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Zhou L, Chen X, Zhang G, Sui Y, Hou L, Hu F, Xia X, Luo S, Peng X, Yue J, Dong B, Dong B, Liu X. Associations of parity and cognitive decline, depression, and chronic comorbidity in West China: Results from WCHAT study. Int J Gynaecol Obstet 2024. [PMID: 38967049 DOI: 10.1002/ijgo.15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 06/06/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To investigate the associations between parity (the number of offspring a female has borne) and cognitive function, depression, and chronic comorbidity in Western China. METHODS A total of 846 women aged 50-55 years were included in the current analysis. Cognitive status was measured using a 10-item short portable mental status questionnaire (SPMSQ). Depressive symptoms were assessed using the 15-item geriatric depression scale (GDS-15). Other characteristics were self-reported. The associations between parity and cognitive decline, depression, and chronic comorbidity were analyzed using univariable and multivariable models. Multivariable models were adjusted for age, ethnic group, occupation, marital status, educational level, lifestyle factors, and sleeping time. RESULTS Among the enrolled women, 26.71% were either childless or had one child, 47.40% had two children, 18.32% had three children, and 7.57% had ≥4 children. Compared to women with low parity, women with two or more children exhibited a higher risk of cognitive decline. Moreover, having four or more children was significantly associated with depression and chronic comorbidity. After adjusting covariates, women with three or more children exhibited a higher risk of cognitive decline than those with low parity. However, high parity was not significantly associated with depression or chronic comorbidity after adjustment for covariates. CONCLUSION Our study showed that ≥3 children was associated with cognitive decline in women. Longitudinal studies are needed to evaluate this conclusion and to investigate the mechanisms involved. More importantly, families and societies should pay more attention to women's long-term health outcomes related to fertility.
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Affiliation(s)
- Lixing Zhou
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoyan Chen
- Zigong Mental Health Center, Zigong, Sichuan Province, China
| | - Gongchang Zhang
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Yunpeng Sui
- Plastic and Aesthetic Department, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lisha Hou
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Fengjuan Hu
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Xin Xia
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Shuyue Luo
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Xuchao Peng
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Jirong Yue
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Biao Dong
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaolei Liu
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, Sichuan Province, China
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Yan Y, Lu H, Lin S, Zheng Y. Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003-2018. BMC Womens Health 2024; 24:222. [PMID: 38581038 PMCID: PMC10996084 DOI: 10.1186/s12905-024-03055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The evidence regarding the association of reproductive factors with cardiovascular diseases (CVDs) is limited. AIMS To investigate the relationship of reproductive factors with the risk of CVDs, as well as all-cause and cardiovascular mortality. METHODS This study included 16,404 adults with reproductive factors from the National Health and Nutrition Examination Survey (NHANES) and followed up until 31 December 2019. Logistic models and restricted cubic spline models were used to assess the association of reproductive factors with CVDs. COX proportional hazards models and restricted cubic spline models, with adjustment for potential confounding, were employed to analyze the relation between reproductive factors and cardiovascular and all-cause death. RESULTS There is a nonlinear relationship between age at menarche and CVDs. Age at menopause ≤ 11(OR 1.36, 95% CI 1.10-1.69) was associated with an increased risk of CVDs compared to ages 12-13 years. Age at Menopause ≤ 44 (OR 1.69, 95% CI 1.40-2.03) was associated with increased CVDs compared to age 35-49 years. Number of pregnancies ≥ 5(OR 1.26, 95% CI 1.02-1.55) was associated with an increased risk of CVDs compared to one pregnancy. In continuous variable COX regression models, a later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of all-cause death. A later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of cardiac death. CONCLUSIONS Female reproductive factors are significant risk factors for CVDs American women.
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Affiliation(s)
- Yufeng Yan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China
| | - Hongjing Lu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China
| | - Song Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China.
| | - Yaguo Zheng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China.
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Rahmati M, Saei Ghare Naz M, Azizi F, Ramezani Tehrani F. Parity and hypertension risk in couples: does number of parity matter: findings from Tehran Lipid and Glucose Study. BMC Public Health 2023; 23:474. [PMID: 36907869 PMCID: PMC10010040 DOI: 10.1186/s12889-023-15397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND AND AIMS As reported, hypertension (HTN) plays a leading role in explaining mortality worldwide, but it still has many confounding factors. This study explored whether the number of parity and age matters for HTN among couples from the Tehran Lipid and Glucose Study (TLGS). METHODS This study was conducted on 2851 couples from TLGS. All the variables were collected based on the standard protocol. The participants were categorized into four and five categories according to the number of parity (childless, one, two, three, or more parities) and age (18-30y, 30-40y, 40-50y, 50-60y, and 60-70y), respectively. Spline regression models via log link function for the binary outcome and linear link function for continuous outcomes were applied to evaluate the effect of interaction term age and parity categories on the desired outcome. RESULTS Among the total of 2851 pairs, 2.3% had no child, 9.5% had 1 child, 38.4% had 2 children, and 49.8% had ≥ 3 children. The adjusted risk (95% CI) of HTN in females aged 40-50y with 1 child, 2 and ≥ 3 children compared to no child were 1.14(1.04, 1.26), 1.05(1.01, 1.10), 1.12(1.07, 1.17), respectively (p < 0.05). Moreover, in those aged 50-60y with 2 and ≥ 3 children, the risk of HTN significantly increased by 4%. In females aged 60-70y with ≥ 3 children compared to those without children, the risk of HTN increased by 2%. For males aged 30-40y with 2 children compared to the no child group, the adjusted risk of HTN increased by 17%, while for those with ≥ 3 children in the same age group, this risk significantly decreased by 13%. Moreover, in males aged 30-40y with 2 children, risk ratio of HTN increased by 17%, but in males with ≥ 3 children, it decreased by 13% and in those in the same groups but aged 40-50y the risk increased by 6% and 11%, respectively. CONCLUSION Our findings suggest that gender, childlessness, having one child, and multi-parity had different impacts on HTN. Further research is needed to confirm our findings.
