{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:19:46Z","timestamp":1761765586931,"version":"build-2065373602"},"reference-count":27,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2012,7,27]]},"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A reduction in sex ratio at live birth has been proposed as a sentinel health indicator that can be used to monitor the health of populations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To test the hypothesis that a lower sex ratio is associated with adverse national population health using the prevalences of HIV and tuberculosis as measures of societal well-being.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>An ecological study design using routinely collected data and adjusting for potential confounding factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean global sex ratio was 1.05. There was marked heterogeneity in the sex ratio between different global regions (p&lt;0.0001). Those regions with the highest prevalences of HIV infection had lower sex ratios, with the value for the highest quartile being 0.022 (95% CIs CI 0.013 to 0.031) lower than the lowest quartile. Similarly, those areas with the highest quartile of tuberculosis infection had a sex ratio of 0.016 (95% CI 0.004 to 0.028) lower than those in the lowest quartile. Similar results were observed in a subgroup analysis limited to countries from the African continent.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The data are consistent with the hypothesis that a reduced sex ratio at live birth is a potential sentinel health indicator of lower population health. However, these data do not demonstrate either a casual relationship or reveal any biological mechanisms that may account for these observations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2011-200744","type":"journal-article","created":{"date-parts":[[2012,8,25]],"date-time":"2012-08-25T20:57:17Z","timestamp":1345928237000},"page":"327-331","source":"Crossref","is-referenced-by-count":9,"title":["Is the human sex ratio at birth a sentinel health indicator that is associated with HIV\/AIDS and tuberculosis prevalences in the 21st century?"],"prefix":"10.1136","volume":"67","author":[{"given":"Anna","family":"Shifotoka","sequence":"first","affiliation":[{"name":"Nottingham Biomedical Research Unit, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew W","family":"Fogarty","sequence":"additional","affiliation":[{"name":"Nottingham Biomedical Research Unit, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,8,25]]},"reference":[{"key":"2025100522435528000_67.4.327.1","unstructured":"United Nations Population Fund. Population Situation Analysis (PSA): a Conceptual and Methodological Guide. 2011. http:\/\/www.unfpa.org\/pds\/PSA_Guide.pdf (accessed 16 Sep 2011)."},{"key":"2025100522435528000_67.4.327.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.13.1018"},{"key":"2025100522435528000_67.4.327.3","doi-asserted-by":"publisher","DOI":"10.1126\/science.566954"},{"key":"2025100522435528000_67.4.327.4","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dem274"},{"key":"2025100522435528000_67.4.327.5","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.20562"},{"key":"2025100522435528000_67.4.327.6","doi-asserted-by":"publisher","DOI":"10.1556\/JEP.7.2009.4.5"},{"key":"2025100522435528000_67.4.327.7","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/17.12.3173"},{"key":"2025100522435528000_67.4.327.8","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/13.8.2321"},{"key":"2025100522435528000_67.4.327.9","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0710711104"},{"key":"2025100522435528000_67.4.327.10","doi-asserted-by":"publisher","DOI":"10.2478\/v10044-008-0005-5"},{"key":"2025100522435528000_67.4.327.11","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1289\/ehp.99107813","article-title":"Environmental chemicals and changes in sex ratio: analysis of 250 years in Finland","volume":"107","author":"Vartianen","year":"1999","journal-title":"Environ Health Perspect"},{"key":"2025100522435528000_67.4.327.12","doi-asserted-by":"publisher","DOI":"10.1126\/science.179.4068.90"},{"key":"2025100522435528000_67.4.327.13","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deg370"},{"key":"2025100522435528000_67.4.327.14","doi-asserted-by":"publisher","DOI":"10.1098\/rsbl.2009.0069"},{"key":"2025100522435528000_67.4.327.15","first-page":"S138","article-title":"Acute undernutrition is not associated with excess of females at birth in humans: the Dutch Hunger Winter","volume":"271","author":"Stein","year":"2003","journal-title":"Proc Roy Soc Lond B"},{"key":"2025100522435528000_67.4.327.16","unstructured":"WHO. 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