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To evaluate the association between ambient particulate matter no larger than 2.5 μm in diameter (PMWe conducted a population-based birth cohort study using the Taiwan Birth Cohort Study. Participants were assessed for developmental conditions through home interviews at 6 months and 18 months of age. Exposure to PMA total of 17 683 term singletons without congenital malformations were included in the final analysis. PMExposure to ambient PM

We sought to develop and validate age-specific instruments for measuring early childhood resilience at ages 3, 5 and 8 in the Taiwan Birth Cohort Study, a national longitudinal study.Using data from 18,553 mother-infant pairs, we conducted exploratory factor analysis (EFA) on a simple random half of our sample. We then used the remaining half of these data for confirmatory factor analysis (CFA) to further assess the fit of 3 CFA models (ie, first-order, second-order, and bifactor). Psychometric properties, distributions, and inter-item and inter-factor correlations of each instrument were also evaluated.EFA and CFA showed that the bifactor model of resilience (which included a general resilience factor and 5 specific factors) had the best fit for all 3 resilience scales, with 19 items at year 3, 18 items at year 5, and 19 items at year 8. All 3 resilience scales showed good psychometric properties, including construct validity, internal consistency, and normal distributions. For predictive validity, we found that in the face of adversity (measured by the High Risk Family Score), individuals with high resilience scores at age 3 had better general health scores at ages 3, 5, and 8 compared to those with low resilience scores.We describe the development and validation of age-appropriate survey instruments to assess resilience in young children at the population level. These instruments can be used to better understand how resilience can impact child health over time, and to identify key factors that can foster resilience.

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorders. Although studies have suggested relationships between ADHD in children and maternal psychosocial stress during pregnancy, little is known about the effects of work-related mental stress. Considering the increasing number of pregnant women who continue to work during the gestation period, this study investigated whether work-related stress during pregnancy is related to offspring ADHD.The Taiwan Birth Cohort Study followed selected representative mother-infant pairs in a face-to-face interview since a child was 6 months old. A total of 10,556 working pregnant women who completed follow-up 8 years later were included. Whether the 8-year-old child had ever received a diagnosis of ADHD were inquired. Self-reported job stress during pregnant period was obtained 6 months after delivery. Factors including perinatal and socioeconomic factors as well as the mother's job conditions were further analyzed with logistic regression.Among those who continued working during pregnancy, 3850 (36.5%) mothers reported having job stress during pregnancy, and 210 (2.0%) of the children were diagnosed as having ADHD before 8 years of age. Compared with mothers who reported no job stress, the adjusted odds ratio of child ADHD was 1.91 (95% CI 1.21-3.07) for mothers with "very stressful" jobs during pregnancy and 1.53 (95% CI 1.04-2.25) for mothers with "rather stressful" jobs.Among pregnant female workers, higher levels of job stress were related to the higher occurrence of ADHD in their children.

Background: This study aims to analyze the influence of Framework of Convention of Tobacco Control (FCTC) on regulatory patterns of trade agreements from 2001 to 2019. Methods: A search of trade agreements from‘WTO Regional Free Trade Agreement Database’ using keywords as “tobacco”, “cigarette”, “smoking” and “FCTC” from May to August 2020 resulted in a total sample of 268 trade agreements, from which 69 trade agreements were coded and analyzed. The keywords-located provisions in the trade agreements were categorized as 6 trade measures. The word counts of the provisions containing keyword as FCTC were calculated. Chi-square tests were applied to analyze the differences of regulatory patterns between different time frames. The import and export values (USD) of tobacco products under trade agreements containing the term “FCTC” were further collected from the “International Trade Statistics 2001-2020” for a preliminary understanding of trade flow impacted by FCTC. Results: Among 69 agreements, the percentage of trade agreements containing keyword as “FCTC” increased significantly from 0% before 2011 to 12% after 2011. A significant decrease of using trade measures as “the exclusion list” was found after 2011 (from 10% to 0). The word counts of provisions containing keyword as FCTC increased from 24 words in 2011 to 164 words in 2018, and the content of the provisions became more concrete over time. There are six trade agreements containing the keyword as “FCTC”, and all these 6 agreements were ratified by European Union (EU). Despite EU ratified trade agreements with “FCTC”, the import and export values of tobacco products between EU and the other party countries increased with time. But the gap of average trade values between trade agreements with and without “FCTC” being widened with time. Conclusions: As a first study evaluated the impact of FCTC on regulatory patterns of trade agreements, our study results showed that after countries signed trade agreements containing keyword FCTC, the regulatory patterns changed significantly. Further studies are recommended to understand the reason and criteria for incorporating FCTC provisions into trade agreements, especially in the EU.