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Affiliation(s)
- Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Super-additive associations between parity and education level on mortality from cardiovascular disease and other causes: the Japan Collaborative Cohort Study. BMC Womens Health 2022; 22:278. [PMID: 35794595 PMCID: PMC9261019 DOI: 10.1186/s12905-022-01805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background While women’s parity status and education level have independent associations with cardiovascular and other diseases, no studies have evaluated the additive interaction of these two factors. Therefore, we examined the additive interaction between parity and education level on mortality from stroke, coronary heart disease, total cardiovascular disease, cancer, non-cardiovascular disease, and non-cancer causes, and all causes in Japanese women. Methods This study followed 41,242 women aged 40–79 years without a history of cardiovascular disease or cancer from 1988 to 1990 until 2009. Baseline parity and education level were classified into four categories, with highly educated parous women as the reference group. Cox proportional hazards regression analyses were performed to calculate the risk of mortality. We also assessed the additive interactions between parity and education level on mortality from cardiovascular disease and other causes using the relative excess risk due to interaction obtained using Cox models. Results During the median follow-up period of 19.1 years, we identified 6299 deaths. In a multivariable model adjusted for cardiovascular disease and other disease risk factors, nulliparous women with low education levels had increased multivariable-adjusted hazard ratios of 1.67 (95% confidence interval [CI] 1.13, 2.47) for stroke, 1.98 (95% CI 1.15, 3.39) for coronary heart disease, 1.71 (95% CI 1.34,2.18) for total cardiovascular disease, 1.69 (95% CI 1.33, 2.14) for non-cardiovascular and non-cancer, and 1.51 (95% CI 1.30, 1.75) for all-cause mortality when compared with highly educated parous women. Moreover, we observed significant additive interactions between parity and education level on total cardiovascular disease mortality (P = 0.04), non-cardiovascular disease and non-cancer mortality (P = 0.01), and all-cause mortality (P = 0.005). Conclusions Nulliparity and low education levels are super-additively associated with total cardiovascular disease, non-cardiovascular and non-cancer, and all-cause mortality risks, suggesting that nulliparous women with low education levels need specific support for preventing mortality related to cardiovascular and other diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01805-y.
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Blankenberger J, Kaufmann M, Albanese E, Amati R, Anker D, Camerini AL, Chocano-Bedoya P, Cullati S, Cusini A, Fehr J, Harju E, Kohler P, Kriemler S, Michel G, Rodondi N, Rodondi PY, Speierer A, Tancredi S, Puhan MA, Kahlert CR. Is living in a household with children associated with SARS-CoV-2 seropositivity in adults? Results from the Swiss national seroprevalence study Corona Immunitas. BMC Med 2022; 20:233. [PMID: 35725472 PMCID: PMC9207841 DOI: 10.1186/s12916-022-02431-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determine whether living in a household with children is associated with SARS-CoV-2 seropositivity in adults and investigated interacting factors that may influence this association. METHODS SARS-CoV-2 serology testing was performed in randomly selected individuals from the general population between end of October 2020 and February 2021 in 11 cantons in Switzerland. Data on sociodemographic and household characteristics, employment status, and health-related history was collected using questionnaires. Multivariable logistic regression was used to examine the association of living with children <18 years of age (number, age group) and SARS-CoV-2 seropositivity. Further, we assessed the influence of reported non-household contacts, employment status, and gender. RESULTS Of 2393 working age participants (18-64 years), 413 (17.2%) were seropositive. Our results suggest that living with children and SARS-CoV-2 seropositivity are likely to be associated (unadjusted odds ratio (OR) 1.22, 95% confidence interval [0.98-1.52], adjusted OR 1.25 [0.99-1.58]). A pattern of a positive association was also found for subgroups of children aged 0-11 years (OR 1.21 [0.90-1.60]) and 12-17 years (OR 1.14 [0.78-1.64]). Odds of seropositivity were higher with more children (OR 1.14 per additional child [1.02-1.27]). Men had higher risk of SARS-CoV-2 infection when living with children than women (interaction: OR 1.74 [1.10-2.76]). CONCLUSIONS In adults from the general population living with children seems associated with SARS-CoV-2 seropositivity. However, child-related infection risk is not the same for every subgroup and depends on factors like gender. Further factors determining child-related infection risk need to be identified and causal links investigated. TRIAL REGISTRATION https://www.isrctn.com/ISRCTN18181860 .
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Affiliation(s)
- Jacob Blankenberger
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Daniela Anker
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Anne-Linda Camerini
- Institute of Public Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Patricia Chocano-Bedoya
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases, Kantonsspital Graubünden, Chur, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.,Division of Infectious Disease & Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Luzern, Luzern, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases, Kantonsspital Graubünden, Chur, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Luzern, Luzern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pierre-Yves Rodondi
- Institute of Family Medicine (IMF), University of Fribourg, Fribourg, Switzerland
| | - Alexandre Speierer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Christian R Kahlert
- Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.
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Salinari G, De Santis G, Zarulli V, Giuliani C, Franceschi C, Breschi M. Fertility decline and the emergence of excess female survival in post-reproductive ages in Italy. GENUS 2022. [DOI: 10.1186/s41118-022-00166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractIn Italy, at least in the cohorts born up to the beginning of the twentieth century, women’s mortality in post-reproductive ages was influenced by fertility, with large progenies (and, to a lesser extent, childlessness) leading to markedly lower survival chances. This relationship proved strong enough to affect the female-to-male ratio in old age as fertility declined. In this paper, we show that various measures of extra female survival at high ages are closely connected to the fertility transition in Italy, and to its peculiar historical and geographical evolution.
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Risk factors and clustering of mortality among older adults in the India Human Development Survey. Sci Rep 2022; 12:6644. [PMID: 35459794 PMCID: PMC9033784 DOI: 10.1038/s41598-022-10583-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
With wide socioeconomic mortality differential among older adults in India, a constant question of death clustering across high-risk families and communities arises. The present study uses a follow-up survey from India to investigate the socioeconomic, demographic and health predictors of old-age mortality clustering. Data of 16,964 older adults nested within 12,981 households from 2352 communities were used from India Human Development Survey (IHDS) round-I (2005) who were further tracked down in round-II (2012). Bivariate association between the determinants of old-age mortality was investigated using the log-rank test. The multivariate analysis involved estimating the random-intercept Weibull proportional hazard model with three levels—individual (level 1), family (level 2) and community (level 3). We analyzed the sensitivity of multivariate results to unobservable variable and selection biases using the e-value method. The empirical analysis confirms that the risk of mortality is significantly heterogeneous between the families. The health status of older adults and the family’s socioeconomic status in the early years emerged as prominent predictors of a longer lifespan. With a strong association between household income and mortality hazard risk, the present study urges early life interventions as those started in late-life might have negligible impact on keeping the older adults alive and healthy.
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Wang YX, Farland LV, Wang S, Gaskins AJ, Wang L, Rich-Edwards JW, Tamimi R, Missmer SA, Chavarro JE. Association of infertility with premature mortality among US women: Prospective cohort study. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 7. [PMID: 35419553 PMCID: PMC9004660 DOI: 10.1016/j.lana.2021.100122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Correspondence author.
