemiol. 1996;144:247–54.

    CAS  PubMed  Google Scholar 

  23. 23.

    Ness RB, Kramer RA, Flegal KM. Gravidity, blood pressure, and hypertension among white women in the Second National Health and Nutrition Examination Survey. Epidemiology. 1993;4:303–9. doi:10.1097/00001648-199307000-00005.

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Palmer JR, Wise LA, Horton NJ, Adams-Campbell LL, Rosenberg L. Dual effect of parity on breast cancer risk in African-American women. J Natl Cancer Inst. 2003;95:478–83.

    PubMed  Article  Google Scholar 

  25. 25.

    Macintyre S. The effects of family position and status on health. Soc Sci Med. 1992;35:453–64. doi:10.1016/0277-9536(92)90338-Q.

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Wyke S, Ford G. Competing explanations for associations between marital status and health. Soc Sci Med. 1992;34:523–32. doi:10.1016/0277-9536(92)90208-8.

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Beral V. Long term effects of childbearing on health. J Epidemiol Community Health. 1985;39:343–6. doi:10.1136/jech.39.4.343.

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Doblhammer G. Reproductive history and mortality later in life: a comparative study of England and Wales and Austria. Popul Stud (Camb). 2000;54:169–76. doi:10.1080/713779087.

    Article  CAS  Google Scholar 

  29. 29.

    Westendorp RG, Kirkwood TB. Human longevity at the cost of reproductive success. Nature. 1998;396:743–6. doi:10.1038/25519.

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Lund E, Arnesen E, Borgan JK. Pattern of childbearing and mortality in married women—a national prospective study from Norway. J Epidemiol Community Health. 1990;44:237–40. doi:10.1136/jech.44.3.237.

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Eisenbach Z, Manor O, Peritz E, Hite Y. The Israel Longitudinal Mortality Study—differential mortality in Israel 1983–1992: objectives, materials, methods and preliminary results. Isr J Med Sci. 1997;33:794–807.

    CAS  PubMed  Google Scholar 

  32. 32.

    Feldman C, Eisenbach Z, Manor O. Mortality differentials by education(Hebrew). Jerusalem: Israel Central Bureau of Statistics; 2003.

    Google Scholar 

  33. 33.

    Jaffe DH, Eisenbach Z, Neumark YD, Manor O. Educational inequalities in mortality among Israeli Jews: changes over time in a dynamic population. Health Place. 2008;14:287–98. doi:10.1016/j.healthplace.2007.07.003.

    Article  PubMed  Google Scholar 

  34. 34.

    Shuval J, Anson O. Social structure and health in Israel. Jerusalem: Magnes Press; 2001.

    Google Scholar 

  35. 35.

    Jaffe DH, Eisenbach Z, Neumark YD, Manor O. Does living in a religiously affiliated neighborhood lower mortality? Ann Epidemiol. 2005;15:804–10. doi:10.1016/j.annepidem.2004.09.014.

    Article  PubMed  Google Scholar 

  36. 36.

    Manor O, Eisenbach Z, Friedlander Y, Kark JD. Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study. Ann Epidemiol. 2004;14:453–60. doi:10.1016/j.annepidem.2003.10.011.

    Article  PubMed  Google Scholar 

  37. 37.

    ICBS. Statistical abstract of Israel, 2002. Jerusalem: Israel Central Bureau of Statistics; 2002.

    Google Scholar 

  38. 38.

    Hall DM. Children in an ageing society. Br Med J. 1999;319:1356–8.

    CAS  Google Scholar 

  39. 39.

    Kravdal O, Hansen S. Hodgkin’s disease: the protective effect of childbearing. Int J Cancer. 1993;55:909–14. doi:10.1002/ijc.2910550606.

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Zhang Z, Hayward MD. Childlessness and the psychological well-being of older persons. J Gerontol B Psychol Sci Soc Sci. 2001;56:S311–20.

    CAS  PubMed  Google Scholar 

  41. 41.

    Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J. Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol. 1987;126:714–23.

    CAS  PubMed  Google Scholar 

  42. 42.

    Hurt LS, Ronsmans C, Thomas SL. The effect of number of births on women’s mortality: systematic review of the evidence for women who have completed their childbearing. Popul Stud (Camb). 2006;60:55–71. doi:10.1080/00324720500436011.

    Article  CAS  Google Scholar 

  43. 43.

    Jacobsen BK. Relationships between childbearing and some food and alcohol habits: the Nordland Health Study. Eur J Epidemiol. 1996;12:327–30. doi:10.1007/BF00145293.

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Neumark YD, Rahav G, Jaffe DH. Socio-economic status and binge drinking in Israel. Drug Alcohol Depend. 2003;69:15–21. doi:10.1016/S0376-8716(02)00248-X.

    Article  PubMed  Google Scholar 

  45. 45.

    Grundy E, Holt G. Adult life experiences and health in early old age in Great Britain. Soc Sci Med. 2000;51:1061–74. doi:10.1016/S0277-9536(00)00023-X.

    Article  CAS  PubMed  Google Scholar 

  46. 46.

    Kroman N, Wohlfahrt J, Andersen KW, Mouridsen HT, Westergaard T, Melbye M. Parity, age at first childbirth and the prognosis of primary breast cancer. Br J Cancer. 1998;78:1529–33.

    CAS  PubMed  Google Scholar 

  47. 47.

    Manor O, Eisenbach Z. Mortality after spousal loss: are there socio-demographic differences? Soc Sci Med. 2003;56(2):405–13. doi:10.1016/S0277-9536(02)00046-1.

    Article  Google Scholar 

Download references


Data were created by grant 93-00015/2 from the US–Israel Binational Science Foundation and grant 03/120 from the Israel National Institute for Health Policy and Health Services Research.

Author information



Corresponding author

Correspondence to Dena H. Jaffe.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jaffe, D.H., Neumark, Y.D., Eisenbach, Z. et al. Parity-related mortality: shape of association among middle-aged and elderly men and women. Eur J Epidemiol 24, 9–16 (2009).

Download citation


  • Elderly
  • Men
  • Mortality
  • Parity
  • Socio-economic position
  • Women