{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:40:17Z","timestamp":1756662017426,"version":"3.44.0"},"reference-count":45,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Taiwan Ministry of Science and Technology","doi-asserted-by":"crossref","award":["MOST 106-2314-B-039-052-MY2","MOST 108-2314-B-039-030-MY3"],"award-info":[{"award-number":["MOST 106-2314-B-039-052-MY2","MOST 108-2314-B-039-030-MY3"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC112-2628-B-400-003-MY3"],"award-info":[{"award-number":["NSTC112-2628-B-400-003-MY3"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2024,10,31]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The causal relationship between advanced paternal age and offspring health is unclear, owing to familial confounders. This study examined the association of paternal age with offspring\u2019s under-five mortality and perinatal outcomes, using sibling comparison analyses to account for familial confounding factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A nationwide birth cohort study was designed based on Taiwan\u2019s single-payer compulsory National Health Insurance programme. Individuals born between 2001 and 2015 were included, resulting in 2454\u2009104 live-born singletons. Among them, 1513\u2009222 individuals had full sibling(s) who were included in the sibling-comparison analyses. Logistic regression analyses were used to evaluate the main study cohort whereas conditional logistic regressions were used in the sibling-comparison analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the main cohort, paternal age categories showed a U-shaped relationship with offspring\u2019s under-five mortality in the crude analysis, which attenuated towards the null hypothesis after accounting for the measured potential confounders. There was an increased risk of premature birth (gestational age &lt;37 weeks), low birth weight (&lt;2500\u2009g), large for gestational age (90th percentile) and low 5\u2009min Apgar Score (&lt;7) in individuals with a paternal age of &gt;35 years. Sibling-comparison analyses that accounted for unmeasured familial time-invariant confounders showed that younger siblings with older paternal age had a lower risk of under-five mortality, low birth weight, small for gestational age (10th percentile), congenital defects and low 5\u2009min Apgar Score, and a higher risk of premature birth and large for gestational age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Children with older fathers had lower risks of under-five mortality, low birth weight, small for gestational age, congenital defects and low 5\u2009min Apgar Score.<\/jats:p>\n               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