Abstract: Background: Many sub-Saharan African countries have large populations of young people, and these cohorts have the potential to bring significant change. Understanding the changing lives of young people is important for ensuring individuals experience healthy and successful transitions to adulthood and for understanding how best to ensure they realise their full potential, for themselves and their communities. Methods: This analysis used detailed, prospectively collected data on men and women from the Karonga Health and Demographic Surveillance Site in rural Malawi between 2004–2017. Multi-channel sequence analysis was conducted for the domains of leaving school, getting married, and having children. Sequences were grouped into clusters and descriptive and multinomial logistic regression carried out to assess differences in the transition to adulthood by sex, calendar time, and sociodemographic factors. Conclusions: Many participants followed a fairly early and rapid transition to adulthood; however, a sizable proportion experienced later marriage. These participants were split into those (mostly men) who received little education and had a long delay between school-leaving and marrying, and those who spent longer in education. Access to secondary school increased over time for both men and women, while only women experienced delays in age at marriage. Where associations between sociodemographic factors and transitions to adulthood were found, they suggested that greater access to resources was associated with a later transition out of education, and therefore to marriage. Contribution: Sequence analysis applied to longitudinal HDSS data proved a useful tool to identify different trajectories to adulthood in this rural Malawian context. PubDate: Tue, 20 Aug 2024 00:00:00 +020
Abstract: Background: Adult obesity has been increasing in the United States since the 1980s. Its future prevalence will be a key determinant for public health. For the cohorts now in young adulthood, the future prevalence of obesity will depend on current prevalence and future increase in weight. Methods: We pooled 92,615 body-mass index (BMI) measures from 26,337 adults interviewed and examined by the National Health and Nutrition Examination Survey (NHANES). We analyzed participants examined between ages 25 and 55 in the years 1998–2018. We applied a functional data analysis technique to probabilistically reconstruct individual BMI trajectories in order to investigate the future prevalence of obesity and severe obesity at age 55, and the mean time spent being obese and severely obese between ages 25 and 55. Results: We found that the prevalence of obesity at age 55 is expected to reach 58% (95% UI, 54%– 61%) for females born in 1984–1988 and 57% (95% UI, 53%–61%) for males born in the same cohort. The prevalence of severe obesity at age 55 will increase rapidly in both sexes. Time spent being obese will increase; e.g., for females from 10.7 years (95% UI, 10.4–10.9 years) in the 1964–1968 cohort to 14.7 years (95% UI, 14.2–15.3 years) in the 1984–1988 birth cohort. Conclusions: Although obesity prevalence may level off in the coming decades, higher prevalence of severe obesity and longer durations of obesity are expected to increase the population burden of this disease. Contribution: Prior research has suggested that prevalence of obesity may level off in the United States. Using innovative functional data analysis methods to probabilistically forecast future obesity, we find that severe obesity and years lived obese will continue to increase. Even if the prevalence of obesity stabilizes, the overall burden of obesity may continue to increase. PubDate: Tue, 13 Aug 2024 00:00:00 +020
Abstract: Background: Research on parents’ divisions of domestic labor during the COVID-19 pandemic has focused on average changes in housework and child care during the pandemic’s first year, limiting our understanding of variation in parents’ experiences as well as the long-term consequences of the pandemic for gender inequality. Objective: This study identifies distinct patterns of change in US parents’ divisions of housework and child care from spring 2020 to fall 2023 and factors associated with changes in parents’ divisions of domestic labor. Methods: We use five waves of survey data (2020–2023) from partnered US parents along with group-based trajectory and fixed effects models to identify longitudinal trajectories of parents’ divisions of housework and child care, and key factors associated with these trajectories. Results: Most US parents (75%–80%) maintained the same division of domestic labor throughout the pandemic. Nonetheless, one-quarter experienced long-term changes. Parents were equally as likely to transition to a nontraditional division of housework as to a traditional one (10%) but were four times more likely to transition to a nontraditional division of child care than to a traditional division (21% vs. 5%). Parents were more likely to shift toward a nontraditional division of domestic labor when mothers worked full-time (and earned more income) and fathers worked from home at least sometimes during the pandemic. Contribution: Overall, results suggest that the COVID-19 pandemic affected the long-term division of domestic labor in only a minority of families. Where change has occurred, however, it has been long-lasting, and in the case of child care, the change has tended to reduce gender inequalities rather than exacerbate them. PubDate: Fri, 09 Aug 2024 00:00:00 +020
