scholarly journals Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study

BMJ ◽  
2020 ◽  
pp. m3464 ◽  
Author(s):  
Yi-Xin Wang ◽  
Mariel Arvizu ◽  
Janet W Rich-Edwards ◽  
Jennifer J Stuart ◽  
JoAnn E Manson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cycle Length ◽  
Premature Mortality ◽  
Health Study ◽  
Menstrual Cycles ◽  
Hazard Ratios

AbstractObjectiveTo evaluate whether irregular or long menstrual cycles throughout the life course are associated with all cause and cause specific premature mortality (age <70 years).DesignProspective cohort study.SettingNurses’ Health Study II (1993-2017).Participants79 505 premenopausal women without a history of cardiovascular disease, cancer, or diabetes and who reported the usual length and regularity of their menstrual cycles at ages 14-17 years, 18-22 years, and 29-46 years.Main outcome measuresHazard ratios and 95% confidence intervals for all cause and cause specific premature mortality (death before age 70 years) were estimated from multivariable Cox proportional hazards models.ResultsDuring 24 years of follow-up, 1975 premature deaths were documented, including 894 from cancer and 172 from cardiovascular disease. Women who reported always having irregular menstrual cycles experienced higher mortality rates during follow-up than women who reported very regular cycles in the same age ranges. The crude mortality rate per 1000 person years of follow-up for women reporting very regular cycles and women reporting always irregular cycles were 1.05 and 1.23 for cycle characteristics at ages 14-17 years, 1.00 and 1.37 for cycle characteristics at ages 18-22 years, and 1.00 and 1.68 for cycle characteristics at ages 29-46 years. The corresponding multivariable adjusted hazard ratios for premature death during follow-up were 1.18 (95% confidence interval 1.02 to 1.37), 1.37 (1.09 to 1.73), and 1.39 (1.14 to 1.70), respectively. Similarly, women who reported that their usual cycle length was 40 days or more at ages 18-22 years and 29-46 years were more likely to die prematurely than women who reported a usual cycle length of 26-31 days in the same age ranges (1.34, 1.06 to 1.69; and 1.40, 1.17 to 1.68, respectively). These relations were strongest for deaths related to cardiovascular disease. The higher mortality associated with long and irregular menstrual cycles was slightly stronger among current smokers.ConclusionsIrregular and long menstrual cycles in adolescence and adulthood are associated with a greater risk of premature mortality (age <70 years). This relation is slightly stronger among women who smoke.

scholarly journals Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study

BMJ ◽  
2021 ◽  
pp. n530
Author(s):  
Yi-Xin Wang ◽  
Lidia Mínguez-Alarcón ◽  
Audrey J Gaskins ◽  
Stacey A Missmer ◽  
Janet W Rich-Edwards ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Confidence Interval ◽  
Spontaneous Abortion ◽  
Premature Mortality ◽  
Premature Death ◽  
Health Study ◽  
Spontaneous Abortions ◽  
Hazard Ratios

Abstract Objective To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70). Design Prospective cohort study. Setting The Nurses’ Health Study II (1993-2017), United States. Participants 101 681 ever gravid female nurses participating in the Nurses’ Health Study II. Main outcomes measures Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models. Results During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman’s reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24). Conclusions Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.

scholarly journals Strategies to maximise study retention and limit attrition bias in a prospective cohort study of men reporting a history of injecting drug use released from prison: The Prison and Transition Health study

2021 ◽  
Author(s):  
Ashleigh Cara Stewart ◽  
Reece Cossar ◽  
Shelley Walker ◽  
Anna Lee Wilkinson ◽  
Brendan Quinn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Drug Use ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Injecting Drug Use ◽  
Health Study ◽  
Attrition Bias ◽  
History Of ◽  
Baseline Characteristics

Abstract Background There are significant challenges associated with studies of people released from custodial settings, including loss to follow-up in the community. Interpretation of findings with consideration of differences between those followed up and those not followed up is critical in the development of evidence-informed policies and practices. We describe attrition bias in the Prison and Transition Health (PATH) prospective cohort study, and strategies employed to minimise attrition.Methods PATH involves 400 men with a history of injecting drug use recruited from three prisons in Victoria, Australia. Four interviews were conducted: one pre-release (‘baseline’) and three interviews at approximately 3, 12, and 24 months post-release (‘follow-up’). We assessed differences in baseline characteristics between those retained and not retained in the study, using two-sample tests of proportions and t-tests.Results Most participants (85%) completed at least one follow-up interview and 162 (42%) completed all three follow-up interviews. Retained participants were younger than those lost to follow-up (mean diff − 3.1 years, 95% CI -5.3, -0.9). There were no other statistically significant differences observed in baseline characteristics.Conclusion The high proportion of participants retained in the PATH cohort study via comprehensive follow-up procedures, coupled with extensive record linkage to a range of administrative datasets, is a considerable strength of the study. Our findings highlight how strategic and comprehensive follow-up procedures, frequent contact with participants and secondary contacts, and established working relationships with the relevant government departments can improve study retention and potentially minimise attrition bias.

