J-Curve? A Meta-Analysis and Meta-Regression of Parity and Parental Mortality

Research suggests that parity and parental health and mortality are associated significantly, although the pattern of association varies across studies. Studies ascribe long-term poor health (and mortality) to either low or high parity, and some studies show that both low and high parity increase the risk of adverse health for parents (i.e., forming a "J-shaped curve"). While a recent meta-analysis (Zeng et al., Sci Rep 6:19351, 2016) has partially addressed this gap in the literature, the present study further extends the literature by using a methodology that allows for more robust control of study heterogeneity and potential confounders. Using data on 223 measures of relative mortality risk from 37 studies, from samples gathered after 1945 from developed nations, meta-analysis and meta-regression (weighted linear regression) results show a nonlinear association (J-shaped curve) between parity and all-cause parental mortality, though the strength of the association varies by both sex and cohort. The results also suggest that the mortality hazard is partially explained by health selection effects.