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Liang Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Janet W. Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rulla Tamimi
- Division of Epidemiology, Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Stacey A. Missmer
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Eun Y, Yoo JE, Han K, Kim D, Lee KN, Lee J, Lee DY, Lee DH, Kim H, Shin DW. Female reproductive factors and risk of joint replacement arthroplasty of the knee and hip due to osteoarthritis in postmenopausal women: a nationwide cohort study of 1.13 million women. Osteoarthritis Cartilage 2022; 30:69-80. [PMID: 34774788 DOI: 10.1016/j.joca.2021.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Previous studies of the relationships between female reproductive factors and osteoarthritis (OA) have shown conflicting results. In this study, we aimed to explore the relationships between reproductive factors and joint replacement arthroplasty of the knee (TKRA) and hip (THRA) in a large nationwide population-based cohort of postmenopausal Korean women. METHODS We included 1,134,680 subjects who participated in national health examinations in 2009 in the study. The study outcomes were incident THRA or TKRA due to severe hip or knee OA. The relationships between reproductive factors and THRA or TKRA were evaluated using a multivariable-adjusted proportional hazards model. RESULTS During a mean follow-up duration of 8.2 years, 1,610 incident THRA cases and 60,670 incident TKRA cases were observed. Later age at menarche, longer breastfeeding, HRT and OC use were associated with increased risk of TKRA for severe knee OA, while later age at menopause and longer reproductive span were associated with decreased risk. With regard to THRA for severe hip OA, later menarche, longer breastfeeding, HRT more than 5 years, and OC use more than 1 year were associated with higher risk. The associations between reproductive factors and severe OA were more pronounced in underweight and younger subjects. CONCLUSION We found that shorter estrogen exposure was associated with higher risk of TKRA due to severe knee OA, and such associations were more pronounced in underweight and younger subjects. The association between shorter estrogen exposure and THRA was not robust.
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Affiliation(s)
- Y Eun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J E Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - K Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - D Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - K N Lee
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, South Korea
| | - J Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - D-Y Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - D-H Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - H Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - D W Shin
- Department of Family Medicine and Supportive Care Centre, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design and Evaluation/ Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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India-Aldana S, Rundle AG, Zeleniuch-Jacquotte A, Quinn JW, Kim B, Afanasyeva Y, Clendenen TV, Koenig KL, Liu M, Neckerman KM, Thorpe LE, Chen Y. Neighborhood Walkability and Mortality in a Prospective Cohort of Women. Epidemiology 2021; 32:763-772. [PMID: 34347687 PMCID: PMC8969891 DOI: 10.1097/ede.0000000000001406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death. METHODS We geocoded baseline residential addresses of 13,832 women in the New York University Women's Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers. RESULTS Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality. CONCLUSION Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - James W. Quinn
- Columbia Population Research Center, Columbia University
| | - Byoungjun Kim
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Yelena Afanasyeva
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Tess V. Clendenen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Karen L. Koenig
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Lorna E. Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Kravdal Ø, Tverdal A, Grundy E. The association between parity, CVD mortality and CVD risk factors among Norwegian women and men. Eur J Public Health 2021; 30:1133-1139. [PMID: 31942974 DOI: 10.1093/eurpub/ckz235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Several studies have shown that women and men with two children have lower mortality than the childless, but there is less certainty about mortality, including CVD mortality, at higher parities and meagre knowledge about factors underlying the parity-mortality relationship. METHODS The association between parity and CVD mortality was analyzed by estimating discrete-time hazard models for women and men aged 40-80 in 1975-2015. Register data covering the entire Norwegian population were used, and the models included a larger number of relevant sociodemographic control variables than in many previous studies. To analyze the relationship between parity and seven CVD risk factors, logistic models including the same variables as the mortality models were estimated from the CONOR collection of health surveys, linked to the register data. RESULTS Men (but not women) who had four or more children had higher mortality from CVD than those with two, although this excess mortality was not observed for the heart disease sub-group. Overweight, possibly in part a result of less physical activity, seems to play a role in this. All CVD risk factors except smoking and alcohol may contribute to the relatively high CVD mortality among childless. CONCLUSIONS Childbearing is related to a number of well-known CVD risk factors, and becoming a parent or having an additional child is, on the whole, associated with lower-or at least not higher-CVD mortality in Norway. However, for men family sizes beyond three children are associated with increased CVD mortality, with risks of overweight one possible pathway.
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Affiliation(s)
- Øystein Kravdal
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Economics, University of Oslo, Oslo, Norway
| | - Aage Tverdal
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Emily Grundy
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Institute for Social and Economic Research, University of Essex, Colchester, UK
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12
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Forbes H, Morton CE, Bacon S, McDonald HI, Minassian C, Brown JP, Rentsch CT, Mathur R, Schultze A, DeVito NJ, MacKenna B, Hulme WJ, Croker R, Walker AJ, Williamson EJ, Bates C, Mehrkar A, Curtis HJ, Evans D, Wing K, Inglesby P, Drysdale H, Wong AYS, Cockburn J, McManus R, Parry J, Hester F, Harper S, Douglas IJ, Smeeth L, Evans SJW, Bhaskaran K, Eggo RM, Goldacre B, Tomlinson LA. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England. BMJ 2021; 372:n628. [PMID: 33737413 PMCID: PMC7970340 DOI: 10.1136/bmj.n628] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic. DESIGN Population based cohort study, on behalf of NHS England. SETTING Primary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020). PARTICIPANTS Two cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020. MAIN OUTCOME MEASURES Adjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household. RESULTS Among 9 334 392adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions. CONCLUSIONS In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.
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Affiliation(s)
- Harriet Forbes
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline E Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Helen I McDonald
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Minassian
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy P Brown
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rohini Mathur
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Schultze
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas J DeVito
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - William J Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Elizabeth J Williamson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Bates
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Kevin Wing
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Henry Drysdale
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Angel Y S Wong
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Robert McManus
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - John Parry
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Frank Hester
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Sam Harper
- The Phoenix Partnership, 129 Low Lane, Horsforth, Leeds, UK
| | - Ian J Douglas
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen J W Evans
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosalind M Eggo
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Laurie A Tomlinson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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O’Kelly AC, Honigberg MC. Sex Differences in Cardiovascular Disease and Unique Pregnancy-Associated Risk Factors in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00860-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Evolutionary theories of senescence, such as the ‘disposable soma’ theory, propose that natural selection trades late survival for early fecundity. ‘Frailty’, a multidimensional measure of health status, may help to better define the long-term consequences of reproduction. We examined the relationship between parity and later life frailty (as measured by the Frailty Index) in a sample of 3,534 adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. We found that the most parous adults were the most frail and that the parity-frailty relationship was similar for both sexes. Whilst this study provided some evidence for a ‘parity-frailty trade-off’, there was little support for our hypothesis that the physiological costs of childbearing influence later life frailty. Rather, behavioural and social factors associated with rearing many children may have contributed to the development of frailty in both sexes.
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15
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Zueras P, Rutigliano R, Trias-Llimós S. Marital status, living arrangements, and mortality in middle and older age in Europe. Int J Public Health 2020; 65:627-636. [PMID: 32350551 PMCID: PMC7360666 DOI: 10.1007/s00038-020-01371-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We study the role of marital status and living arrangements in mortality among a 50+ population living in Europe by gender and welfare states. METHODS Using data from waves 4, 5, and 6 of the Survey of Health Age and Retirement in Europe (n = 54,171), we implemented Cox proportional hazard models by gender and age groups (50-64 and 65-84). We estimated pooled models and separated models for two regions representing different welfare states (South-East and North-West). RESULTS Among people aged 50-64, nonpartnered individuals (except never-married women) showed a higher mortality risk as compared with those partnered. Among the older population (65-84), divorce was associated with higher mortality among men, but not among women, and living with someone other than a partner was associated with higher mortality risk as compared to those partnered. In the South-East region living with a partner at ages 50-64 was associated with lower mortality. CONCLUSIONS Partnership and residential status are complementary for understanding the role of family dimensions in mortality. The presence of a partner is mortality protective, especially among 50-64-year-old men in South-East Europe.
