Socio-demographic Risk

Factors for Down

Syndrome in Sibu
Dr. Ling Kho Lee
Medical Officer, Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia

Introduction
Risk factor of having children with Down
syndrome = mother's age.
However, the well-established risk factor,
advanced maternal age, was not found in
many of the Down syndrome cases in
Egypt.
[1]

http://www.cdc.gov/ncbddd/birthdefects/downsyndrome.html

 Research done in Egypt showed other

than advaced maternal age, educational
status of parents are risk factors for Down
syndrome.
Another research done in United States
showed ethnic differences a risk factos of
having children with Down syndrome.

Introduction
Other socio-demographic risk factors less
well studied no one knows for sure how
many different other factors play a role
Little has been researched on Down
Syndrome in Sarawak

Objectives
1. To determine sociodemographic risk
factors of having having children with
Down Syndrome
2. To determine if sociodemographic play a
role among children with Down sydrome
with or without comorbidities.

Methods
Case Control Study
Case:
Those registered in child development center
in Sibu
Less than 18 years old
From Sibu

Methods
Case Control Study
Control group:
- All term baby in Hospital Sibu from
February 2015 to April 2015

Data Collection

Sex
Ethnic Gorup
Parents age
Parents educational background
Parents occupation
Co-morbidities in children with Down
syndrome

Sample Size

MREC approval
This research is approved by Malaysia
Research Ethnic Center (MREC).
MREC No: 13-1503-16349

Child developmental center

(n =176 )
Excluded ( n = , %)
> 18 ( n = 32)
Not from Sibu ( n= 8)
Missing data (n = 15)

Case
(n=121 )

Total birth
(n = )

Excluded ( n = , %)
Preterm
Lethal

Control
(n= )

Results
Sociodemogr
Down
aphic
Syndro
characteristic
me
s

Term
Babies

Total Subject, n
Gender
-Male

124

506

73 (58.9%)

275
(54.3%)

Ethnic
-Chinese
-Iban
-Others

51 (42.1%)
45 (37.2%)
25 (20.6%)

90
(17.8%)
263
(52.1%)
152
(30.1%)

Stat
(df)

pvalue

0.824
(1)

0.364

34.324
(3)

<0.001

Results
(Univariate analysis)
SDC

Mother
Age (Mean, in
years)
Education
- Primary/No formal
- Secondary
- Tertiary
Employment
- Employed
- Unemployed

Down
Syndrome

Term Babies

Stat (df)

pvalue

32.46
SD IQR

26.70

8.522
(609)

<0.00
1

26 (25.2%)
66 (64.1%)
11 (10.7%)

33 (27.3%)
88 (72.7%)

80 (16.0%) 10.617 0.014

309
(3)
(61.7%)
112
(22.4%)

146
(28.9%)
360

120 (1) 0.729

Results
(Univariate analysis)
SDC
Father
Age (Mean, in
years)

Down
Syndrome

Term
Babies

Stat
(df)

pvalue

35.41

30.39

5.775
(600)

<0.00
1

Education
- Primary/No formal
- Secondary
- Tertiary

36 (34.3%)
63 (60.0%)
6 (5.7%)

84 (16.7%)
330
22.167 <0.00
(65.6%)
(3)
1
89 (17.7%)

Employment
- Self-employed
- Monthly-paid
- Daily-paid
- Others

14 (12.1%)
84 (72.4%)
7 (6.0%)
11 (9.5%)

56 (11.1%)
396
10.365 0.016
(78.4%)
(3)
38 (7.5%)
15 (3.0%)

Results
(Multivariate analysis)
Variables
Mother Age
(years)
-< 18
-18 - <35
->35
Family
Income
-<RM1000
-RM1000-3000
-RM3001-5000
->RM5000

Adjusted
OR

95% CI
OR

X2 stat
(df)a

p-value

1.2
1
7.7

0.38, 3.50

0.066 (1)

0.797

4.60,
12.80

61.076 (1)

<0.001

0.35, 1.04
0.51, 2.29
1.13, 5.66

3.295 (1)
0.039 (1)
5.117 (1)

0.069
0.843
0.024

1
0.6
1.1
2.5

SDC of DS with
& without Comorbid
There is no significant
sociodemographic risk factors among
children with Down Syndrome with or
without comorbidities.

Discussion
Advanced maternal age and family income
are significant risk factors of having children
with Down Syndrome.

Comparison
Population

Adjusted 95% CI OR
OR
7.6
4.7, 12.4
6.5
5.4, 7.7

Sibu
Mexican
Americans
African
5.2
4.3, 6.3
Americans
Non-Hispanic
3.2
3.0, 3.5
Khoshnood B, Pryde P, Wall S, Singh J, Mittendorf R, Lee KS. Ethnic
Whites
differences in the impact of advanced maternal age on birth

prevalence of Down syndrome.Am J Public Health.2000;90:177881

 Family income > RM5000 per month had

higher risk of having children with Down
Syndrome.
Mot
her
s
age

Frequen
cy

Perce
nt

1519

2029

15

37.5

37.5

3039

22

55.0

55.0

40-

2.5

2.5

5.0

Valid
Percent

Fathe
rs
age

Frequen
cy

Percen Valid
t
Percent

20-29

10

25.0

27.8

30-39

21

52.5

58.3

40-49

12.5

13.9

Total

36

90.0

100.0

5.0

Limitations
Relatively few samples
Comparing a study group with sociodemographic data up until 18 years earlier
against a control group in recent time

Conclusion
Advanced maternal age and high family
income are significant risk factors for having
children with Down Syndrome in Sibu
population.
No identifiable socio-demographic risk
factors between Down sydrome with or
without comorbidities.

Acknowledgement
1.Co-authors
Dr Ha Siaw Jing, Dr Tan Shong Sheng, Nurhilda
Abdullah, Jenniffer Jee, Shirin Tan Hui

2. Dr Law Houng Nai

3. Supervisor : Dr Toh Teck Hock
4. Child developemental center
5. Special care nursery

THANK YOU