scholarly journals Validity of self-reported diagnoses of gynaecological and breast cancers in a prospective cohort study: the Japan Nurses’ Health Study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045491
Author(s):  
Kiyoshi Takamatsu ◽  
Yuki Ideno ◽  
Mami Kikuchi ◽  
Toshiyuki Yasui ◽  
Naho Maruoka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Predictive Value ◽  
Prospective Cohort ◽  
Health Study ◽  
Breast Cancers ◽  
Expert Review ◽  
The Mean

ObjectivesTo validate the self-reported diagnoses of gynaecological and breast cancers in a nationwide prospective cohort study of nursing professionals: the Japan Nurses’ Health Study (JNHS).Design and settingRetrospective analysis of the JNHS.Participants and measuresData were reviewed for 15 717 subjects. The mean age at baseline was 41.6±8.3 years (median: 41), and the mean follow-up period was 10.5±3.8 years (median: 12). Participants are regularly mailed a follow-up questionnaire once every 2 years. Respondents who self-reported a positive cancer diagnosis were sent an additional confirmation questionnaire and contacted the diagnosing facility to confirm the diagnosis based on medical records. A review panel of experts verified the disease status. Regular follow-up, confirmation questionnaires and expert review were validated for their positive predictive value (PPV) and negative predictive value (NPV).ResultsNew incidences were verified in 37, 47, 26 and 300 cervical, endometrial, ovarian and breast cancer cases, respectively. The estimated incidence rates were 22.0, 25.4, 13.8 and 160.4 per 100 000 person-years. These were comparable with those of national data from regional cancer registries in Japan. For regular follow-up, the corresponding PPVs for cervical, endometrial, ovarian and breast cancer were 16.9%, 54.2%, 45.1% and 81.4%, and the NPVs were 100%, 99.9%, 99.9% and 99.9%, respectively. Adding the confirmation questionnaire improved the PPVs to 31.5%, 88.9%, 76.7% and 99.9%; the NPVs were uniformly 99.9%. Expert review yielded PPVs and NPVs that were all ~100%.ConclusionsGynaecological cancer cannot be accurately assessed by self-reporting alone. Additionally, the external validity of cancer incidence in this cohort was confirmed.

scholarly journals Association of healthy lifestyle score with all-cause mortality and life expectancy: a city-wide prospective cohort study of cancer survivors

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ce Sun ◽  
Ke Li ◽  
Huan Xu ◽  
Xiangjun Wang ◽  
Pengzhe Qin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Life Expectancy ◽  
Cancer Survivors ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Healthy Lifestyle ◽  
Education And Health ◽  
Hazard Ratios ◽  
All Cause Mortality

Abstract Background Adherence to a healthy lifestyle could reduce the cancer mortality in the western population. We conducted a city-wide prospective study in China investigating the association of a healthy lifestyle score with all-cause mortality and the life expectancy in cancer survivors. Methods This prospective cohort study included 46,120 surviving patients who were firstly diagnosed with cancer in Guangzhou. Five low-risk lifestyle factors including never smoking, never alcohol use, regular physical activity (≥ 2 h/week), sufficient sleep (≥ 6 h/day), and normal or high BMI (≥ 18.5 kg/m2) were assessed and a lifestyle score (0–5, a higher score indicates healthier lifestyle) was generated. Hazard ratios (HRs) of all-cause mortality and the life expectancy by levels of the lifestyle scores were estimated. Results Of 46,120 cancer survivors registered from 2010 to 2017, during an average follow-up of 4.3 years (200,285 person-years), 15,209 deaths were recorded. Adjusted HRs for mortality in cancer survivors with lifestyle score of 0–2, versus 5, were 2.59 (95% confidence interval (CI): 2.03–3.30) in women, 1.91 (95%CI 1.77–2.05) in men, 2.28 (95%CI 2.03–2.55) in those aged <65 years, and 1.90 (95%CI 1.75, 2.05) in those aged ≥ 65 years. Life expectancy at age 55 for those with a score of 0–2 and 5 was 53.4 and 57.1 months, respectively. We also found that cancer survivors with healthy lifestyle scores of 5 showed 59.9 months of life expectancy on average, which was longer than those with a score of 0–2. Conclusion Adopting a healthy lifestyle was associated with a substantially lower risk of all-cause mortality and longer life expectancy in cancer survivors. Our findings should be useful for health education and health promotion in primary care and clinical practice.

