Age at menarche, age at menopause, reproductive years and risk of fatal stroke occurrence among Chinese women: the Guangzhou Biobank Cohort Study

Abstract Background The relationship between women’s reproductive characteristics and stroke events is unclear. We aimed to investigate age at menarche, age at menopause and number of reproductive years in relation to fatal stroke occurrence in the Guangzhou Biobank Cohort Study. Methods In total, 16,504 postmenopausal women without stroke, heart disease or a cancer history at baseline were included and followed up for a median of 12.0 years. After review of available records, 222 stroke deaths were recorded. Cox proportional hazards regression was used to assess the associations between the risk of fatal stroke occurrence and age at menarche, age at menopause and number of reproductive years. Results In the whole cohort, compared with those aged 15 years at menarche, an increased risk of fatal stroke among women at menarche showed respectively in those aged 12 years (aHR (adjusted hazard ratio) = 1.86, 95% confidence interval (CI) 0.96–3.60), aged 13 years (aHR = 1.69, 95% CI 0.98–2.92), aged 17 years (aHR = 1.83, 95% CI 1.10–3.05) and aged ≥ 18 years (aHR = 1.66, 95% CI 1.03–2.70), wherein the associations revealed an atypically U-shaped; similar U-shaped association to the cohort of postmenopausal women born before 1940 released a range of incremental risks of fatal stroke in women at menarche aged ≤ 12 years (aHR = 3.68, 95% CI 1.68–8.05), aged 13 years (aHR = 2.11, 95% CI 1.02–4.34), aged 14 years (aHR = 2.07, 95% CI 1.04), aged 17 years (aHR = 2.30, 95% CI 1.20–4.39) and aged 18 years (aHR = 2.50, 95% CI 1.37–4.57), respectively. Compared with menopausal women aged 51–52 years, those aged < 43 years at menopause had an increased risk for fatal stroke among postmenopausal women born in and after 1940 (aHR = 1.64, 95% CI 0.97–2.78) and postmenopausal women born before 1940 (aHR = 1.97, 95% CI 1.05–3.69). Additionally, compared with those with 32–34 reproductive years, women with ≤ 28 reproductive years had an increased risk for fatal stroke in the whole cohort (aHR = 1.91, 95% CI 1.28–2.86) and the cohort of postmenopausal women born before 1940 (aHR = 1.79, 95% CI 1.15–2.80). Conclusions Younger and older age at menarche, younger age at menopause and fewer reproductive ages were related to an increased risk of fatal stroke in postmenopausal women.

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Age At Menarche, Age At Menopause, Reproductive Years and Risk of Fatal Stroke Occurrence Among Chinese Women: The Guangzhou Biobank Cohort Study

10.21203/rs.3.rs-763575/v1 ◽

2021 ◽

Author(s):

Zhi-bing Hu ◽

Ze-xiong Lu ◽

Feng Zhu

Keyword(s):

Cohort Study ◽

Ischaemic Stroke ◽

Postmenopausal Women ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche ◽

Age At Menopause ◽

Fatal Stroke ◽

Increased Risk ◽

Menarche Age

Abstract Background The relationship between women’s reproductive characteristics and stroke events is unclear. We aimed to investigate age at menarche, age at menopause and number of reproductive years in relation to fatal stroke occurrence in the Guangzhou Biobank Cohort Study. Methods In total, 16504 postmenopausal women without stroke, heart disease or a cancer history at baseline were included and followed up for a median of 12.0 years. After review of available records, 222 stroke deaths were recorded. Cox proportional hazards regression was used to assess the associations between the risk of fatal stroke occurrence and age at menarche, age at menopause and number of reproductive years. Results In the whole cohort, compared with those aged 15 years at menarche, women aged 17 years at menarche had an increased risk for fatal stroke (adjusted hazard ratio [aHR] = 1.83, 95% confidence interval (CI) 1.10–3.05) and fatal haemorrhagic stroke (HR = 2.65, 95% CI 1.14–6.18), and women aged ≥ 18 years at menarche had an increased risk for fatal stroke (HR = 1.66, 95% CI 1.03–2.70) and fatal ischaemic stroke (HR = 2.01, 95% CI 1.01–3.99). Among postmenopausal women born before 1940, women aged < 43 years at menopause had an increased risk for fatal stroke (HR = 1.97, 95% CI 1.05–3.69) compared with those aged 51–52 years at menopause. Additionally, in the whole cohort, women with ≤ 28 reproductive years had an increased risk for fatal stroke (HR = 1.91, 95% CI 1.28–2.86) and fatal ischaemic stroke (HR = 2.26, 95% CI 1.26–4.05) compared with those with 32–34 reproductive years; postmenopausal women born before 1940 had a similar risk for fatal stroke and fatal ischaemic stroke. Conclusions Older age at menarche, younger age at menopause and fewer reproductive ages were related to an increased risk of fatal stroke in postmenopausal women.