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Affiliation(s)
- Pilar Zueras
- Centre d’Estudis Demogràfics (a Member of the CERCA Programme/Generalitat de Catalunya), Barcelona, Spain
| | - Roberta Rutigliano
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Sergi Trias-Llimós
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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16
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Ross KM, Carroll J, Horvath S, Hobel CJ, Coussons-Read ME, Schetter CD. Immune epigenetic age in pregnancy and 1 year after birth: Associations with weight change. Am J Reprod Immunol 2020; 83:e13229. [PMID: 32061136 PMCID: PMC8401279 DOI: 10.1111/aji.13229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
PROBLEM Epigenetic age indices are markers of biological aging determined from DNA methylation patterns. Accelerated epigenetic age predicts morbidity and mortality. Women tend to demonstrate slower blood epigenetic aging compared to men, possibly due to female-specific hormones and reproductive milestones. Pregnancy and the post-partum period are critical reproductive periods that have not been studied yet with respect to epigenetic aging. The purpose of this paper was to examine whether pregnancy itself and an important pregnancy-related variable, changes in body mass index (BMI) between pregnancy and the post-partum period, are associated with epigenetic aging. METHOD OF STUDY A pilot sample of 35 women was recruited as part of the Healthy Babies Before Birth (HB3) project. Whole blood samples were collected at mid-pregnancy and 1 year post-partum. DNA methylation at both time points was assayed using Infinium 450K and EPIC chips. Epigenetic age indices were calculated using an online calculator. RESULTS Paired-sample t-tests were used to test differences in epigenetic age indices from pregnancy to 1 year after birth. Over this critical time span, women became younger with respect to phenotypic epigenetic age, GrimAge, DNAm PAI-1, and epigenetic age indices linked to aging-related shifts in immune cell populations, known as extrinsic epigenetic age. Post-partum BMI retention, but not prenatal BMI increases, predicted accelerated epigenetic aging. CONCLUSION Women appear to become younger from pregnancy to the post-partum period based on specific epigenetic age indices. Further, BMI at 1 year after birth that reflects weight retention predicted greater epigenetic aging during this period.
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Affiliation(s)
- Kharah M. Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Judith Carroll
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California – Los Angeles, Los Angeles, CA, USA
| | - Steve Horvath
- Department of Biostatistics, University of California – Los Angeles, Los Angeles, CA, USA
| | - Calvin J. Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary E. Coussons-Read
- Psychology Department, University of Colorado – Colorado Springs, Colorado Springs, CO, USA
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Sironi M, Ploubidis GB, Grundy EM. Fertility History and Biomarkers Using Prospective Data: Evidence From the 1958 National Child Development Study. Demography 2020; 57:529-558. [PMID: 32133595 PMCID: PMC7162827 DOI: 10.1007/s13524-020-00855-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Research on the later-life health implications of fertility history has predominantly considered associations with mortality or self-reported indicators of health. Most of this previous research has either not been able to account for selection factors related to both early-life and later-life health or has had to rely on retrospectively reported accounts of childhood circumstances. Using the 1958 National Child Development Study, and in particular the biomedical survey conducted in 2002-2003, we investigate associations between fertility histories (number of children and age at first and at last birth) and biomarkers for cardiometabolic risk and respiratory function in midlife among both men and women. Results from models that adjusted for a very wide range of childhood factors, including early-life socioeconomic position, cognitive ability, and mental health, showed weak associations between parity and biomarkers. However, we found an inverse association between age at first birth and biomarkers indicative of worse cardiometabolic health, with poorer outcomes for those with very young ages at entry to parenthood and increasingly better outcomes for those becoming parents at older ages. A very young age at last birth was also associated with less favorable biomarker levels, especially among women. Results highlight the value of prospectively collected data and the availability of biomarkers in studies of life course determinants of health in midlife and later.
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Affiliation(s)
- Maria Sironi
- Department of Social Science, University College London, 55-59 Gordon Square, London, WC1H 0NU United Kingdom
| | - George B. Ploubidis
- Department of Social Science, University College London, 55-59 Gordon Square, London, WC1H 0NU United Kingdom
- UCL Center for Longitudinal Studies, University College London, 55-59 Gordon Square, London, WC1H 0NU United Kingdom
| | - Emily M. Grundy
- Institute for Social & Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ United Kingdom
- Centre for Fertility and Health, Norwegian Institute for Public Health, Lovisenberggata 8, 0456 Oslo, Norway
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18
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Meyer AC, Torssander J, Talbäck M, Modig K. Parents survive longer after stroke than childless individuals: a prospective cohort study of Swedes over the age of 65. Eur J Public Health 2019; 29:1090-1095. [PMID: 31220242 PMCID: PMC6896977 DOI: 10.1093/eurpub/ckz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women. METHODS This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education, income and comorbidities. RESULTS Childlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18-1.39)] and smallest among married men [1.09 (1.03-1.15)]. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 15 and 9 months among married and unmarried women, respectively. CONCLUSIONS Having children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women's survival. These results may have implications for the improvement of informal care for childless older individuals.
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Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Torssander
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Abstract
Understanding the association between fertility histories and health later in life is necessary in the context of ageing societies. Past literature has generally found a U-shaped relationship between parity, age at first birth, and several health-related outcomes. However, these findings differed to some extent depending on the country under analysis and on the measures of health considered. As such, using wave 3 (2008-2009) and 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE), this work aimed to answer the question: "Are fertility histories associated with the presence of chronic conditions later in life in Europe?" The analysis included 11 European countries and compared results using two different measures of chronic conditions: self-reported chronic or long-term illness and chronic diseases diagnosed by a doctor. Results showed that age at first birth is more relevant than parity for health outcomes at older ages. Moreover, in socio-democratic and continental countries, the association between fertility and chronic conditions-in particular between age at first birth and long-term illnesses-is statistically significant among women, but not among men. Finally, the association between fertility history and health was similar when using self-reported measures and chronic diseases diagnosed by a doctor.
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Affiliation(s)
- Maria Sironi
- Department of Social Science, University College London, 20 Bedford Way, London, WC1H 0AL UK
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20
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Wu P, Mamas MA, Gulati M. Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. J Womens Health (Larchmt) 2019; 28:1037-1050. [DOI: 10.1089/jwh.2018.7480] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Pensee Wu
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Unit of Obstetrics and Gynecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
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Infertility: a marker of future health risk in women? Fertil Steril 2019; 110:783-789. [PMID: 30316412 DOI: 10.1016/j.fertnstert.2018.08.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/28/2022]
Abstract
Infertility, may be a harbinger for future health risk in women, including early mortality. Fertility status itself could serve as an early biomarker, (present in a woman's reproductive years) for risk stratification later in life. The relationship between infertility and early mortality involves the impact of nulliparity on future adverse health events, potential sequelae from the underlying cause(s) of infertility, the risks of fertility treatments, as well as the potential for risk reduction from a healthy pregnancy. This complex interplay coupled with difficulties ascertaining infertility on a population level has presented unique challenges to assessing infertility and early mortality risk. With further study, a better understanding the role of fertility status in health at various stages of life may provide unique opportunities for surveillance and risk reduction.
