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Introduction: Gender gap in aging

Early age at first birth, but not parity, is associated with poor physical performance in older age. Presented by Catherine M. Pirkle, on behalf of Ana-Carolina Patricio de Albuqueque Sousa, Beatriz Alvarado, Maria-Victoria Zunzunegui and the IMIAS research team.

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Introduction: Gender gap in aging

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  1. Early age at first birth, but not parity, is associated with poor physical performance in older age Presented by Catherine M. Pirkle, on behalf of Ana-Carolina Patricio de Albuqueque Sousa, Beatriz Alvarado, Maria-Victoria Zunzunegui and the IMIAS research team

  2. Introduction: Gender gap in aging • Women- Greater burden of physical decline and disability with advancing age • Gender gap varies by country • Greatest in countries with highest levels of inequity • Decline/disability greatest among the least educated & most impoverished individuals

  3. Explanations for the gender gap • Greater physiological dysregulation in the post-menopausal period? • Greater risk of chronic disease? • Less educational and professional opportunities? • More hardships (hunger, violence, etc.)?

  4. Role of reproductive history less explored • Women from low-income countries and impoverished backgrounds tend to: • Start childbearing earlier • Have more children • Face more risks during childbirth • Receive less care for childbirth-related health problems (e.g. pelvic floor disorders)

  5. Pregnancy can fundamentally alter a woman’s physiology • Interferes with bone mineral density (osteoporosis) • Alters long-term glucose homeostasis (diabetes, coronary heart disease) • Drains nutritional reserves (anaemia) • Results in injury to pelvic region (fistula, prolapse) • Changes/risks most profound in young mothers and mothers of many children

  6. Childbearing shapes life opportunities Early childbearing and elevated parity can • Lower educational attainment • Limit professional opportunities • Heighten familial and personal stress • Increase social status • Be a source of pride and distinction • Serve as an escape route from a stressful family environment

  7. Objectives & Hypotheses Obj.: Assess the link between reproductive history -early age at first birth and multiparity- and physical function in older age. Hyp. 1: Women who gave birth as teenagers and women who have had numerous children will have poorerphysical function in older age. Hyp. 2: The relationship between early age at first birth and parity with physical function will be more profound in Latin America than the Canadian and European sites.

  8. Study Measures • Exposures • Early age at first birth (≤18 years of age) • Parity (continuous, ≥3 births) • Outcome • SPPB (continuous, score ≤8) • Covariates • Age & education • Chronic diseases (at 65-74 years): osteoporosis, diabetes, chronic lung disease, high blood pressure, stroke, coronary heart disease, arthritis, & cancer

  9. Statistics • Measures of frequency (mean, SD, etc.) • Logistic regression • Poor physical function (SPPB ≤8) • General linear model • SPPB score

  10. Results: Exposures Age at first Birth Lifetime births 25 5.4 22 2.4

  11. Age at first birth & parity with poor physical function (SPPB ≤8) * * • Early age at first birth significantly associated w/ poor physical function, even after controlling for parity. • Much of the association lost when adjusting for chronic conditions • Parity (3+ children) is not associated with poor physical function *P-value < 0.05

  12. Early age at 1st birth significantly associated with SPPB (cont. measure) Adjusted for site, age, education, parity) Also adjusted for chronic diseases

  13. Association varies by study site Canada and Albania- early age at first birth significantly associated with lower SPPB Latin America- no difference in SPPB scores

  14. Summary of Results • Early age at 1st birth significantly associated with poor physical function in older age • Mediated at least in part by chronic diseases • No association between parity and physical function • Parity likely a consequence of early age at 1st birth • Association heterogeneous across study sites • Strongest in Canada and Albania

  15. Implications Identification of a high risk group • May benefit from interventions throughout the life-course and in old age (e.g. better treatments & follow-up of chronic disease, greater physical activity, social support) Importance of access to contraception for young women who do not want to have children

  16. Acknowledgements • Funding for this research was provided by the Canadian Institutes for Health Research • We thank all the participants of for their time and support of this study • We greatly appreciate the comments and feedback we received from Alban Ylli and Jack Guralnik

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