Taiwan: a cohort analysis TE TE-YI SHEN, CAROL STRONG AND TSUNG YU* - - PowerPoint PPT Presentation

Age at menopause and mortality in Taiwan: a cohort analysis

TE TE-YI SHEN, CAROL STRONG AND TSUNG YU* *DEPARTMENT OF PUBLIC HEALT LTH, COLLEGE OF MEDICINE, NATIONAL CHENG KUNG UNIVERSITY, TAINAN, TAIWAN CHICAGO, 27 SEPT 2019

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Age at menopause and mortality in women’s later life

Higher risk of all-cause, CVD mortality in

women having premature (<40) and early (40-

45) menopause

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Source：JAMA Cardiol. 2016;1:767–776.

For all-cause mortality For CVD mortality

Inconsistent results for the effect of early

menopause on cancer mortality

• Women having menopause at 41-44 or 45-49 had

twice the risk of cancer mortality than women having menopause at 50-54 (Roman Kay, 2018)

• Cancer mortality was lower in US women having

menopause at 40-44 and 45-49 years (Mondul, 2005)

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Source：Am J Epidemiol. 2005; 162:1089–97. Source : Maturitas. 2018 Nov;117:29-33.

Study objective

➢To investigate the association of age at menopause with risk of all-cause, CVD and cancer mortality in later life of Taiwanese women

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Data Source

➢ The MJ Health Database in Taiwan. ➢ A cohort of 36,931 postmenopausal women entered health check-up programs during 1999 to 2016. ➢ Information on age at menopause and covariates –

➢The first visit data after menopause was kept for analysis.

➢ Causes of death

➢obtained from the National Register of Death as of July 2018.

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Survival analysis

➢Event was death from call-causes, cardiovascular disease

• r cancer; Time scale was age

➢Cox proportional hazards models with adjustment for covariates were conducted ➢Delayed entry was used to adjust for age differences at the first survey

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Baseline characteristics

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Age at menopause (years) All n=36,931 <40-44 n=3,384 45-49 n=9,155 50-54 n=19,265 55-60 n=5,127 P-value Age at baseline in yrs, mean ± SD 61.2±6.9 61.1±7.1 61.1±7.2 61.0±6.9 62.3±6.2 <0.001 Birth cohort, % <0.001 1930 or before 7.8 7.6 8.6 7.7 7.2 1931-1935 10.8 10.6 11.3 10.5 11.2 1936-1940 20.3 18.9 20.7 19.7 23.2 1941-1945 27.0 27.0 25.5 27.0 29.9 1946-1950 34.0 35.9 34.0 35.2 28.5

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Person-years

• No. of deaths

Adjusted Hazard ratio 95% CI All-causes <40-44 48853 498 1.09 0.99-1.19 45-49 135469 1424 1.07 1.01-1.14 50-54 (ref) 282783 2667 1.00

• 55-60

71354 727 0.98 0.90-1.06 Cardiovascular diseases <40-44 48853 101 1.05 0.85-1.30 45-49 135469 342 1.22 1.07-1.40 50-54 (ref) 282783 563 1.00

• 55-60

71354 135 0.84 0.70-1.02 All cancers <40-44 48853 182 1.07 0.91-1.25 45-49 135469 534 1.10 0.99-1.22 50-54 (ref) 282783 991 1.00

• 55-60

71354 304 1.12 0.99-1.27

Hazard ratios of age at menopause and mortality

Adjusted for birth cohort, education, smoking status, hypertension, diabetes, and high blood cholesterol

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Person-years

• No. of deaths

Adjusted Hazard ratio 95% CI All-causes <40-44 15936 229 1.11 0.97-1.27 45-49 72641 945 1.11 1.03-1.20 50-54 (ref) 173284 1855 1.00

• 55-60

46378 536 1.00 0.91-1.10 Cardiovascular diseases <40-44 15936 52 1.07 0.80-1.43 45-49 72641 234 1.22 1.03-1.43 50-54 (ref) 173284 416 1.00

• 55-60

46378 100 0.82 0.66-1.02 All cancers <40-44 15936 72 1.08 0.85-1.38 45-49 72641 327 1.16 1.01-1.32 50-54 (ref) 173284 634 1.00

• 55-60

46378 209 1.15 0.99-1.35

Sensitivity analysis: Hazard ratios among women who had never used contraceptives or hormone therapies, or had not underwent gynecology surgeries

Adjusted for birth cohort, education, smoking status, hypertension, diabetes, and high blood cholesterol

Adjusted hazard ratios of age at menopause and mortality

▪Lowest risk of all-cause mortality at around 52 years of age at menopause ▪Highest risk of cardiovascular mortality for women having menopause at around 45 years, and the risk was decreasing for women having menopause at a later age ▪Cancer risk was slightly higher for women having menopause at an earlier age, but the risk was increasing again for women having a later age at menopause

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Conclusions

➢Earlier age at menopause is associated with increased all-cause and CVD mortality in Taiwanese women. ➢ Strength: Large sample size (n = 36,931) of postmenopausal women and the prospective long-term follow-up. ➢Limitation: Lack of complete hysterectomy or bilateral oophorectomy status; Lack of detailed hormone therapy and oral contraceptive use data; Recall bias

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