Peer Review #1 of "The impact of the Wenchuan earthquake on early puberty: a natural experiment (v0.1)"

Abstract

The factors influencing pubertal timing have gained much attention due to a secular trend toward earlier pubertal onset in many countries. However, no studies have investigated the association between the great earthquake and early puberty. We aimed to assess whether Wenchuan earthquake is associated with early puberty , in both boys and girls. Methods: We used data from two circles of a survey on reproductive health in China to explore the impact of Wenchuan earthquake on early puberty , and a total of 9,785 adolescents (4,830 boys, 49.36%) aged 12-20 years from 29 schools in 8 provinces were recruited. Wenchuan earthquake exposure, defined as those Sichuan students who had not experienced oigarche/menarche before May 12, 2008. Early puberty was identified as a reported onset of oigarche/menarche at 11 years or earlier. We tested the association between Wenchuan earthquake and early puberty in boys and girls. Then subgroup analysis stratified by the age at earthquake exposure also was performed. Results: In total, 8,883 adolescents (4,543 boys, 51.14%) with a mean (SD) age of 15.13 (1.81) were included in the final sample. In general, children exposed to earthquake had three times greater risk of early puberty (boys, RR [95%CI] =3.18[2.21-4.57]; girls: RR [95%CI] =3.16[2.65-3.78]). Subgroup analysis showed that the adjusted RR was 1.90[1.19-3.03] for boys and 2.22[1.75-2.80] for girls. Earthquake exposure predicted almost a fourfold (RR [95%CI] =3.91[1.31-11.72]) increased risk of early puberty in preschool girls, whereas the increase was about twofold (RR [95%CI] =2.09[1.65-2.64]) in school girls. Among boys, only older age at earthquake exposure linked to early puberty (RR [95%CI ] =1.93[1.18-3.16]). Conclusions: Wenchuan earthquake exposure increased the risk of early puberty in boys and girls, and preschoolers were more at risk than schoolchildren. The implications are relevant to support policies for those survivors, especially children, to build back better after disasters.