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Barclay K, Kolk M. Parity and Mortality: An Examination of Different Explanatory Mechanisms Using Data on Biological and Adoptive Parents. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2019; 35:63-85. [PMID: 30976268 PMCID: PMC6357259 DOI: 10.1007/s10680-018-9469-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/07/2018] [Indexed: 11/01/2022]
Abstract
A growing literature has demonstrated a relationship between parity and mortality, but the explanation for that relationship remains unclear. This study aims to pick apart physiological and social explanations for the parity-mortality relationship by examining the mortality of parents who adopt children, but who have no biological children, in comparison with the mortality of parents with biological children. Using Swedish register data, we study post-reproductive mortality amongst women and men from cohorts born between 1915 and 1960, over ages 45-97. Our results show the relative risks of mortality for adoptive parents are always lower than those of parents with biological children. Mortality amongst adoptive parents is lower for those who adopt more than one child, while for parents with biological children we observe a U-shaped relationship, where parity-two parents have the lowest mortality. Our discussion considers the relative importance of physiological and social depletion effects, and selection processes.
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Affiliation(s)
- Kieron Barclay
- Max Planck Institute for Demographic Research, 18057 Rostock, Germany
- Department of Social Policy, London School of Economics and Political Science, London, WC2A 2AE UK
- Department of Sociology, Stockholm University, 106 91 Stockholm, Sweden
| | - Martin Kolk
- Department of Sociology, Stockholm University, 106 91 Stockholm, Sweden
- Centre for the Study of Cultural Evolution, Stockholm University, 106 91 Stockholm, Sweden
- Institute for Futures Studies, Holländargatan 13, 101 31 Stockholm, Sweden
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Lee J, Oh M, Ko S, Park C, Lee ES, Kim HA, Jung Y, Lee J. Parity Differently Affects the Breast Cancer Specific Survival from Ductal Carcinoma In Situ to Invasive Cancer: A Registry-Based Retrospective Study from Korea. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223418825134. [PMID: 30728717 PMCID: PMC6350119 DOI: 10.1177/1178223418825134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Abstract
Purpose: Multiparity might increase general mortality for women, but has inconclusive
in patients with breast cancer. Here, we aim to discover their effect in
terms of the breast cancer development hypothesis: from ductal carcinoma in
situ to invasive carcinoma. Methods: We included 37 947 patients from the web-based breast cancer registration
program of the Korean Breast Cancer Society and analyzed survivals using
multivariate Cox regression analysis and whether the associations of these
factors displayed linear trends. They were divided into the following
groups: (1) pure ductal carcinoma in situ (DCIS), (2) invasive ductal
carcinoma (IDC) mixed with intraductal component (DCIS-IDC), and (3) node
negative pure IDC. Results: The mean age was 48.9 ± 9.9 years including premenopausal women was 61.8%.
Although patients with parities of 1-3 had better prognosis compared with
patients with nulliparous women, high parity (⩾4) increased the hazard ratio
(HR) of overall survival (OS) (DCIS: HR, 1.52; 95% confidence interval [CI]
0.62-3.78; IDC: HR, 1.43, 95% CI 0.89-2.31; and DCIS-IDC: HR, 1.44, 95% CI
0.45-4.59) during 84.2 (±10.7) months. For breast cancer specific survival
(BCSS), the HR of the IDC group (P-value for trend = .04)
increased along with increasing parity and was worse than nulliparous
patients, and the HR of the DCIS-IDC group increased but was better than
nulliparous patients (P-value for trend = .02). Compared
with nulliparous patients, any age at first birth (AFB) decreased HR of OS
in the DCIS and IDC groups (DCIS: P = .01; IDC:
P = .04). Conclusions: Parity show dual effects on OS of women with all ductal typed breast cancer
but show different effects on BCSS in Korea.
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Affiliation(s)
- JungSun Lee
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Minkyung Oh
- Department of Pharmacology and Clinical Trial Center, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - SeungSang Ko
- Department of Surgery, College of Medicine, Dankook University and Cheil General Hospital, Seoul, Korea
| | - Chanheun Park
- Department of Surgery, College of Medicine, SungKyunkwan University and Kangbuk Samsung Hospital, Seoul, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Yongsik Jung
- Department of Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jungyeon Lee
- Department of Surgery, College of Medicine, Dong-A University, Busan, Korea
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Otsuki S, Saito E, Sawada N, Abe SK, Hidaka A, Yamaji T, Shimazu T, Goto A, Iwasaki M, Iso H, Mizoue T, Shibuya K, Inoue M, Tsugane S. Female reproductive factors and risk of all-cause and cause-specific mortality among women: The Japan Public Health Center–based Prospective Study (JPHC study). Ann Epidemiol 2018; 28:597-604.e6. [DOI: 10.1016/j.annepidem.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/15/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
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Konishi S, Ng CFS, Watanabe C. U-shaped association between fertility and mortality in a community-based sample of Japanese women. J Epidemiol Community Health 2018; 72:337-341. [PMID: 29317469 DOI: 10.1136/jech-2017-209809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prospective cohort studies of contemporary populations in both Western and Asian settings have reported a U-shaped association between fertility and mortality. We examined whether an association exists between fertility and all-cause and cause-specific mortality in a sample of Japanese women. METHODS A prospective cohort study was conducted in one rural and one urban community in Gunma Prefecture, Japan, in 1993. A follow-up survey was conducted in the year 2000 in 4858 women aged 47-77 years, and information on demographic and lifestyle characteristics was collected. Mortality and migration data through December 2008 were obtained. A Cox proportional hazard model was used to examine the relationship between parity and mortality. RESULTS Compared with women with 2-4 children (reference group), higher total mortality was observed among women with 0-1 or 5+ children. Low (HR 1.7, 95% CI 1.2 to 2.3) and high (HR 2.1, 95% CI 1.0 to 4.7) parities were both associated with higher all-cause mortality even after adjusting for potential confounders. Mortality due to ischaemic heart disease exhibited a significant association with parity; the HRs were 3.2 (95% CI 1.1 to 9.2) for women with 0-1 child and 8.7 (95% CI 1.7 to 45.5) for women with 5 or more children. No significant association was observed for mortality from malignancies, cancer of the digestive system, cardiovascular disease or cerebrovascular disease. CONCLUSIONS There exists a U-shaped association between parity and all-cause mortality and cause-specific mortality due to ischaemic heart disease among Japanese women.
