Is the human sex ratio at birth a sentinel health indicator that is associated with HIV/AIDS and tuberculosis prevalences in the 21st century?

Anna Shifotoka, Andrew W Fogarty
2012 Journal of Epidemiology and Community Health  
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. Objective 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. Methods An ecological study design using routinely collected data and adjusting for potential confounding factors. Results The mean global sex ratio was 1.05. There
more » ... tio was 1.05. There was marked heterogeneity in the sex ratio between different global regions ( p<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. Conclusions 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.
doi:10.1136/jech-2011-200744 pmid:22923770 fatcat:f4jq4zqn4ndjbkswxfp7s4fazy