Stolen childhood taking a toll at young adulthood: The higher risk of high blood pressure and high blood glucose comorbidity among child brides

Association between child marriage and high blood glucose level in women: A birth cohort analysis

Objectives

Child marriage prematurely forces girls (<18 years of age) to perform adult roles prior to physical and psychological maturity. Such precocious transitions to young adulthood can have consequences on their long-term health, however, limited work has examined such relationships to date. As such, this study examines whether child marriage is associated with the risk of having hyperglycemia, or high blood glucose, in adulthood.

Study design

Observational study using repeated cross-sectional data.

Methods

Using data from the 2015-16 and 2019-21 waves of the India National Family Health Survey, we matched 432,080 and 418,409 women, aged 20-49 years, by birth year and month to create birth cohorts. Fitting multivariable binomial and multinomial logistic models, we compared the odds of having hyperglycemia across groups by marriage age (i.e., before or after age 18 years) within respective birth cohorts.

Results

We found that the adjusted odds of having high blood glucose among women married as children were 1.12 (95 % CI: 1.07-1.16) times that of their peers married as adults in the full-sample. The adjusted relative risks of having blood glucose levels higher than normal but lower than diabetic and diabetic ranges were 1.09 (95 % CI: 1.04-1.14) and 1.23 (95 % CI: 1.15-1.31), respectively, in comparison to blood glucose within normal range. These results were persistent across sub-groups of different birth cohorts.

Conclusion

Our findings suggest that child marriage was associated with higher risk of having high blood glucose in women, later in life.

Adolescent pregnancy persists in Nigeria: Does household heads' age matter?

About 700,000 pregnant youths die each year in developing countries. To determine whether the persistent adolescent pregnancy in Nigeria between 2013 and 2018 was influenced by proximal factors, particularly household head age, we carried out a cross-sectional study on adolescent girls that participated in the 2018 Nigeria Demographic and Health Survey (NDHS). Age of first birth, residence type, age, and gender of household heads was collected using a 2018 standardized NDHS. Multiple logistic regression was performed to test for associations. We analyzed 8,448 adolescents who had experienced pregnancy during the study period. The results demonstrated that girls with male household heads aged 45 and older have lower odds of adolescent pregnancy (OR = 0.619; 95% CI = 0.447, 0.856; p = 0.004 compared to those with female household heads in the same age group. Girls with male household heads in three younger age groups have higher odds of adolescent pregnancy than those with female household heads in the corresponding age group (15-24: OR = 1.719, 95% CI = 1.042, 2.835, p = 0.034; 25-34: OR = 4.790, 95% CI = 1.986, 11.551, p < 0.001; 35-44: OR = 2.080, 95% CI = 1.302, 3.323, p = 0.002). Girls with household heads aged in the 15-24 and 25-34 groups had higher odds of adolescent pregnancy compared to those with household heads aged 45 and older. Higher odds of adolescent pregnancy in Nigeria were found among girls with household heads aged in the 15-24 and 25-34 groups compared to those with household heads aged 45 and older. Although girls with younger male household heads are at an increased risk nationally, those living in the rural areas with younger household heads are at an even higher risk for adolescent pregnancy. Therefore, levels of socioecological model must be considered in planning for effective interventions.

Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score

INTRODUCTION

Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health.

AIM

This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults.

METHODS

Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator.

RESULTS

We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups.

CONCLUSIONS

These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.

Child marriage as a risk factor for non-communicable diseases among women in India

BACKGROUND

Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored.

METHODS

We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015-2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition.

RESULTS

Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17-1.24)], diabetes [1.29 (1.22-1.37)], heart disease [1.27 (1.18-1.36)], asthma [1.19 (1.11-1.28)] and thyroid disorder [1.10 (1.02-1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages.

CONCLUSIONS

Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group.

The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India

Child marriage is associated with negative health trajectories among women in low- and middle-income countries (LMICs). Marital disruptions in LMICs are also associated with adverse socioeconomic and health outcomes in women. Yet, little is known about the compounded health effects of experiencing both child marriage and marital disruptions. Using nationally representative data from India among women aged 18-49 years, we examined the effects of marital age (i.e., marriage before or after 18 years) and martial disruptions (i.e., widowed/divorced/separated) on the odds of having hypertension. Findings suggest that together, marital disruptions and child marriage increase the risk of hypertension. Specifically, women married as children and who experienced marital disruptions were 1.2 (95% CI: 1.2-1.3) times more likely to have hypertension compared to women who married as adults and currently in marriage. Additionally, among women married as children, those who experienced martial disruptions had a higher risk (AOR = 1.1, 95% CI: 1.0-1.2) of hypertension compared to their currently married peers. These results suggest public health strategies must consider contextual effects of being widowed/divorced/separated among women who were married as children. Simultaneously, prevention initiatives should be strengthened to reduce the incidence of child marriage in LMICs and associated downstream health consequences.

Child Marriage and Later-Life Risk of Obesity in Women: A Cohort Analysis Using Nationally Representative Repeated Cross-Sectional Data from Tajikistan

Child marriage, defined as union before age 18 years, has detrimental health and socioeconomic consequences. This study examines whether women married as children have a disproportionately higher risk of being obese at adulthood compared to their peers married as adults. Using data from the 2012 and 2017 waves of the Tajikistan Demographic and Health Survey, we matched women aged 25 to 49 years by birth year and month to create four birth cohorts. We fitted multivariable logistic regressions to assess the differential odds of being obese and estimated simultaneous quantile regression models to examine the differences in average body mass index (BMI) between women married as adults and as children within birth cohorts. We found that the adjusted odds of being obese for women married as children were 1.5 (CI: 1.3–1.7) times those of those who were married as adults, after controlling for sociodemographic correlates along with birth cohort and survey wave fixed effects. Results of the quantile regression analyses suggest higher expected BMI levels among women married as children compared to those of women married as adults across different quantiles of BMI. The differences though were more pronounced in the younger cohorts than in the older cohorts.

Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India

The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.

Early Marriage in Adolescence and Risk of High Blood Pressure and High Blood Glucose in Adulthood: Evidence from India

Adolescence, the transition phase to adulthood, is a critical period for physical and psychological development. Disruptions during this period, such as getting married, could result in various adverse short- and long-term health outcomes. This study aimed to assess the differential risk of two common chronic conditions—high blood pressure and high blood glucose—in adult women (20–49 years) who were married during different stages of adolescence (10–19 years) compared to women who were married in their youth (20–24 years). Using the most recent nationally representative data from India, we separately assessed the odds in favor of having the two chronic conditions for women who were married during early (10–14 years), middle (15–17 years), and late (18–19 years) adolescence. We found that an earlier age at marriage during adolescence was associated with a higher risk of chronic conditions later in life. Women who were married during early adolescence were respectively 1.29 and 1.23 times more likely (p < 0.001) to have high blood pressure and high blood glucose compared to women who were married in their youth. These findings highlight the importance of preventing underage marriage among adolescent females to address the risk of downstream chronic health consequences as adults.