Background and Objectives Taiwan implemented its first National 10-Year Long-Term Care Plan in 2008 and its second in 2017. Over the first 10 years, the number of home care workers grew too slowly to meet demand. To increase the home care workforce, the government introduced 2 new payment mechanisms in 2018. This study assesses these mechanisms’ impact on growth in numbers of home care workers and use of home care services in Taiwan. Research Design and Methods Data were collected from the Ministry of Health and Welfare (2014–2019) and the Division of Long-Term Care (2017–2019). Generalized estimating equations compared rates of growth in the number of home care, institutional care, and foreign care workers and the number of care recipients receiving care from each group before and after 2018. Results Before 2018, rates of growth in all three groups of care workers increased slowly. After 2018, the rate of growth for home care workers increased to 31.8% from 9%, while growth in the other two groups remained stable. While there was greater workforce growth among home care than institutional care workers post-implementation of the payment mechanisms (p < .05), the number of home care recipients (p < .05) and monthly home care visits (p < .05) also increased. Discussion and Implications The new payment mechanisms improved home care workers’ autonomy and salaries and appear to have contributed to immediate increased recruitment and retention. Whether this increase continues over the long run will need to be determined.

Background Relatively few studies have investigated the effects of diet on behavior problems among preschoolers, particularly, physical aggression. In addition, children raised by poorly educated mothers usually have a higher probability of developing negative outcomes. Additionally, highly educated mothers have a higher probability of providing more healthy foods for their children. Thus, mothers providing healthy foods might mitigate children’s behavior problems. The study aims to examine whether preschoolers’ dietary pattern, as a manipulable factor, mediates the association between maternal education level and physical aggression. Methods Data came from the Taiwan Birth Cohort Study (TBCS), a nationally representative population-based cohort study, which included 18,513 five-year-old Taiwanese children. Mothers and primary caregivers reported the information on preschoolers’ physical aggression and food consumption at age 5 and maternal education level at age 6 months. Two dietary patterns, namely a healthy diet and a high-fat-sugar-salt (HFSS) diet, were retrieved by exploratory factor analysis. Mediation hypotheses were tested by a series of multiple regression models conducted using the PROCESS macro of SAS 9.4. All models were adjusted for children’s sex, parental marital status, household income, mental distress at age 5 and children’s physical aggression at age 3. Results Maternal education positively linked to healthy dietary patterns (B = 0.014, p = 0.002) which was negatively associated with preschoolers’ physical aggression (B = -0.096, p = 0.013), and it is negatively related to the HFSS dietary pattern (B = -0.042, p = 0.002) which was directly positively associated with preschoolers’ physical aggression (B = 0.123, p = 0.008). The association between maternal education and preschoolers’ physical aggression was partially mediated by preschoolers’ healthy (B = -0.001, p Conclusions Preschoolers’ dietary patterns directly associate with their physical aggression. In addition, mothers with poor education may provide less healthy foods and more unhealthy foods to their children, which may increase the level of physical aggression. The results imply partial mediating effects of dietary patterns between maternal education and physical aggression. It is suggested that a parent-based nutritional education program focusing on healthy meal preparation for poor educated mothers might be beneficial for preschoolers’ healthy development.

This study aimed to investigate (1) the reliability and validity of the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI) 8-year-old scale; (2) the pathway relationship among the cognitive, emotional and social-communication dimensions of the TBCS-DI 8-year-old scale; (3) the predictive validity and association of the TBCS-DI dimensions at 6, 18, 36, and 66 months, with the dimensions of the 8-year-old scale. The Taiwan Birth Cohort Study dataset of 19,516 children followed from 6 months to the age of eight was used. The TBCS-DI 8-year-old scale showed good reliability and validity. A recursive relationship of emotion as the basis, affecting cognition and later social communication was found. Children's 18-month development was able to predict the development of children at 8 years, implying that 18 months may be a critical age for screening and intervention. Clinical intervention should also take into consideration the cultural disparity of emotional development in Asian countries.