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Age at Menarche and Asthma Onset Among US Girls and Women: Findings from NHANES, 2001-2018

10.21203/rs.3.rs-910534/v1 ◽

2021 ◽

Author(s):

Li Cai ◽

Lan Qiu ◽

Yaqi Wang ◽

Li Wu ◽

Xiaojie Wu ◽

...

Keyword(s):

Family Income ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche ◽

Adult Onset ◽

Childhood Onset ◽

Early Menarche ◽

Representative Study ◽

Increased Risk ◽

Menarche Age

Abstract Background: Findings on the association between early menarche and asthma onset remain inconsistent and the evidence in the US is lacking. Furthermore, there was no clear separation of childhood- and adult-onset asthma in previous studies. Therefore, we aim at quantitatively estimating the association of age at menarche with risk of childhood- and adult-onset asthma separately in US girls and women.Methods: We conducted a retrospective cohort study of 24,282 US girls and women aged less than 80 years by using continuous NHANES data in 2001-2018. Weighted Cox proportional-hazards regression models with censoring ages of 19 and 79 were used to separately estimate hazard ratios of childhood- and adult-onset asthma associated with age at menarche. Results: Each one-year increase of age at menarche was significantly associated with a 17% (HR [95%CI]: 0.83 [0.77, 0.90]) decrease in the risk of childhood-onset asthma. Compared with age at menarche of 12-14, we observed a 60% (HR [95%CI]: 1.60 [1.22, 2.09]) increased risk of childhood-onset asthma for early menarche (age at menarche <12 years) and 41% (HR [95%CI]: 0.59 [0.32, 1.08]) decreased risk for late menarche (age at menarche ≥15 years). Race, family income, education and family history of asthma did not modify these associations. No significant association between age at menarche and adult-onset asthma.Conclusions: In this US nationally representative study, we found that early menarche was associated with increased risk of childhood-onset asthma, but not adult-onset asthma. These findings help demonstrate early menarche may be a risk factor for childhood-onset asthma in US, indicating timely and effective management of special individuals with early menarche for preventing asthma.

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Abstract P120: Women With Menopause After Age 45 and Take Hormone Therapy After Age 60 Increase the Risk of Cardiovascular Disease

Circulation ◽

10.1161/circ.141.suppl_1.p120 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Dongshan Zhu ◽

Hsin-Fang Chung ◽

Annette Dobson ◽

Nirmala Pandeya ◽

Gita Mishra

Keyword(s):

Cardiovascular Disease ◽

Hormone Therapy ◽

Postmenopausal Women ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cvd Risk ◽