Abstract: Background: International migration is influenced by economic and social factors that change over time. However, given the complexity of these relationships, global population scenarios to date include only stylized migration assumptions that do not account for changes in the drivers of migration. On the other hand, existing projection models of international migration do not resolve all demographic dimensions necessary to interact with the cohort-component models typically used for population projections. Objective: Here we present a global model of bilateral migration that resolves these dimensions while also accounting for important external, economic, and social factors. Methods: We include age, education, and gender dependencies into a recently developed model of migration by origin, destination, and country of birth. We calibrate the model on bilateral flow data, couple it to a widely used cohort-component population model, and project migration until 2050 under three alternative socioeconomic scenarios. Conclusions: The extended model fits data better than the original migration model and is more sensitive to the choice of socioeconomic scenario, thus yielding a wider range of projections. Regional net migration flows projected by the model are substantially larger than in the stylized assumptions. The largest flows are projected in the most economically unequal scenario, while previously, the same scenario was assumed to have the smallest flows. Contribution: The results offer an opportunity to reconcile stylized migration assumptions with quantitative estimates of the roles of important migration drivers. The coupled migration-population modeling framework means that interactions between migration and other demographic processes can be captured, and the migration component can be evaluated in more detail than before. PubDate: Thu, 08 Aug 2024 00:00:00 +020
Abstract: Background: Uruguay was one of the pioneers of the demographic transition in Latin America and the Caribbean. It experienced very early declines in both fertility and mortality, but teenage fertility remained high until recently. Objective: We study the short- and long-term determinants of fertility at different reproductive age stages (less than 20 years old, 20 to 29 years old, and 30 years old and over). Methods: We employ time-series analysis methods based on data from 1968 to 2021 and panel-data techniques based on department-level statistical information from 1984 to 2019. Conclusions: Our time-series analysis indicates a cointegration (long-term) relationship between fertility and economic performance, education, and infant mortality, with differences observed by reproductive age stage. It finds a negative relationship between income and fertility for women aged 20 to 29 that persists for women aged 30 and over and a negative relationship between education and adolescent fertility. A panel-data exercise with econometric techniques allowing us to control for unobserved heterogeneity confirms that income is a relevant factor for all groups of women and reinforces the crucial role of education in reducing teenage fertility. We also identify a negative correlation between fertility and employment rates for women aged 30 years old and over. Our study suggests a very relevant role for education in curbing fertility, especially among teenagers. It also confirms the importance of the level of economic development, providing support for conventional structural or diffusion, maternal role incompatibility, and institutional theories. Our evidence on female employment is not robust to the estimation method. Contribution: We provide the first comprehensive analysis of fertility at different stages of reproductive life for a Latin American and Caribbean country based on a long series of statistical data. Moreover, the case of Uruguay is particularly interesting because of the idiosyncratic features of this magnitude in the country. Our results yield additional evidence that contributes to increasing our understanding of the determinants of this phenomenon and informs policymakers regarding the design of interventions that shape fertility. PubDate: Wed, 07 Aug 2024 00:00:00 +020
Abstract: Background: Omissions and misreported ages in both death and exposure data cause bias in mortality and life expectancy estimates. Most discussions of data errors have focused on a single type of error only, and most rely on empirical examples rather than formal analysis. Objective: We wish to analyze data errors and their interactions in a single, coherent framework in which all three of the major data problems – death under-registration, census underenumeration, and age misreporting – coexist and interact. Methods: We build a framework for decomposing the biases caused by various data errors in mortality rates and life expectancy calculations. In addition to purely mathematical analysis, we apply the calculations to mortality and population data from Brazil, a country with intermediate data quality. Conclusions: Analytical and empirical calculations show that biases caused by data errors vary considerably across ages; that age misreporting has very small effects on life expectancy calculations at old ages; and that enumeration and registration errors are likely to cause much larger biases than age misreporting. Contribution: Combining an explicit analytical structure with empirical examples allows improved understanding of the consequences of data errors for mortality estimates in a wide variety of settings. It also provides insights for further study. PubDate: Mon, 05 Aug 2024 00:00:00 +020
Abstract: Background: The COVID-19 pandemic highlighted the importance of civil registration and vital statistics (CRVS) systems for tracking and monitoring mortality outcomes during a public health crisis, especially in low- and middle-income countries. Alternative mortality data sources, such as censuses and surveys, offer an opportunity to assess the impact of health crises on countries with incomplete CRVS systems. Objective: Our aim is to show that data on retrospective household deaths collected in household surveys produce informative adult mortality numbers that can be useful in estimating mortality in the context of the COVID-19 pandemic in countries with incomplete CRVS systems, such as Peru. Methods: Using data on household deaths in the previous five years from the National Demographic and Family Health Surveys of Peru (ENDES) from 2018, 2019, 2021, and 2022, we estimate the probability of dying between ages 20 and 64 (45q20) and compare the results with estimates from the World Population Prospects (WPP) 2022 revision and with estimates attained using the sibling survival method. Results: We verify that 45q20 estimates from ENDES household death information fall close to those reported by the WPP 2022. However, these estimates have high confidence intervals due to the small sample size. The sibling survival method consistently estimates lower adult mortality probabilities, even in pandemic years. Despite the difference in magnitude between the WPP 2022 estimates and those from household deaths, both provide a picture of an increase in the probability of dying among adults during the pandemic period. This is not reflected in estimates made using the sibling survival method. Contribution: Despite small sample size and irregularities in age-specific estimates, our work shows that survey questions on household deaths have a great potential for informing adult mortality over time in countries with deficient CRVS systems. PubDate: Fri, 02 Aug 2024 00:00:00 +020