Incineration is a solution to waste problems; however, it has adverse effects on human health. Our study aimed to investigate the direct and indirect effects of living near an incinerator and breastfeeding on children’s development at 6, 18, 36 and 66 months, and 8 years of age. The Taiwan Birth Cohort Study dataset used included randomized community data on 19,519 children from 6 months to 8 years old. The Taiwan Birth Cohort Study Developmental Instrument was used to measure children’s development at different developmental ages. The results of our study showed that living within 3 km of an incinerator had a negative effect on children’s 6-month development, however the effect dissipated after 18 months. Having been breastfed and living in the city had a more persistent and pervasive positive effect on children’s development. Conversely, living in the city had an adverse effect on children’s social-communication and emotional development when they were 8 years old; possibly due to the Chinese cultural characteristic of collectivism. Further follow-up of the long-term interactive effects of proximity to an incinerator and breastfeeding on children’s development and health is needed.

This study identified developmental patterns of handwashing habit formation during childhood and examined their associations with later COVID-19 preventive practices.We used data from the Taiwan Birth Cohort Study, which included 11,254 adolescents with complete data on childhood handwashing behavior and age-15 COVID-19 survey items. Bias-adjusted 3-step latent class analysis was used to test study hypotheses.The rates of handwashing and mask-wearing during the pandemic were 63.8% and 93.8%, respectively. Five distinct patterns of handwashing habit formation were identified: early formation (14.89%), delayed formation (17.73%), gradual formation (42.98%), inconsistent formation (9.78%), and nonformation (14.62%). Compared with adolescents with an early formation pattern of handwashing habits, those with other patterns exhibited lower odds ratios (ORs) of handwashing during COVID-19; these ORs were 0.67 (95% confidence interval [CI], 0.49-0.85), 0.60 (95% CI, 0.44-0.77), 0.29 (95% CI, 0.08-0.49), and 0.21 (95% CI, 0.01-0.40) for those with delayed formation, gradual formation, inconsistent formation, and nonformation patterns, respectively. Moreover, relative to that of adolescents with the early formation pattern, mask-wearing was less common among adolescents with gradual formation, inconsistent formation, and nonformation patterns, with ORs of 0.54 (95% CI, 0.16-0.92), 0.50 (95% CI, 0.03-0.96), and 0.26 (95% CI, 0.00-0.65), respectively.The early formation of hygienic habits is associated with higher adherence to pandemic preventive practices among adolescents. Our findings suggest that interventions to promote hygienic behaviors can start as early as age 3 through the introduction of healthy habits such as handwashing.

ObjectiveThis study analyses the mediating effects of early health prior to age 3 on the association between early poverty and the health outcomes of children at age 12.DesignPopulation-based longitudinal birth cohort study.SettingTaiwan Birth Cohort Study (TBCS), 2005–2017.Participants16 847 TBCS children born in 2005 and followed up at 18 months, 3, 5, 8 and 12 years with available data on poverty and health status.Main outcome measuresChild’s general health, measured by the mothers’ ratings of their child’s health, and hospitalisation experience at 12 years of age.ResultsAmong the TBCS children, the prevalence of fair/poor health and hospitalisation was 20.8% and 2.5% at age 12. The ORs of experiencing fair/poor health and hospitalisation at age 12 were 1.33 (95% CI 1.21 to 1.45) and 1.35 (1.07 to 1.69) for early poverty, respectively. When early poor health was added in the multiple logistic regression models, the effects of early poverty were attenuated on poor general health and no longer significant on hospitalisation for children aged 12 years. Mediation analysis showed that 50%–87% of the total effect of early poverty on health at age 12 was mediated by early health status before age 3.ConclusionsOur findings suggest that poor health in early life plays as a significant mediator in the relationship between early poverty and the long-term health outcomes of children. Universal health coverage thus should be achieved to prevent the adverse health effects of poverty throughout the life course, as one of the most important strategies for children growing up in poverty.

There are growing concerns about the effects of poverty on children’s health, but few studies have examined how the long-term experience of poverty affects the general health of children. We sought to investigate the relationship between children’s poverty experience from birth to school age and their general health status. Data from the Taiwan Birth Cohort Study (TBCS), a nationally representative sample of 17,853 children born in 2005 were used. Mother-rated health of children at age 8 was assessed. We used logistic regression to examine how the duration and timing of child poverty are related to children’s general health, controlling for child and maternal characteristics. Of the 17,853 cohort members, 23.6% experienced early poverty (persistent, 5.9%; occasional, 17.7%) before age 5, and 11.4% experienced concurrent poverty at the age of 8. Children born into poverty and remaining poor were more likely to have poor health than those who were never poor. Early poverty (persistent poverty: odds ratio (OR) = 1.50; 95% confidence interval (CI) 1.27–1.78; occasional poverty: OR = 1.25; 95% CI 1.12–1.39) was more detrimental to children’s general health than concurrent poverty (OR = 1.23; 95% CI 1.09–1.40). A long-lasting gradient effect of early poverty on the general health of children was detected, suggesting an urgent need to prevent children from growing up in persistent poverty.