Natural Menopause ◽

Individual Level ◽

Age At Menopause ◽

Increased Risk

Introduction: Evidence from clinical trials and observational studies on the relationship between menopausal hormone therapy (MHT) and cardiovascular disease (CVD) risk has been discordant. Hypothesis: We hypothesized that the association between MHT and risk of CVD might be affected by both age at menopause and age when initiated MHT. Methods: We harmonised and pooled individual-level data from 15 studies across five countries/regions (Australia, Scandinavia, USA, Japan, and UK). Postmenopausal women who had reported their MHT status (user or non-user) and CVD status (occurred or not, including coronary heart disease (CHD) and stroke) were included. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between MHT use and incident CVD. We stratified the analyses by age when initiated MHT and age at natural menopause to examine the interaction between MHT, age initiated MHT, and age at menopause on incident CVD. Results: Overall, 190 625 postmenopausal women were included. We identified 10 601 incident CVD events, including 7615 CHD and 3543 strokes. Around 39% (74 585) women were MHT users. Compared to non-users of MHT, women who were MHT users had 10% higher risk of incident CVD (HR 1.10, 95% CI 1.06-1.14), with HR (95% CI) of (1.15, 1.10-1.20) for CHD and (1.02, 0.96-1.09) for stroke. After stratifying by age at natural menopause, women who experienced menopause after age 45 years and took MHT had around 15% higher risk of CHD, while the significant association with incident stroke was only observed in women who had menopause after 55 years (1.16, 1.01-1.33). After a further stratification by age initiated MHT, we found the significant associations between MHT users and incident CVD were only observed in women who experienced menopause after age 45 years and took MHT at age 60 years or old (Table 1). Conclusions: Postmenopausal women who experienced natural menopause after age 45 years and took MHT after age 60 years had increased risk of incident CVD.

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A cohort study of dietary fibre intake and menarche

Public Health Nutrition ◽

10.1079/phn2002261 ◽

2002 ◽

Vol 5 (2) ◽

pp. 353-360 ◽

Cited By ~ 40

Author(s):

Malcolm M Koo ◽

Thomas E Rohan ◽

Meera Jain ◽

John R McLaughlin ◽

Paul N Corey

Keyword(s):

Cohort Study ◽

Dietary Intake ◽

Dietary Fibre ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche ◽

Relative Hazard ◽

Component Level ◽

Cox Proportional Hazards Models

AbstractObjective:To evaluate the influence of dietary fibre on menarche in a cohort of pre-menarcheal girls.Design:Prospective cohort study.Setting:Ontario, Canada.Subjects:Free-living pre-menarcheal girls (n = 637), 6 to 14 years of age.Methodology:Information on dietary intake, physical activity and date of menarche was collected at baseline and was updated annually by self-administered questionnaires for three years. Cox proportional hazards models were used to evaluate the association between dietary fibre and menarche, adjusting for age at entry to the study and potential confounders.Results:A higher intake of energy-adjusted dietary fibre was associated with a lower risk of (i.e. a later age at) menarche (relative hazard 0.54, 95% confidence interval (CI) 0.31–0.94 for highest vs. lowest quartile, P for trend = 0.027). At the fibre component level, a higher intake of energy-adjusted cellulose was associated with a lower risk of menarche (relative hazard 0.45, 95% CI 0.26–0.76, P for trend = 0.009).Conclusions:The findings are consistent with the hypothesis that pre-menarcheal dietary intake can influence menarche.

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Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.613426 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jia Wangping ◽

Han Ke ◽

Wang Shengshu ◽

Song Yang ◽

Yang Shanshan ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Mortality Risk ◽

Proportional Hazards ◽

Oldest Old ◽

Population Based ◽

Cox Proportional Hazards ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals.Design: Prospective population-based cohort study.Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years).Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk.Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84–0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79–0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78–0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06–3.27).Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

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Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study

Family Medicine and Community Health ◽

10.1136/fmch-2020-000390 ◽

2020 ◽

Vol 8 (3) ◽

pp. e000390

Author(s):

