scholarly journals The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017

2021 ◽  
Author(s):  
Nurunnahar Akter ◽  
Elena Kulinskaya ◽  
Nicholas Steel ◽  
Ilyas Bakbergenuly
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Hormone Replacement ◽  
Health Improvement ◽  
New Information ◽  
Treatment Type ◽  
All Cause Mortality

Objective: To estimate the effect of hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in women aged 46 to 65 at first prescription. Design: Matched cohort study. Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017). Population: 105,199 cases and 224,643 controls matched on age and general practice (GP). Methods: Parametric Weibull-Cox regression model adjusted for age at first treatment, type of HRT, birth year, type 2 diabetes, hypertension and its treatments, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. Main outcome measures: All-cause mortality. Results: The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), respectively, compared to non-users. Age-specific adjusted HRs for all-cause mortality in groups aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), in combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) in oestrogen-only users, respectively. Conclusions: Oestrogen-only HRT has no impact on all-cause mortality, but combined HRT reduced the risks. This new information on the long-term risks and benefits of HRT should be used to inform women deciding whether to start or continue with HRT. Funding: IFoA. Keywords: Hormone replacement therapy, menopause, mortality, primary care records. Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

scholarly journals The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017

2021 ◽  
Author(s):  
Nurunnahar Akter ◽  
Elena Kulinskaya ◽  
Nicholas Steel ◽  
Ilyas Bakbergenuly
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Hormone Replacement ◽  
Health Improvement ◽  
All Cause Mortality ◽  
The Health Improvement Network

Objective: To estimate the effect of oestrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46 to 65 at first prescription. Design: Matched cohort study. Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017). Population: 105,199 HRT users (cases) and 224,643 non-users (controls) matched on age and general practice. Methods: Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. Main outcome measures: All-cause mortality. Results: A total of 21,751 women died over an average of 13.5 years follow-up per participant, of whom 6,329 were users and 15,422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), compared to non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), for combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) for oestrogen-only users, respectively. Conclusions: Combined HRT was associated with a 9% lower risk of all-cause mortality and oestrogen-only formulation was not associated with any significant changes. Funding: IFoA. Keywords: Hormone replacement therapy, menopause, mortality, primary care records, THIN. Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

scholarly journals The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017

2021 ◽  
Author(s):  
Nurunnahar Akter ◽  
Elena Kulinskaya ◽  
Nicholas Steel ◽  
Ilyas Bakbergenuly
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Hormone Replacement ◽  
Health Improvement ◽  
All Cause Mortality ◽  
The Health Improvement Network

Objective: To estimate the effect of oestrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46 to 65 at first prescription. Design: Matched cohort study. Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017). Population: 105,199 HRT users (cases) and 224,643 non-users (controls) matched on age and general practice. Methods: Weibull Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. Main outcome measures: All-cause mortality. Results: A total of 21,751 women died over an average of 13.5 years follow-up per participant, of whom 6,329 were users and 15,422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), compared to non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), for combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) for oestrogen-only users, respectively. Conclusions: Combined HRT was associated with a 9% lower risk of all-cause mortality and oestrogen-only formulation was not associated with any significant changes. Funding: IFoA. Keywords: Hormone replacement therapy, menopause, mortality, primary care records, THIN. Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

scholarly journals Mortality in COVID-19 amongst women on Hormone Replacement Therapy or Combined Oral Contraception: A cohort study

2021 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
William Hinton ◽  
Mark Joy ◽  
Michael Feher ◽  
Simon de Lusignan
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Oral Contraception ◽  
Logistic Regression Models ◽  
Lower Likelihood ◽  
All Cause Mortality ◽  
The Impact

ABSTRACTObjectiveTo investigate the association between Hormone Replacement Therapy (HRT) or Combined Oral Contraception (COCP) use, and the likelihood of death in women with COVID-19.DesignA cohort studySetting465 general practices in England within the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database.Population1,863,478 women aged over 18 yearsMethodsWe identified a cohort of women with COVID-19 from the computerised medical records of the RCGP RSC database. Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use, and all-cause mortality among women with COVID-19 in unadjusted and adjusted models.ResultsThere were 5451 COVID-19 cases within the cohort. HRT was associated with a significantly lower likelihood of all-cause mortality in COVID-19 (adjusted OR 0.22, 95%□CI 0.05 to 0.94). There were no reported events for all-cause mortality in women prescribed COCPs. This prevented further examination of the impact of COCP.ConclusionsWomen on HRT with COVID-19 had a lower likelihood of death. Further work is needed in larger cohorts to examine the association of COCP in COVID-19. Our findings support the current hypothesis that oestrogens may contribute a protective effect against COVID-19 severity.FundingThis study was funded by a School for Primary Care National Institute for Health Research grant (SPCR2014-10043).

