Multiple Recurrent Events and Terminal Event in the Presence of Cure: The Impact of Childbirth and Abortions on Maternal Health

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Naderi Azadeh; Najafimehr Hadis; Azam Kamal; Rahimi Foroushani Abbas; Hosseini Mostafa; Yaseri Mehdi

مرکز اطلاعات علمی Scientific Information Database (SID) - Trusted Source for Research and Academic Resources

Journal Paper

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Journal: International Archives of Health Sciences Year:2025 | Volume:12 | Issue:2 Page(s): 134-141

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Title

Multiple Recurrent Events and Terminal Event in the Presence of Cure: The Impact of Childbirth and Abortions on Maternal Health

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Keywords

Recurrent events

Joint frailty models

Mixture cure

Childbirth

Abstract

Objectives: This study aims to examine the relationship between Childbirth, abortions, and maternal death in determining maternal health. The research specifically focuses on the birth rate in Hamadan province.Methods: This retrospective cohort study considers birth and abortion as Recurrent events, with the times to birth, abortion, and maternal death as outcome measures. The parents' education level is also taken into account as a covariate. The rate of birth is estimated using a Mixture cure frailty model, a bivariate joint frailty Mixture cure model, and a multivariate joint frailty Mixture cure model, depending on the presence of cure and terminal event.Results: A total of 633 mothers who gave birth to their first child in 2012 at Fatemiyeh Hospital in Hamadan participated in this study. The majority of couples (60.6%) had two children, and 526 (83.1%) had no abortions. The results show a significant decrease in the probability of Childbirth among parents with an education level below a diploma (P-value < 0.05). Furthermore, the education level of mothers was found to have a significant impact on the birth rate. Specifically, having a diploma (Hazard Ratio = 0.826) or below a diploma (Hazard Ratio = 0.905) was associated with a lower rate of birth.Conclusion: The findings suggest a decline in the birth rate in Hamadan province over the past decade. Further research is needed to investigate the factors contributing to this decrease, taking into account the impact of abortions and maternal deaths on population growth.

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