Marc P Morissette ◽

Heather J Prior ◽

Robert B Tate ◽

John Wade ◽

Jeff R S Leiter

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cohort Study ◽

Proportional Hazards ◽

Geographical Location ◽

International Classification Of Diseases ◽

Population Based ◽

Cox Proportional Hazards ◽

Control Group ◽

Increased Risk

ObjectiveTo investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.DesignA retrospective population-based cohort study.SettingAdministrative health data for the Province of Manitoba between 1990–1991 and 2014–2015.ParticipantsA total of 47 483 individuals were diagnosed with a concussion using International Classification of Diseases (ICD) codes (ICD-9-CM: 850; ICD-10-CA: S06.0). All concussed subjects were matched with healthy controls at a 3:1 ratio based on age, sex and geographical location. Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model, with adjustments for socioeconomic status and pre-existing medical conditions.Results28 021 men (mean age ±SD, 25±18 years) and 19 462 women (30±21 years) were included in the concussion group, while 81 871 men (25±18 years) and 57 159 women (30±21 years) were included in the matched control group. Concussion was associated with adjusted hazard ratios of 1.39 (95% CI 1.32 to 1.46, p<0.001) for ADHD, 1.72 (95% CI 1.69 to 1.76; p<0.001) for MADs, 1.72 (95% CI 1.61 to 1.84; p<0.001) for dementia and 1.57 (95% CI 1.41 to 1.75; p<0.001) for Parkinson’s disease.ConclusionConcussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.

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A prospective study of reproductive factors, hormone use, and risk of lung cancer in postmenopausal women

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.1501 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 1501-1501 ◽

Cited By ~ 1

Author(s):

C. S. Baik ◽

G. M. Strauss ◽

D. Feskanich

Keyword(s):

Lung Cancer ◽

Postmenopausal Women ◽

Reproductive Factors ◽

Smoking History ◽

Age At Menarche ◽

Hormonal Factors ◽

Age At Menopause ◽

Increased Risk ◽

Hormone Use ◽

Never Smokers

1501 Background: There has been increased interest in understanding the role of hormonal factors in lung cancer (LC) in women with the observation that it exhibits different epidemiologic patterns and treatment response when compared to men. However, results of published studies have been inconsistent, possibly due to inadequate smoking adjustment. Methods: We prospectively examined the associations between reproductive factors, exogenous hormone use, and LC incidence in 106,574 postmenopausal women in the Nurses’ Health Study. Participants completed biennial questionnaires which included updated smoking history. We assessed age at menopause, age at menarche, type of menopause, parity, postmenopausal hormone (PMH), and oral contraceptive use. Cox proportional hazards modeling was used to estimate the relative risks (RR) of each exposure, adjusted for smoking status, number of cigarettes, time since quitting, age of initiating smoking, fruit/vegetable intake, body mass index, and environmental smoking exposure. Results: We identified 1,565 LC cases during follow up from 1984 to 2004. Parity was associated with decreased LC risk in never smokers (RR = 0.54, 95% CI 0.31–0.96) but increased risk in current smokers (RR = 1.44, 95% CI 1.03–2.02). No association was seen in former smokers. Also, younger age at menopause was associated with higher LC risk in women with natural menopause (p-trend = 0.016). PMH use was not associated with LC incidence. The RR for current PMH users was 1.01 (95% CI 0.87–1.17) and for past users was 0.95 (95% CI 0.82–1.1). No significant association was seen when assessed by duration of PMH use, time since last use, or type of PMH. However, past use of oral contraceptives for greater than 5 years was associated with increased LC risk (RR = 1.2, 95% CI 1.03–1.41). Conclusions: These results suggest that there may be an association between hormonal factors and LC development, and further suggest that the mechanism may differ in smokers versus lifelong never smokers. No significant financial relationships to disclose.

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Birthweight and subsequent risk for thyroid and autoimmune conditions in postmenopausal women

Journal of Developmental Origins of Health and Disease ◽

10.1017/s204017442100057x ◽

2021 ◽

pp. 1-8

Author(s):

Brian Monahan ◽

Leslie V. Farland ◽

Aladdin H. Shadyab ◽

Susan E. Hankinson ◽

JoAnn E. Manson ◽

...

