birth distance influential factors: a multilevel recurrent events approach

background: the study was developed in order to find a subset of potential factors, which affect birth distance pattern, regarding consideration on correlation of events of birth in a family and correlation within clusters/centers which other studies omit these correlations. methods: referring to documents that were registered for family in the health care centers on socio-economical zone, we consider the families with at least one successful birth. data were drawn from four health care centers, which selected via 27-health center in hamedan city, western iran, each from a socio-economic zone. it was expected, same socio-economic status family have same specific birth distance and a family follows a specific pattern. the multilevel recurrent approach was conducted to analyze the sample. the sample was 480 families and 1115 birth events occurred in these families. results: the final step model shows that significant factors on the birth distance time were mothers job ( p =0.018). the random effect of second level (clusters/centers) was significant ( p =0.038). in other words, the socio-economic of family affects on the birth distance patterns. other potential variables were not significantly affected birth distances and were deleted from the final model. conclusions: there are many potential factors, which may affect to birth distance, but multilevel recurrent event model has a better fit to data because of frailty and center effects. application of other model such as cox and frailty models may result in misleading reports.