scholarly journals Hormone replacement therapy use in UK general practice: Duration, discontinuation and women’s experience

2016 ◽  
Vol 22 (4) ◽  
pp. 155-164 ◽  
Author(s):  
Pippa Anderson ◽  
Caroline O’Leary ◽  
Margaret Moffat ◽  
Xuemei Luo
Keyword(s):  
Hormone Replacement Therapy ◽  
Side Effects ◽  
Replacement Therapy ◽  
Treatment Duration ◽  
Rating Scale ◽  
Hormone Replacement ◽  
Medical Advice ◽  
Health Improvement ◽  
Duration Of Treatment ◽  
Treatment Type

Objective Investigate characteristics of women treated with combined estrogen and progestogen hormone replacement therapy (study-HRT); HRT patterns; reasons and outcomes associated with HRT discontinuation. Study design Retrospective observational study using The Health Improvement Network database examining women’s characteristics and treatment patterns (Database). Postal questionnaire exploring reasons and outcomes associated with HRT discontinuation (Survey). Main outcome measures Database: Demographic and clinical characteristics. HRT patterns, time from diagnosis to treatment, duration of treatment, type of treatment and change of treatment (switch, add-on, re-start and discontinuation). Survey: HRT therapy status, menopause rating scale and reasons for discontinuation. Results Database: 8968 women prescribed study-HRT between January 2006 and January 2010 were matched 1:1 on GP practice and age with women not prescribed HRT. Women prescribed study-HRT were more likely to be a current/past smoker ( p<0.05) and experienced higher levels of co-morbidities related to menopause ( p < 0.05) versus women not prescribed HRT. Treatment duration was approximately 14 months and 95% changed treatment during the study. Survey: 116 respondents. Women on HRT had lower MRS scores ( p < 0.05) than women who discontinued HRT. Main reasons for discontinuation were medical advice, side-effects/potential side-effects. Fear of breast cancer was also stated as a reason. Conclusions Duration of HRT was relatively short, with 95% of women changing treatment. HRT discontinuation was associated with more severe menopause symptoms. Medical advice and concerns about side-effects were major reasons for the discontinuation, suggesting that there was a need for a balanced dialogue with women about risks and benefits of HRT, as emphasised by NICE guidance.

scholarly journals Hormone replacement therapy and cancer survival: a longitudinal cohort study: protocol paper

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046701
Author(s):  
Tom Alan Ranger ◽  
Judith Burchardt ◽  
Ashley Kieran Clift ◽  
Winnie Xue Mei ◽  
Carol Coupland ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Cancer Diagnosis ◽  
Cancer Survival ◽  
Hormone Replacement ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Subsequent Cancer

IntroductionHormone replacement therapy (HRT) can help women experiencing menopausal symptoms, but usage has declined due to uncertainty around risks of cancer and some cardiovascular diseases (CVD). Moreover, improved cancer survival rates mean that more women who survive cancer go on to experience menopausal symptoms. Understanding these relationships is important so that women and their clinicians can make informed decisions around the risks and benefits of HRT. This study’s primary aim is to determine the association between HRT use after cancer diagnosis and the risk of cancer-specific mortality. The secondary aims are to investigate the risks of HRT on subsequent cancer, all-cause mortality and CVD.Methods and analysisWe will conduct a population-based longitudinal cohort study of 18–79 year-old women diagnosed with cancer between 1998 and 2020, using the QResearch database. The main exposure is HRT use, categorised based on compound, dose and route of administration, and modelled as a time-varying covariate. Analysis of HRT use precancer and postcancer diagnosis will be conducted separately. The primary outcome is cancer-specific mortality, which will be stratified by cancer site. Secondary outcomes include subsequent cancer diagnosis, CVD (including venous thrombo-embolism) and all-cause mortality. Adjustment will be made for key confounders such as age, body mass index, ethnicity, deprivation index, comorbidities, and cancer grade, stage and treatment. Statistical analysis will include descriptive statistics and Cox proportional hazards models to calculate HRs and 95% CIs.Ethics and disseminationEthical approval for this project was obtained from the QResearch Scientific Committee (Ref: OX24, project title ‘Use of hormone replacement therapy and survival from cancer’). This project has been, and will continue to be, supported by patient and public involvement panels. We intend to the submit the findings for peer-reviewed publication in an academic journal and disseminate them to the public through Cancer Research UK.