Keyword(s):

Postmenopausal Women ◽

Low Birthweight ◽

Proportional Hazards ◽

Later Life ◽

Demographic Variables ◽

Cox Proportional Hazards ◽

Increased Risk ◽

Autoimmune Conditions ◽

Prenatal Interventions

Abstract The objective of this study was to determine the association between birthweight and risk of thyroid and autoimmune conditions in a large sample of postmenopausal women. Baseline data from the Women’s Health Initiative (n = 80,806) were used to examine the associations between birthweight category (<6 lbs., 6–7 lbs. 15 oz, 8–9 lbs. 15 oz, and ≥10 lbs.) and prevalent thyroid (underactive and overactive thyroid and goiter) and autoimmune (lupus, rheumatoid arthritis (RA), multiple sclerosis, ulcerative colitis/Crohn’s disease) conditions. Follow-up questionnaire data were used to examine the associations between birthweight and incident underactive and overactive thyroid, lupus, and RA. Logistic and Cox proportional hazards regression models were used to estimate crude and adjusted odds (OR) and hazards ratios (HR), respectively. Overall, women born weighing ≥10 lbs. had an increased risk for underactive thyroid [OR 1.14 (95% CI 1.02, 1.28)] and incident lupus [HR 1.51 (95% CI 1.12, 2.03)] and a decreased risk for overactive thyroid [OR 0.67 (95% CI 0.50, 0.92)] compared to women born weighing 6–7.99 lbs., after adjustment for adult BMI, demographic variables, and lifestyle factors. Further, women born weighing <6 lbs. were at increased risk for underactive thyroid [OR 1.13 (95% CI 1.04, 1.22)]. Birthweight was not associated with other thyroid or autoimmune disorders. High birthweight was associated with later-life thyroid and autoimmune conditions while low birthweight was associated with underactive thyroid. Preconception and prenatal interventions aimed at reducing the risk of both high and low birthweights may reduce the burden of later-life thyroid and autoimmune conditions.

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Abstract P390: Relationship between BMI and Risk of Hypertension in an urban Japanese cohort study: the Suita study

Circulation ◽

10.1161/circ.129.suppl_1.p390 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Michikazu Nakai ◽

Makoto Watanabe ◽

Kunihiro Nishimura ◽

Misa Takegami ◽

Yoshihiro Kokubo ◽

...

Keyword(s):

Cohort Study ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Men And Women ◽

Japanese Cohort ◽

Hazards Model ◽

Increased Risk

Objective: The positive relation between body mass index (BMI) and risk of incident hypertension (HT) has been reported mainly in the Western subjects with high BMI. However, there are a few reports in the Asian with relatively lower BMI. This study investigated the relation of BMI with risk of incident HT in the population-based prospective cohort study of Japan, the Suita study. Methods: Participants who had no HT at baseline (1,591 men and 1,973 women) aged 30-84 years were included in this study. BMI categories were defined as following: underweight (BMI<18.5), normal (18.5≤BMI<25.0), and overweight (BMI ≥ 25.0). The Cox proportional hazards model was used to estimate hazard ratios (HRs) of BMI categories for incident HT by sex. HRs were adjusted for age, cigarette smoking and alcohol drinking. The HRs according to quartiles of BMI were also estimated, using the lowest quartile of BMI as a reference. Results: During median follow-up of 7.2 years, 1,325 participants (640 men and 685 women) developed HT. The HR (95% CI) of 1kg/m2 increment of BMI for HT in men and women was 1.08 (1.05-1.11) and 1.10 (1.07-1.12), respectively. When we set a normal BMI as a reference, HR of overweight BMI in men and women was 1.37 (1.13-1.67) and 1.45 (1.18-1.77), whereas HR of underweight BMI in men and women was 0.63 (0.45-0.90) and 0.60 (0.45-0.80), respectively. In addition, compared to the lowest quartile, HR of the highest quartile of BMI in men and women was 1.67 (1.33-2.10, trend p<0.001) and 2.10 (1.67-2.64, trend p<0.001), respectively. Conclusion: In this study, we showed that higher BMI was associated with increased risk of hypertension in both Japanese men and women.

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Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

RMD Open ◽

10.1136/rmdopen-2018-000670 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000670 ◽

Cited By ~ 12

Author(s):

Isabelle A Vallerand ◽

Ryan T Lewinson ◽

Alexandra D Frolkis ◽

Mark W Lowerison ◽

Gilaad G Kaplan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Future Research ◽

Health Improvement ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Antidepressant Use

ObjectivesMajor depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA.MethodsA retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use.ResultsA cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.ConclusionMDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.

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