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 1

Age at menopause and mortality in women’s later life 2

Higher risk of all-cause, CVD mortality in women having premature (<40) and early (40- 45) menopause For all-cause mortality For CVD mortality Source ： JAMA Cardiol. 2016;1:767 – 776. 3

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) Source ： Am J Epidemiol. 2005; 162:1089 – 97. Source : Maturitas. 2018 Nov;117:29-33. 4

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 5

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. 6

Survival analysis ➢ Event was death from call-causes, cardiovascular disease or 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 7

Baseline characteristics Age at menopause (years) All <40-44 45-49 50-54 55-60 P-value n=36,931 n=3,384 n=9,155 n=19,265 n=5,127 Age at baseline in yrs, 61.2±6.9 61.1±7.1 61.1±7.2 61.0±6.9 62.3±6.2 <0.001 mean ± SD 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 8

Hazard ratios of age at menopause and mortality 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 Adjusted for birth cohort, education, smoking status, hypertension, diabetes, and high blood cholesterol 9

Sensitivity analysis: Hazard ratios among women who had never used contraceptives or hormone therapies, or had not underwent gynecology surgeries 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 Adjusted for birth cohort, education, smoking status, hypertension, diabetes, and high blood cholesterol 10

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 11

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 12