Equity is the status in which all students, regardless of their personal and social circumstances, are given proper resources and support to achieve their educational potential. Higher education has always been a key element of social mobilization since it is considered a right that should be given to all in a world of knowledge economy. Under the influence of higher education massification, the admission rate to higher education in Taiwan has come to a peak of over 90%. Equity in accessing higher education for all students has still been challenged. In this chapter, the authors discuss the challenge of higher education equity in Taiwan by investigating who benefits from higher education massification. The chapter examines the influence of the two important policies for equity—the Multiple Entrance Program (MEP) and the Tuition and Miscellaneous Fees Exemption (TMFE)—on students’ access to higher education. The struggles and challenges that the students from lower socioeconomic backgrounds face before and after they receive higher education are identified. Nonetheless, positive findings regarding the two policies and potentials for Taiwanese higher education institutions in providing quality education for all are also presented in the chapter, which also discusses the remaining concerns and future challenges of fulfilling the goal of equity in higher education in Taiwan.

As one of the Confucian societies, higher education in Taiwan has experienced varying stages of change, from a colonial to a Chinese system, now moving into a modern system. Owing to divergence of global trends, coupled with local concerns since the 1990s, Taiwan’s higher education system has encountered several challenges as those in East Asia. This chapter aims to provide background information for the readers by exploring the evolution and changes in Taiwan’s higher education system from a historical perspective. The objectives and impacts of the policy change at each stage are stated respectively. An introduction to the content of the book is highlighted at the end of the chapter.

For the past two decades, the quality assurance (QA) system in Taiwan has undergone substantial transformation from an unsystematic approach to a more comprehensive mechanism. As a result of notable university requests for deregulating university governance and management, the Ministry of Education (MOE) in Taiwan decided to launch the self-accreditation policy in 2012 in order to increase university autonomy and build internal QA mechanisms on campus (MOE, 2013). In 2017, the policy was applied to all Taiwan universities. Based on this wider policy context, the purpose of this paper is to better comprehend: (1) governmental policy in constructing a national QA system in Taiwan higher education since 2000; (2) a QA model of Higher Education Evaluation & Accreditation of Council (HEEACT) in Taiwan, and its impact; (3) context of the paradigm shift from a focus on external review to internal QA; (4) future prospects for QA policy and an examination of a new role for the national QA agency. In addition, Olsen’s governance model as an analytic framework is applied for examining the relationship between QA agencies, government, and institutions in Taiwan over the past decade.

Background Poverty has adverse effects on child health. While children in poverty face greater health challenges, some still achieve positive health outcomes. This is in part due to their resilience when facing adversity. Identifying the factors that foster child resilience can aid in developing strategies to promote child resilience and reduce the harmful effects of child poverty. This study aims to identify the biological and social factors of resilience among children in poverty from birth to age 12. Methods Data for the analysis came from the Taiwan Birth Cohort Study, a nationally representative sample of 17,354 children who completed six waves of interview surveys between 2005 and 2017. Our sample included 4,570 children who experienced poverty from birth to age 12. The primary outcome variable was child resilience, defined as impoverished children who maintained good health outcomes over the 12-year survey period. Multiple logistic regression was used to examine the factors of child resilience. Results Of the 4,570 children, 36.1% always had good health despite experiencing poverty before the age of 12. An easy temperament (OR = 2.5, 95% CI: 1.9-3.0), female (OR = 1.1, 95% CI: 1.0-1.3), a birth weight greater than 2,500 grams (OR = 1.6, 95% CI: 1.2-2.1), having a foreign-born mother (OR = 1.5, 95% CI: 1.2-1.7), receiving breast milk after birth (OR = 1.3, 95% CI: 1.1-1.5), and good parent-child interaction at 3 years of age (OR = 1.4, 95% CI: 1.2-1.7) were associated with child resilience. Early parent-child interactions can moderate the effect of children's birth weight on later resilience. Conclusions Our findings indicated the factors associated with child resilience in the context of poverty, suggesting that supporting breastfeeding and nurturing parent-child relationships are effective public health actions to foster child resilience. Future research is needed to unravel the underlying mechanisms of biological factors associated with child resilience. Key messages Breastfeeding after birth and high-quality parent-child interaction can lead to positive adaptations to child poverty. Children with difficult temperaments, boys and those born at low birthweight are more vulnerable to poverty and should be targeted for building resilience against poverty.

