A scoping review of methods for assessment of sex differentials in early childhood mortality

Abstract

Background While assessment of sex differentials in child mortality is straightforward, their interpretation must consider that, in the absence of gender bias, boys are more likely to die than girls. The expected differences are also influenced by levels and causes of death. However, there is no standard approach for determining expected sex differences. Methods We performed a scoping review of studies on sex differentials in under-five mortality, using PubMed, Web of Science, and Scopus databases. Publication characteristics were described, and studies were grouped according to their methodology. Results From the 17,693 references initially retrieved we included 154 studies published since 1929. Indian, Bangladeshi, and Chinese populations were the focus of 44% of the works, and most studies addressed infant mortality. Fourteen publications were classified as reference studies, as these aimed to estimate expected sex differentials based upon the demographic experience of selected populations, either considered as gender-neutral or not. These studies used a variety of methods – from simple averages to sophisticated modeling – to define values against which observed estimates could be compared. The 21 comparative studies mostly used life tables from European populations as standard for expected values, but also relied on groups without assuming those values as expected, otherwise, just as comparison parameters. The remaining 119 studies were categorized as narrative and did not use reference values, being limited to reporting observed sex-specific estimates or used a variety of statistical models, and in general, did not account for mortality levels. Conclusion Studies aimed at identifying sex differentials in child mortality should consider overall mortality levels, and report on more than one age group. The comparison of results with one or more reference values, and the use of statistical testing, are strongly recommended. Time trends analyses will help understand changes in population characteristics and interpret findings from a historical perspective.

Determinants of under-five mortality in Indonesia: A nationwide study

“…This aligned with the results of a previous study in Bangladesh (Karra et al, 2017;Khan & Awan, 2017). This research demonstrated that boys had a higher risk of death than girls, and these findings aligned with previous studies in Africa, including Nigeria, and Indonesia (Adebowale et al, 2020;Costa & Victora, 2021;dewuyi et al, 2016;Titaley et al, 2008). Boys are genetically and biologically weaker and more susceptible to contracting infectious diseases than girls (Muenchhoff & Goulder, 2014), such as congenital malformations of the urogenital system (Nair et al, 2013) and acute lung respiratory infection (Antehunegn & Worku, 2021).…”

Derivation and assessment of a sex-specific fetal growth standard: secondary analysis of a prospective observational study

“…10,12 A prior analysis found that the Hadlock standard was twice as likely to consider female fetuses as being <10 th percentile compared with male fetuses, even though female fetuses had significantly lower morbidity than male fetuses. 14,15 Population fetal growth standards that do not account for fetal sex, such as the Hadlock standard, may generate disparities in diagnoses of abnormal growth between fetal sexes that may not be justified by morbidity. Given the knowledge of sex differences in fetal growth and the routine prenatal assessment of fetal genitalia, 1 the lack of investigation into sex-specific intrauterine growth standards represents an important gap in both research and clinical practice.…”

Analysis of sex disparities in under-five mortality rates in Ghana: Insights from vector autoregressive modeling

“…After early infancy, however, girls do not show the same advantages in survival due to infectious diseases; thus, sex differentials in child mortality tend to be lower than those of infant mortality, with those of under-five mortality taking values between the two [3]. Excess female mortality could indicate the presence of factors outweighing the expected biological survivorship conferred on girls during these ages, as would occur if girls are subjected to unequal access to healthcare, nutrition, or sex-related biases because of community preference for males [4]. On the other hand, higher-than-expected sex mortality ratios, indicative of inequities against male children, might point to a change in mortality to an extent greater than biologically expected.…”