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Affiliation(s)
- Shoko Konishi
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Chris Fook Sheng Ng
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Chiho Watanabe
- National Institute of Environmental Sciences, Tsukuba, Japan
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26
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Ren L, Guo P, Sun QM, Liu H, Chen Y, Huang Y, Cai XJ. Number of parity and the risk of rheumatoid arthritis in women: A dose-response meta-analysis of observational studies. J Obstet Gynaecol Res 2017; 43:1428-1440. [PMID: 28613016 DOI: 10.1111/jog.13370] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/10/2017] [Accepted: 04/02/2017] [Indexed: 01/16/2023]
Abstract
AIM The association between parity and rheumatoid arthritis (RA) risk has been investigated, but results are controversial. Thus, our aim was to systematically analyze the effect of number of parity on the risk of RA in women. METHODS Relevant published studies were identified using PubMed and embase databases through 1 April 2016. We pooled the relative risks (RR) and 95% confidence intervals (CI) using random-effects models. RESULTS In all, 12 studies with a total of 2 497 580 participants and 11 521 RA cases were included. A borderline significant inverse association was observed when we compared parity with nulliparity for RA, with summarized RR = 0.90 (95%CI: 0.79-1.02; I2 = 58.5%, Pheterogeneity = 0.010). In dose-response analysis, we observed a significant nonlinear (Pnonlinearity = 0.000) relation between parity number and the risk of RA. Compared with null parity, the pooled RR of RA were 0.89 (95%CI: 0.86-0.93), 0.84 (95%CI: 0.79-0.89), 0.85 (95%CI: 0.79-0.90), 0.88 (95%CI: 0.81-0.95), 0.90 (95%CI: 0.83-0.97), 0.92 (95%CI: 0.84-1.02), and 0.94 (95%CI: 0.83-1.07) for 1, 2, 3, 4, 5, 6, and 7 live births, respectively. Subgroup and sensitivity analyses showed similar associations. No publication bias was found. CONCLUSION The findings from the current meta-analysis indicate that parity was related to decreased risk of RA. The greatest risk reduction appeared when the parity number reached two. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Lei Ren
- Department of Spinal Surgery, Third Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, China
| | - Peng Guo
- Department of Hepatobiliary Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiao-Mei Sun
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, China.,School of Graduate Studies, Zunyi Medical University, Zunyi, China
| | - Hong Liu
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Yu Chen
- Department of Joint Surgery, Third Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, China
| | - Ying Huang
- Department of Respiration, Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Jun Cai
- Department of Spinal Surgery, Third Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, China
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27
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Modig K, Talbäck M, Torssander J, Ahlbom A. Payback time? Influence of having children on mortality in old age. J Epidemiol Community Health 2017; 71:424-430. [PMID: 28292784 PMCID: PMC5484032 DOI: 10.1136/jech-2016-207857] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/04/2016] [Accepted: 11/15/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is known that parents have lower mortality than childless individuals. Support from adult children to ageing parents may be of importance for parental health and longevity. The aim of this study was to estimate the association between having a child and the risk of death, and to examine whether the association increased at older ages when health starts to deteriorate and the need of support from a family member increases. METHODS In this nationwide study, all men and women (born between 1911 and 1925 and residing in Sweden), as well as their children, were identified in population registers and followed over time. Age-specific death risks were calculated for each calendar year for individuals having at least one child and for individuals without children. Adjusted risk differences and risk ratios were estimated. RESULTS Men and women having at least one child experienced lower death risks than childless men and women. At 60 years of age, the difference in life expectancy was 2 years for men and 1.5 years for women. The absolute differences in death risks increased with parents' age and were somewhat larger for men than for women. The association persisted when the potential confounding effect of having a partner was taken into account. The gender of the child did not matter for the association between parenthood and mortality. CONCLUSIONS Having children is associated with increased longevity, particularly in an absolute sense in old age. That the association increased with parents' age and was somewhat stronger for the non-married may suggest that social support is a possible explanation.
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Affiliation(s)
- K Modig
- Epidemiology unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Talbäck
- Epidemiology unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Torssander
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - A Ahlbom
- Epidemiology unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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28
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J-Curve? A Meta-Analysis and Meta-Regression of Parity and Parental Mortality. POPULATION RESEARCH AND POLICY REVIEW 2016. [DOI: 10.1007/s11113-016-9421-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Shadyab AH, Gass MLS, Stefanick ML, Waring ME, Macera CA, Gallo LC, Shaffer RA, Jain S, LaCroix AZ. Maternal Age at Childbirth and Parity as Predictors of Longevity Among Women in the United States: The Women's Health Initiative. Am J Public Health 2016; 107:113-119. [PMID: 27854529 DOI: 10.2105/ajph.2016.303503] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine associations of maternal age at childbirth and parity with survival to age 90 years (longevity). METHODS We performed a prospective study among a multiethnic cohort of postmenopausal US women in the Women's Health Initiative recruited from 1993 to 1998 and followed through August 29, 2014. We adjusted associations with longevity for demographic, lifestyle, reproductive, and health-related characteristics. RESULTS Among 20 248 women (mean age at baseline, 74.6 years), 10 909 (54%) survived to age 90 years. The odds of longevity were significantly higher in women with later age at first childbirth (adjusted odds ratio = 1.11; 95% confidence interval = 1.02, 1.21 for age 25 years or older vs younger than 25 years; P for trend = .04). Among parous women, the relationship between parity and longevity was significant among White but not Black women. White women with 2 to 4 term pregnancies compared with 1 term pregnancy had higher odds of longevity. CONCLUSIONS Reproductive events were associated with longevity among women. Future studies are needed to determine whether factors such as socioeconomic status explain associations between reproductive events and longevity.
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Affiliation(s)
- Aladdin H Shadyab
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Margery L S Gass
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Marcia L Stefanick
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Molly E Waring
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Caroline A Macera
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Linda C Gallo
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Richard A Shaffer
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Sonia Jain
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
| | - Andrea Z LaCroix
- Aladdin H. Shadyab and Andrea Z. LaCroix are with the Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla. Margery L. S. Gass is with the North American Menopause Society, Emeritus, Cleveland, OH. Marcia L. Stefanick is with the Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA. Molly E. Waring is with the departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester. Caroline A. Macera and Richard A. Shaffer are with the Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA. Linda C. Gallo is with the Department of Psychology, San Diego State University. Sonia Jain is with the Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine
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Parity and serum lipid levels: a cross-sectional study in chinese female adults. Sci Rep 2016; 6:33831. [PMID: 27645134 PMCID: PMC5028753 DOI: 10.1038/srep33831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022] Open
Abstract
Reproductive factors have been shown to correlate with lipid metabolism. The aim of this study was to investigate the relationship between parity and serum lipid levels in community-based Chinese female adults. A total of 4,217 female participants were enrolled. Parity was recorded according to questionnaire and serum lipid profile, including triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), was measured. Logistic regression models were used to analyze the association of parity to serum lipid levels, while adjusting for demographics and metabolic risk factors. Parity in this population ranged from 0 to 7. After adjusting for potential confounders, it indicated that females with more than 2 parities appeared to be less likely to suffer from abnormal serum TC level compared with nulliparae (parity = 2, odds ratio (OR) = 0.457, 95% confidence interval (CI) = 0.284–0.736; parity ≥ 3, OR = 0.363, 95% CI = 0.202–0.653). These findings suggested that parity could correlate with lipid metabolism in Chinese women. Individuals with higher parity appeared to have a lower total cholesterol in blood.