Background We are living in an urban age. This study aims to examine whether living in big cities can be of help to reduce the health gap between the rich and poor children. Methods Data for the analysis came from the Taiwan Birth Cohort Study with a nationally representative sample of 18,814 children who completed the first (6-month) and eighth (12-year) waves of household interview survey. Poverty was defined as parental income below US$1,000 per month. Residence area was grouped into two groups: big city and non-big city; big city was defined as a national or provincial city. Children's health at age 12 was rated by mothers and divided into two groups: poor and non-poor. Multiple logistic regression was used to examine the joint effect of urbanization and poverty on children's health. Results We found that children who lived in poverty were more likely to have poor health than those who did not live in poverty (28.2% v 19.9%). When children were grouped according to the combination of residence at age of 6 months and 12 years old, we found that the prevalence of poor health at age 12 was the highest for poor children who lived continuously in big city (35.8%), followed by poor children who moved to big city (30.0%), poor children who lived continuously in non-big city (26.7%) and poor children who left big city (25.0%). Importantly, the prevalence of poor health for non-poor children was much lower and varied less across different residence groups, ranging from 19.7% to 21.4%. The interaction of poverty and urbanization on children's health was statistically significant (p Conclusions Our findings suggest that living in big cities be detriment to the health of children in poverty and widen the health gap between rich and poor children. Thus it is extremely important to shape urbanization for children, particularly for poor children. Key messages The poor children who live in big cities are more likely to have the worst health. We shall pay attention to the joint effect of urbanization and poverty on children’s health in order to reduce health inequalities.

Background Functional and excessive use of internet is hard to distinguish, and internet use can affect adolescents’ development of self-identity. The aim of our study was to investigate the pathway relationship of the risk and protective factors of internet use, including mother care, absorptive dissociative trait, having been bullied, exercise, self-perceived depressive mood and happiness of 12-year-old adolescents. Methods The Taiwan Birth Cohort Study dataset, which used a national household probability sampling method and included 17,694 12-years-old adolescents, was used for this study. Results Our results showed 5.3% adolescents reported to spend more than five hours online during schooldays. Additionally, adolescents that spend more than five hours online during schooldays tended to have higher absorptive trait, perceived less care from mothers, more likely to have been bullied, expressed higher level of depressed mood, which leads to lower level of perceived happiness. Conclusions Adolescents that spend more than 5 hours online during schooldays, compared to those that spent less than an hour online, were more likely to have been bullied and affect their level of happiness, showing that they may be a group of higher concern. Since parental care and regular exercise are protective factors for internet addiction, it should be promoted to all adolescents, especially those in the high risk group, to prevent them from being addicted online.

Background: Many studies have shown that parents express higher stress when taking care of children with autism spectrum disorder (ASD). However, cultural context should be taken into consideration when investigating children's diagnosis and parental quality of life (QOL). Therefore, this study aimed to investigate the pathway relationship among parental QOL, child development, ASD and developmental delay (DD) risk at 3 years of age, and ASD or DD diagnosis 2.5 years later.Methods: A birth cohort study database collected at age 3 and 5.5 years was used (N=1618). The Modified Checklist of Autism in Toddlers, Taiwan Birth Cohort Study Developmental Instrument, and the Short Form-36 was used to assess ASD risk, developmental condition (DD risk), and parental QOL, respectively.Results: By structural equation modeling, an indirect influence was found between children's diagnosis and maternal health QOL. Mothers of children diagnosed with ASD perceived more family support, and those who perceived more family support had better health QOL. Conversely, mothers of children diagnosed with DD perceived higher childcare pressure, and mothers who perceived higher childcare pressure had worse health QOL.Conclusions: The differences in mother's experience when their children are diagnosed with DD and ASD can only be found in pathway analysis, showing the importance of structural equation models. Healthcare personnel should take into consideration the cultural context of the families we encounter, and the vital role family support plays should be taken into consideration when interacting with families from collectivism cultures.

