Sex Ratio at Birth after Concurrent Events of Earthquakes and the COVID-19 Pandemic in Croatia.

The sex ratio at birth (ratio of males to females) has been known to be affected by exogenous shocks such as wars, pollution, natural catastrophes, economic crises, and others. Among these stressful events, both earthquakes and the COVID-19 pandemic have been reported to lower the sex ratio at birth. In this article, a rather unusual situation of two episodes of simultaneous events of COVID-19 lockdown and earthquakes approximately nine months apart (March and December of 2020) is investigated to assess whether they were associated with a bias in sex ratio at birth 3-5 months later (in utero loss) and 9 months later (loss at conception) in Croatia. The monthly time series of sex ratio at birth, total number of births, and total number of both male and female births from January 2010 to December 2021 were analyzed. Seasonally adjusted autoregressive moving-average models were used to estimate the functional form of the time series from January 2010 to February 2020. These results were used to predict the future values of the series until December 2021 and to compare them with the actual values. For all series used, there was no indication of deviation from the values predicted by the models, neither for 3-5 months nor for 9 months after the COVID-19 lockdown and earthquake events. The possible mechanisms of the absence of bias, such as the threshold of the stressful events and its localized reach, as well as the statistical methods employed, are discussed.