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- Title
Teen Pregnancy and Risk of Premature Mortality.
- Authors
Ray, Joel G.; Fu, Longdi; Austin, Peter C.; Park, Alison L.; Brown, Hilary K.; Grandi, Sonia M.; Vandermorris, Ashley; Boblitz, Alexa; Cohen, Eyal
- Abstract
Key Points: Question: What is the risk of premature mortality from 12 years of age onward in association with teen pregnancy? Findings: In this population-based cohort study of 2.2 million female teenagers, the risk of premature death was 1.9 per 10 000 person-years among those without a pregnancy, 4.1 per 10 000 person-years among those with 1 pregnancy, and 6.1 per 10 000 person-years among those with 2 or more pregnancies. Meaning: This study suggests that teen pregnancy may be a readily identifiable marker for subsequent risk of premature mortality in early adulthood. Importance: Unintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences. Objective: To evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy. Design, Setting, and Participants: This population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022. Exposures: The main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or ≥2). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy. Main Outcomes and Measures: The main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality. Results: Of 2 242 929 teenagers, 163 124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60 037 (36.8%) ended in a birth (of which 59 485 [99.1%] were live births), and 106 135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10 000 person-years [95% CI, 1.9-2.0 per 10 000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10 000 person-years [95% CI, 3.8-4.5 per 10 000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10 000 person-years [95% CI, 5.5-6.8 per 10 000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury. Conclusions and Relevance: In this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood. This population-based cohort study evaluates the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy in Ontario, Canada.
- Subjects
CANADA; MORTALITY risk factors; RISK assessment; MISCARRIAGE; MATERNAL age; RESEARCH funding; TEENAGE pregnancy; AGE distribution; CAUSES of death; DESCRIPTIVE statistics; LONGITUDINAL method; PREGNANCY complications; CONFIDENCE intervals; DATA analysis software; PROPORTIONAL hazards models; DISEASE risk factors; ADULTS; MIDDLE age
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe241833
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.1833