The potential risk of internet use on adolescents’ self-harm is a major concern. Vulnerable adolescents who are susceptible to bullying are also susceptible to the negative influence of the internet. In this study, the pathway associations were investigated between the risk factors of deliberate self-harm, experience of being bullied, internet use, and protective factors of maternal monitoring on perceived happiness of 12- and 13-year-old adolescents in the Taiwan Birth Cohort Pilot Study dataset (n = 1,457). The Chinese Oxford Happiness Questionnaire was used to measure the adolescents’ self-perceived levels of happiness, in two dimensions of social adaptation status and psychological well-being. Our results show that 354 (24.3%) of the 12-year-olds reported having been bullied, and 289 (19.8%) of the 13-year-olds reported this. Seventy-nine (5.4%) of 13-year-olds reported deliberate self-harm in the past year. Results of a structural equation model showed that those who had been bullied at age 12 years were at greater risk of deliberate self-harm at age 13 years. A negative association was found between duration of internet use and perceived level of happiness. Adolescents who spent >5 h online during days off school were at higher risk of deliberate self-harm, and perceived a lower level of happiness. Therefore, spending >5 h online during days off school could be used as an indicator in future preventive action programs to screen out those at a high risk of excessive internet use, deliberate self-harm, and psychological well-being and social adjustment issues.

Background: This study analyses the mediation effects of early health prior to age 3 on the association between early poverty and the health outcomes of children at age 12. Methods: Data for the analysis came from the Taiwan Birth Cohort Study (TBCS), a nationally representative sample of 16,847 children who completed six waves of surveys between 2005 and 2017. The outcome variables were child’s general health and hospitalization experience at 12 years of age. Multiple logistic regression and causal mediation analysis were conducted. Findings: Among the TBCS children, the prevalence of fair/poor health and hospitalization was 20 · 8% and 2 · 5% at age 12. The odds ratios of experiencing fair/poor health and hospitalization at age 12 were 1 · 33 (95% confidence interval 1 · 21 to 1 · 45) and 1 · 35 (1 · 07 to 1 · 69) for early poverty, respectively. When early poor health was added in the multiple logistic regression models, the effects of early poverty were attenuated on poor general health and no longer significant on hospitalizations for children aged 12 years. Mediation analysis showed that 50-87% of the total effect of early poverty on health at age 12 was mediated by early health status before age 3. Interpretation: This study suggests that the negative effects of early poverty on early health prior to age 3 have long-lasting impacts on the later health status of children. Protecting children from growing up in poverty may help prevent poor health throughout the life course. Funding: The Health Promotion Administration, Department of Health and Welfare and the Ministry of Science and Technology in Taiwan. Declaration of Interests: None declared. Ethics Approval Statement: The study was approved by the Institutional Review Board at National Taiwan University Hospital (reference number 201612181RIND).

A yearly increase in the proportion of very low birth weight (VLBW) live births has resulted in the slowdown of decreasing trends in crude infant mortality rates (IMRs). In this study, we examined the trends in birth weight-specific as well as birth weight-adjusted IMRs in Taiwan. Methods: We linked three nationwide datasets, namely the National Birth Reporting Database, National Birth Certification Registry, and National Death Certification Registry databases, to calculate the IMRs according to the birth weight category. Trend tests and mortality rate ratios in the periods 2010–2011 and 2004–2005 were used to examine the extent of reduction in birth weight-specific and birth weight-adjusted IMRs. Results: The proportion of VLBW (

Objective Previous studies have shown inconsistent results with regard to the association between advanced parental age and autism spectrum disorder (ASD). The sociodemographic status of parents has been found to be associated with children with ASD, however. Therefore, a pathway analysis was undertaken of the roles of maternal age and education in ASD diagnosis and community screening, in a national birth cohort database, using a propensity score matching (PSM) method. Method The 6- and 66-month Taiwan Birth Cohort Study dataset was used (N = 20,095). The PSM exact matching method was used to select 1700 families (ratio of 1:4 between ASD diagnosis and control) from the Taiwan Birth Cohort Study dataset. Results (1) The results from the complete dataset and the PSM exact matching dataset both show that the risk of a child being diagnosed with ASD was increased by the mother being over 40 years old. (2) Although more children of mothers with lower-than-average education were positive on screening, more children of mothers with higher-than-average education were also diagnosed with ASD. Conclusions for Practice Advanced maternal age had a higher association with the diagnosis of ASD, and maternal educational disparity was found between ASD clinical diagnosis and community screening. Community and primary medical care services should pay more attention to children of parents with lower education during ASD screening to prevent delayed diagnosis.