Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database

Abstract

Reproductive lives of men and women may provide significant insight into later-life morbidity and mortality. Sociological, biological, and evolutionary theories predict a relationship between reproductive history and later-life health; however, current research is lacking consensus on the direction of the relationship. Parity, early age at first birth and last birth, birth weight of offspring, having a child die as an infant, and having a preterm birth may have long-term effects on health for both men and women. In this study, the relationship between these measures of reproductive history and later-life health is examined using the Utah Population Database (a rich source of longitudinal data), and Medicare claims data from 1992–2009. Later-life health is measured using annual Charlson comorbidity index scores, a construct that summarizes most serious illnesses afflicting older individuals. Group-based trajectory modeling that accounts for nonrandom attrition due to death is used to identify the number and types of morbidity trajectories by sex and age for 52,924 individuals aged 65–84 in 1992. For females, early age at first birth, high parity, and having a preterm or high-birth-weight baby are associated with increased risks of comorbidity; later age at last birth is associated with a decreased risk of comorbidity. For males, early age at first birth and having a child with an abnormal birth weight leads to increased risk of comorbidity. The results suggest that both biological and social factors play important roles in the relationships between fertility and morbidity profiles at older ages.

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Acknowledgments

This work was supported by the National Institutes of Health – National Institute of Aging (Grant Nos. 1R21AG036938-01 and 2R01 AG022095). This work was performed under CMS DUA 14187. The authors wish to thank the Huntsman Cancer Foundation for database support provided to the Pedigree and Population Resource of the HCI, University of Utah. We also thank Alison Fraser and Diana Lane Reed for valuable assistance in managing the data. We are also grateful to Rebecca L. Utz, Antoinette Stroup, and Ming Wen for their invaluable feedback. Partial support for all datasets within the UPDB was provided by the HCI Cancer Center Support Grant (P30 CA42014) from National Cancer Institute.

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Correspondence to Heidi A. Hanson.

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Hanson, H.A., Smith, K.R. & Zimmer, Z. Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database. Demography 52, 2021–2049 (2015). https://doi.org/10.1007/s13524-015-0439-5

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Keywords

  • Fertility
  • Health trajectories
  • Life course
  • Morbidity
  • Biodemography