scholarly journals The association between daily total physical activity and risk of cardiovascular disease among hypertensive patients: a 10-year prospective cohort study in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tingyu Zhou ◽  
Jian Su ◽  
Ran Tao ◽  
Yu Qin ◽  
Jinyi Zhou ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Daily Physical Activity ◽  
Total Physical Activity ◽  
Optimum Level ◽  
Hazard Ratios ◽  
Daily Total

Abstract Background The effect of high levels of physical activity and relationship between daily total physical activity and the risk of cardiovascular disease (CVD) among hypertensive people were not clear. This study aimed to explore the optimum level of physical activity for CVD prevention. Methods Data used in the present study was derived from the sub-study of China Kadoorie Biobank study (CKB) in Jiangsu province of China. The CKB was a prospective cohort study established during 2004–2008. At baseline, 53,259 participants aged 35–74 years were recruited for the CKB Jiangsu sub-study conducted in Wuzhong district of Suzhou City. Among those 53,259 participants, the 20,179 hypertensive individuals were our study population. The outcome events were cardiovascular diseases (CVDs), while the independent variable was total daily physical activity. The Cox proportional hazard models were introduced to investigate the association between total physical activity and CVDs, reporting as hazard ratios (HR) and 95% confidence intervals (CIs). Results During a 10.1-year follow-up, 2419 CVD cases were identified. After adjustment for potential confounding factors, compared with participants at the lowest level of daily total physical activity, the hazard ratios for CVDs were 0.87 (95%CI: 0.79–0.97), 0.73 (95%CI: 0.65–0.83) and 0.75 (95%CI: 0.65–0.85) for participants within 2, 3 and 4 quartiles of physical activity. Such a negative association between total physical activity and CVDs were also observed among participants by gender and age-group, but within patients with stage 1 hypertension only. Moreover, the association of physical activity with CVDs was U-shape and the lowest HR (0.63, 95%CI: 0.54–0.74) was observed at 35.4 MET-h/d of total physical activity. Conclusions Total daily physical activity was negatively associated with CVDs among hypertensive adults in China, and this association was U-shape. It has some public health implications that community-based total physical activity intervention campaigns can be of help for CVDs prevention among hypertensive people in China.

scholarly journals Oral contraceptive use and mortality after 36 years of follow-up in the Nurses' Health Study: prospective cohort study

BMJ ◽  
2014 ◽  
Vol 349 (oct31 7) ◽  
pp. g6356-g6356 ◽  
Author(s):  
B. M. Charlton ◽  
J. W. Rich-Edwards ◽  
G. A. Colditz ◽  
S. A. Missmer ◽  
B. A. Rosner ◽  
...  
Keyword(s):  
Cohort Study ◽  
Oral Contraceptive ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Contraceptive Use ◽  
Health Study ◽  
Oral Contraceptive Use

scholarly journals Strategies to maximise study retention and limit attrition bias in a prospective cohort study of men reporting a history of injecting drug use released from prison: the prison and transition health study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashleigh Cara Stewart ◽  
Reece Cossar ◽  
Shelley Walker ◽  
Anna Lee Wilkinson ◽  
Brendan Quinn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Drug Use ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Injecting Drug Use ◽  
Health Study ◽  
Attrition Bias ◽  
History Of ◽  
Baseline Characteristics

Abstract Background There are significant challenges associated with studies of people released from custodial settings, including loss to follow-up in the community. Interpretation of findings with consideration of differences between those followed up and those not followed up is critical in the development of evidence-informed policies and practices. We describe attrition bias in the Prison and Transition Health (PATH) prospective cohort study, and strategies employed to minimise attrition. Methods PATH involves 400 men with a history of injecting drug use recruited from three prisons in Victoria, Australia. Four interviews were conducted: one pre-release (‘baseline’) and three interviews at approximately 3, 12, and 24 months post-release (‘follow-up’). We assessed differences in baseline characteristics between those retained and not retained in the study, reporting mean differences and 95% confidence intervals (95% CIs).  Results Most participants (85%) completed at least one follow-up interview and 162 (42%) completed all three follow-up interviews. Retained participants were younger than those lost to follow-up (mean diff − 3.1 years, 95% CI -5.3, − 0.9). There were no other statistically significant differences observed in baseline characteristics. Conclusion The high proportion of participants retained in the PATH cohort study via comprehensive follow-up procedures, coupled with extensive record linkage to a range of administrative datasets, is a considerable strength of the study. Our findings highlight how strategic and comprehensive follow-up procedures, frequent contact with participants and secondary contacts, and established working relationships with the relevant government departments can improve study retention and potentially minimise attrition bias.

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