Abstract: Background: We investigate the contribution of socio-behavioral factors to changes in US adult mortality over the period 1997–2019 using National Health Interview Surveys for the years 1997–2018 linked to death records through 2019. The variables studied include alcohol consumption, cigarette smoking, health insurance coverage, educational attainment, mental distress, obesity, and race/ethnicity. We evaluate the contribution of each socio-behavioral variable to mortality change by estimating the mortality risks associated with each variable in a hazards model and applying the risks to changes in the variable’s distribution. Results: When all variables are included in the model, we find that reductions in cigarette smoking and increases in educational attainment are the largest contributors to recent mortality improvements, accounting between them for 66% of mortality improvements. The contribution of educational attainment nearly doubles when variables that may be considered downstream to it are omitted from the analysis. In a secondary analysis, we compare two subperiods to investigate whether the variables can account for a widely observed slowdown in the rate of mortality reduction that occurred within the period of study. Rising levels of psychological distress, combined with very high risks associated with distress, contributed substantially to the slowdown. However, most of the slowdown remains unaccounted for. Contribution: We develop and apply a rigorous method to identify the role of many socio-behavioral factors in recent mortality change in the United States. Results highlight the role of a behavioral change (declines in smoking) and a broad social advance (educational expansion). PubDate: Thu, 01 Aug 2024 00:00:00 +020
Abstract: Background: Global climate change poses grave risks to population health, especially in low- and middle-income countries (LMICs). It both threatens the sustainability of nascent epidemiological transitions and raises prospects for counter transitions driven by indirect climate impacts on mortality, such as those from reemerging infectious diseases and by direct impacts of extreme climatic events. Objective: We investigate how the relationship between climate and mortality has changed as Antananarivo, Madagascar, progressed through the stages of the epidemiological transition, focusing on enteric infection mortality in children under 5. Methods: Using death registration, precipitation, and temperature time series data spanning over four decades, we model the climate–cause-specific mortality relationships during each stage of the epidemiological transition using generalized additive models. Results: While we find that enteric infection mortality has become less sensitive to low rainfall, higher temperatures, and climate extremes overall, it has become somewhat more sensitive to heavy rainfall. Mortality from remaining causes exhibits little climatic variation. Conclusions: While we find that childhood enteric infection mortality has become less sensitive to low rainfall and higher temperatures, it has become more sensitive to heavy rainfall. Mortality from other causes has also become less sensitive to high temperatures but has become slightly more sensitive to heavy rainfall while significantly more sensitive to low temperatures. Contribution: This is the first multidecade climate–mortality study of a city in sub-Saharan Africa out-side of South Africa. PubDate: Wed, 31 Jul 2024 00:00:00 +020
Abstract: Objective: This paper investigates and predicts the impact of family policies and the economic situation on women’s reproductive behavior in Tehran Province, Iran. Methods: The low fertility behavior of women in terms of simultaneous interaction among such agents as household, women, and government is modeled using a multi-agent-based modeling. The probability, heterogeneity, uncertainty, and interactions of agents are the top features of the model. The model is developed based on the micro level and utilized at the macro level for the prediction of a range of such reproductive outcomes as the total fertility rate (TFR), the cumulative frequency of children ever born, unwanted and wanted pregnancies, miscarriage, and induced abortions of women in Tehran Province during 2019 and 2029. Results: The results derived by the model projects show that the TFR in Tehran Province will decline with a steep downward trend over 10 years from 1.4 children in 2019 to 1.06 children in 2029 while the peak of childbearing is observed for the age group 25 to 29. With the implementation of the optimistic economic scenario and the provision of family support policies by the government, the TFR would reach 1.1 children in 2029, and the peak of childbearing will shift to the 20 to 24 age group. Contribution: This paper provides a multi-agent-based model for low fertility as a complex system. This model facilitates computer-based simulations, enhances demographic methods, and is a useful tool for evaluating the impacts of long-term population policies. The results help policymakers to predict the outcomes that may be obtained in the future based on the current population policies and programs. PubDate: Sat, 20 Jul 2024 00:00:00 +020
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