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31
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Einiö E, Nisén J, Martikainen P. Number of children and later-life mortality among Finns born 1938-50. Population Studies 2016; 70:217-38. [PMID: 27362776 DOI: 10.1080/00324728.2016.1195506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938-50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50-72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless.
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Affiliation(s)
| | | | - Pekka Martikainen
- a University of Helsinki.,b University of Stockholm / Karolinska Institute.,c Max Planck Institute for Demographic Research
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32
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Zeng Y, Ni ZM, Liu SY, Gu X, Huang Q, Liu JA, Wang Q. Parity and All-cause Mortality in Women and Men: A Dose-Response Meta-Analysis of Cohort Studies. Sci Rep 2016; 6:19351. [PMID: 26758416 PMCID: PMC4725925 DOI: 10.1038/srep19351] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/08/2015] [Indexed: 11/09/2022] Open
Abstract
To quantitatively assess the association between parity and all-cause mortality, we conducted a meta-analysis of cohort studies. Relevant reports were identified from PubMed and Embase databases. Cohort studies with relative risks (RRs) and 95% confidence intervals (CIs) of all-cause mortality in three or more categories of parity were eligible. Eighteen articles with 2,813,418 participants were included. Results showed that participants with no live birth had higher risk of all-cause mortality (RR= 1.19, 95% CI = 1.03–1.38; I2 = 96.7%, P < 0.001) compared with participants with one or more live births. Nonlinear dose-response association was found between parity and all-cause mortality (P for non-linearity < 0.0001). Our findings suggest that moderate-level parity is inversely associated with all-cause mortality.
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Affiliation(s)
- Yun Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ze-min Ni
- Women and Children Medical Center of Jiang-an District, Wuhan, Hubei Province, China
| | - Shu-yun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xue Gu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qin Huang
- Department of Medical Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun-an Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Merritt MA, Riboli E, Murphy N, Kadi M, Tjønneland A, Olsen A, Overvad K, Dossus L, Dartois L, Clavel-Chapelon F, Fortner RT, Katzke VA, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Tumino R, Sacerdote C, Panico S, Bueno-de-Mesquita HB, Peeters PH, Lund E, Nakamura A, Weiderpass E, Quirós JR, Agudo A, Molina-Montes E, Larrañaga N, Dorronsoro M, Cirera L, Barricarte A, Olsson Å, Butt S, Idahl A, Lundin E, Wareham NJ, Key TJ, Brennan P, Ferrari P, Wark PA, Norat T, Cross AJ, Gunter MJ. Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study. BMC Med 2015; 13:252. [PMID: 26515238 PMCID: PMC4627614 DOI: 10.1186/s12916-015-0484-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/09/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Reproductive events are associated with important physiologic changes, yet little is known about how reproductive factors influence long-term health in women. Our objective was to assess the relation of reproductive characteristics with all-cause and cause-specific mortality risk. METHODS The analysis was performed within the European Investigation into Cancer and Nutrition prospective cohort study, which enrolled >500,000 women and men from 1992 to 2000, who were residing in a given town/geographic area in 10 European countries. The current analysis included 322,972 eligible women aged 25-70 years with 99 % complete follow-up for vital status. We assessed reproductive characteristics reported at the study baseline including parity, age at the first birth, breastfeeding, infertility, oral contraceptive use, age at menarche and menopause, total ovulatory years, and history of oophorectomy/hysterectomy. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality were determined using Cox proportional hazards regression models adjusted for menopausal status, body mass index, physical activity, education level, and smoking status/intensity and duration. RESULTS During a mean follow-up of 12.9 years, 14,383 deaths occurred. The HR (95 % CI) for risk of all-cause mortality was lower in parous versus nulliparous women (0.80; 0.76-0.84), in women who had ever versus never breastfed (0.92; 0.87-0.97), in ever versus never users of oral contraceptives (among non-smokers; 0.90; 0.86-0.95), and in women reporting a later age at menarche (≥15 years versus <12; 0.90; 0.85-0.96; P for trend = 0.038). CONCLUSIONS Childbirth, breastfeeding, oral contraceptive use, and a later age at menarche were associated with better health outcomes. These findings may contribute to the development of improved strategies to promote better long-term health in women.
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Affiliation(s)
- Melissa A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Neil Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Mai Kadi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
| | - Anja Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2 - Building 1260, DK-8000, Aarhus, Denmark.
| | - Laure Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France.
- Université Paris Sud, UMRS 1018, F-94805, Villejuif, France.
- Institut Gustave Roussy, F-94805, Villejuif, France.
| | - Laureen Dartois
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France.
- Université Paris Sud, UMRS 1018, F-94805, Villejuif, France.
- Institut Gustave Roussy, F-94805, Villejuif, France.
| | - Françoise Clavel-Chapelon
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France.
- Université Paris Sud, UMRS 1018, F-94805, Villejuif, France.
- Institut Gustave Roussy, F-94805, Villejuif, France.
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Verena A Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
| | - Antonia Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M Asias Street, Goudi GR-115 27, Athens, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M Asias Street, Goudi GR-115 27, Athens, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori", Via delle Oblate 4, 50141, Florence, Italy.
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP, Via Dante N° 109, 97100, Ragusa, Italy.
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital- University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy.
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, via Pansini 5, 80131, Naples, Italy.
| | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands.
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Heidelberglann 100, 3584, CX, Utrecht, The Netherlands.
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Huispost Str. 6.131, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika, N-9037, Tromsø, Norway.
| | - Aurelie Nakamura
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika, N-9037, Tromsø, Norway.
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika, N-9037, Tromsø, Norway.
- Department of Research, Cancer Registry of Norway, 0310, Oslo, Norway.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden.
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, FI-00290, Finland.
| | - J Ramón Quirós
- Public Health Directorate, Asturias, Ciriaco Miguel Vigil St, 9, 33006, Oviedo, Spain.
| | - Antonio Agudo
- Unit of Nutrition and Cancer, IDIBELL, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, 08908, Spain.
| | - Esther Molina-Montes
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs and Hospitales Universitarios de Granada/Universidad de Granada, Cuesta del Observatorio, 4, Campus Universitario de Cartuja, 18080, Granada, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Nerea Larrañaga
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Basque Health Department, Avenida de Navarra, 4-20013, Donostia San Sebastian, Spain.
| | - Miren Dorronsoro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Public Health Direction and Biodonostia-Ciberesp, Basque Regional Health Department, 01010, Vitoria, Spain.
| | - Lluís Cirera
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Ronda de Levante 11, 30008, Murcia, Spain.
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Navarre Public Health Institute, Leyre 15, 31003, Pamplona, Spain.
| | - Åsa Olsson
- Institute of Clinical Sciences, Malmö and Department of Surgery, Lund University, Skane University Hospital, SE-205 02, Malmö, Sweden.
| | - Salma Butt
- Institute of Clinical Sciences, Malmö and Department of Surgery, Lund University, Skane University Hospital, SE-205 02, Malmö, Sweden.