scholarly journals Hormone replacement therapy in women with cancer and risk of cancer-specific mortality and cardiovascular disease: a protocol for a cohort study from Scotland and Wales

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Úna McMenamin ◽  
Blánaid Hicks ◽  
Carmel Hughes ◽  
Peter Murchie ◽  
Julia Hippisley-Cox ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Hormone Replacement Therapy ◽  
Venous Thromboembolism ◽  
Replacement Therapy ◽  
Cancer Diagnosis ◽  
Hormone Replacement ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

Abstract Background Hormone replacement therapy (HRT) is widely used and has proven benefits for women with menopausal symptoms. An increasing number of women with cancer experience menopausal symptoms but the safety of HRT use in women with cancer is unclear. There are particular concerns that HRT could accelerate cancer progression in women with cancer, and also that HRT could increase the risk of cardiovascular disease in such women. Therefore, our primary aim is to determine whether HRT use alters the risk of cancer-specific mortality in women with a range of common cancers. Our secondary objectives are to investigate whether HRT alters the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. Methods The study will utilise independent population-based data from Wales using the SAIL databank and Scotland based upon the national Prescribing Information System. The study will include women newly diagnosed with common cancers from 2000 to 2016, identified from cancer registries. Women with breast cancers will be excluded. HRT will be ascertained using electronic prescribing in Wales or dispensing records in Scotland. The primary outcome will be time to cancer-specific mortality from national mortality records. Time-dependent cox regression models will be used to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer specific death in HRT users compared with non-users after cancer diagnosis after adjusting for relevant confounders, stratified by cancer site. Analysis will be repeated investigating the impact of HRT use immediately before cancer diagnosis. Secondary analyses will be conducted on the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. Analyses will be conducted within each cohort and pooled across cohorts. Discussion Our study will provide evidence to inform guidance given to women diagnosed with cancer on the safety of HRT use and/or guide modifications to clinical practice.

scholarly journals Postoperative acute kidney injury requiring continuous renal replacement therapy and outcomes after coronary artery bypass grafting: a nationwide cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song
Keyword(s):  
Cohort Study ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Cox Regression ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Population Based ◽  
Bypass Grafting ◽  
All Cause Mortality ◽  
Postoperative Aki

Abstract Background Previous studies reported that patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiac surgery were at a higher risk of postoperative mortality. However, the impact of AKI and CRRT on long-term mortality has not yet been identified. Therefore, we investigated whether postoperative AKI requiring CRRT was associated with one-year all-cause mortality after coronary artery bypass grafting (CABG). Methods For this population-based cohort study, we analyzed data from the National Health Insurance Service database in South Korea. The cohort included all adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2017. Results A total of 15,115 patients were included in the analysis, and 214 patients (1.4%) required CRRT for AKI after CABG during hospitalization. They received CRRT at 3.1 ± 8.5 days after CABG, for 3.1 ± 7.8 days. On multivariable Cox regression, the risk of 1-year all-cause mortality in patients who underwent CRRT was 7.69-fold higher. Additionally, on multivariable Cox regression, the 30-day and 90-day mortality after CABG in patients who underwent CRRT were 18.20-fold and 20.21-fold higher than the normal value, respectively. Newly diagnosed chronic kidney disease (CKD) requiring renal replacement therapy (RRT) 1 year after CABG in patients who underwent CRRT was 2.50-fold higher. In the generalized log-linear Poisson model, the length of hospital stay (LOS) in patients who underwent CRRT was 5% longer. Conclusions This population-based cohort study showed that postoperative AKI requiring CRRT was associated with a higher 1-year all-cause mortality after CABG. Furthermore, it was associated with a higher rate of 30-day and 90-day mortality, longer LOS, and higher rate of CKD requiring RRT 1 year after CABG. Our results suggest that CRRT-associated AKI after CABG may be associated with an increased risk of mortality; hence, there should be interventions in these patients after hospital discharge.

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