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE-901 87, Umeå, Sweden.
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, SE-901 87, Umeå, Sweden.
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, PO Box 285, Cambridge, CB2 0QQ, UK.
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Oxford, OX3 7LF, UK.
| | - Paul Brennan
- International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69372, Lyon, Cedex 08, France.
| | - Pietro Ferrari
- International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69372, Lyon, Cedex 08, France.
| | - Petra A Wark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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Parity and Cardiovascular Disease Mortality: a Dose-Response Meta-Analysis of Cohort Studies. Sci Rep 2015; 5:13411. [PMID: 26299306 PMCID: PMC4547137 DOI: 10.1038/srep13411] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022] Open
Abstract
Parity has been shown to inversely associate with cardiovascular disease (CVD) mortality, but the evidence of epidemiological studies is still controversial. Therefore, we quantitatively assessed the relationship between parity and CVD mortality by summarizing the evidence from prospective studies. We searched MEDLINE (PubMed), EMBASE and ISI Web of Science databases for relevant prospective studies of parity and CVD mortality through the end of March 2015. Fixed- or random-effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity among studies was assessed using the I2 statistics. All statistical tests were two-sided. Ten prospective studies were included with a total of 994,810 participants and 16,601 CVD events. A borderline significant inverse association was observed while comparing parity with nulliparous, with summarized RR = 0.79 (95% CI: 0.60–1.06; I2 = 90.9%, P < 0.001). In dose-response analysis, we observed a significant nonlinear association between parity number and CVD mortality. The greatest risk reduction appeared when the parity number reached four. The findings of this meta-analysis suggests that ever parity is inversely related to CVD mortality. Furthermore, there is a statistically significant nonlinear inverse association between parity number and CVD mortality.
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Song N, Choi JY, Sung H, Jeon S, Chung S, Song M, Park SK, Han W, Lee JW, Kim MK, Yoo KY, Ahn SH, Noh DY, Kang D. Tumor subtype-specific associations of hormone-related reproductive factors on breast cancer survival. PLoS One 2015; 10:e0123994. [PMID: 25875532 PMCID: PMC4397050 DOI: 10.1371/journal.pone.0123994] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE It is inconclusive whether reproductive factors, which are known as risk factors of breast cancer, also influence survival. We investigated overall and subtype-specific associations between reproductive factors and breast cancer survival. METHODS Among 3,430 incident breast cancer patients who enrolled in the Seoul Breast Cancer Study, 269 patients (7.8%) died and 528 patients (15.4%) recurred. The overall and subtype-specific associations of reproductive factors including age at menarche and menopause, duration of estrogen exposure, menstrual cycle, parity, age at first full-term pregnancy, number of children, age at last birth, time since the last birth, and duration of breastfeeding, on overall and disease-free survival (OS and DFS) were estimated by hazard ratios (HRs) and 95% confidence intervals (95% CIs) using a multivariate Cox proportional hazard model. RESULTS An older age at menarche (HR for OS=1.10, 95% CI=1.03-1.19), a greater number of children (≥ 4 vs. 2, HR for DFS=1.58, 95% CI=1.11-2.26), and a shorter time since last birth (<5 vs. ≥ 20 years, HR for DFS=1.67, 95% CI=1.07-2.62) were associated with worse survival while longer duration of estrogen exposure with better survival (HR for DFS=0.97, 95% CI=0.96-0.99). In the stratified analyses by subtypes, those associations were more pronounced among women with hormone receptor and human epidermal growth factor 2 positive (HR+ HER2+) tumors. CONCLUSIONS It is suggested that reproductive factors, specifically age at menarche, number of children, time since last birth, and duration of estrogen exposure, could influence breast tumor progression, especially in the HR+ HER2+ subtype.
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Affiliation(s)
- Nan Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Yeob Choi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Hyuna Sung
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Division of Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Sujee Jeon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seokang Chung
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Minkyo Song
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K. Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, University of Ulsan College of Medicine and ASAN Medical Center, Seoul, Korea
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Management, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
| | - Keun-Young Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sei-Hyun Ahn
- Department of Surgery, University of Ulsan College of Medicine and ASAN Medical Center, Seoul, Korea
| | - Dong-Young Noh
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Daehee Kang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jaffe D, Kogan L, Manor O, Gielchinsky Y, Dior U, Laufer N. Influence of late-age births on maternal longevity. Ann Epidemiol 2015; 25:387-91. [PMID: 25976022 DOI: 10.1016/j.annepidem.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To examine the association between the mother's age at last birth and maternal long-term survival. METHODS Data from three national censuses (1972, 1983, and 1995) and national birth and death records (1972-2009) were used to examine the association between age at last birth and mortality while accounting for potential confounders, such as parity. Age-adjusted mortality rates and Cox proportional hazard models were used in the analysis. RESULTS A total of 887 women who delivered their last child after 45 years of age were identified from among 178,507 women (1,592,379 person-years). Age-adjusted mortality rates from 55 years of age were highest for childless women (9.2 per 1000) and decreased linearly (P < .001) for parous women with increased age at last birth (5.2 per 1000 for women aged ≥45 years at last birth). In models adjusted for age at first birth and parity, mortality risks were lowest among parous women with late-age births (≥45 years) compared with parous women with their last births before 35 years of age (hazard ratio, 0.58; 95% confidence interval, 0.40-0.86). CONCLUSIONS This study provides new empirical evidence that late-age births are associated with maternal longevity, although a direct causal relation cannot be established with the information available.
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Affiliation(s)
- Dena Jaffe
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
| | - Liron Kogan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Gielchinsky
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Uri Dior
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel; Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Neri Laufer
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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Pathways from fertility history to later life health: Results from analyses of the English Longitudinal Study of Ageing. DEMOGRAPHIC RESEARCH 2015. [DOI: 10.4054/demres.2015.32.4] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Uggla C, Mace R. Someone to live for: effects of partner and dependent children on preventable death in a population wide sample from Northern Ireland. EVOL HUM BEHAV 2015; 36:1-7. [PMID: 25593513 PMCID: PMC4286120 DOI: 10.1016/j.evolhumbehav.2014.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/22/2014] [Indexed: 01/30/2023]
Abstract
How to allocate resources between somatic maintenance and reproduction in a manner that maximizes inclusive fitness is a fundamental challenge for all organisms. Life history theory predicts that effort put into somatic maintenance (health) should vary with sex, mating and parenting status because men and women have different costs of reproduction, and because life transitions such as family formation alter the fitness payoffs from investing in current versus future reproduction. However, few tests of how such life history parameters influence behaviours closely linked to survival exist. Here we examine whether specific forms of preventable death (accidents/suicides, alcohol-related causes, and other preventable diseases) are predicted by marital status and dependent offspring in a modern developed context; that of Northern Ireland. We predict that men, non-partnered individuals and individuals who do not have dependent offspring will be at higher risk of preventable death. Running survival analyses on the entire adult population (aged 16-59, n = 927,134) controlling for socioeconomic position (SEP) and other potential confounds, we find that being single (compared to cohabiting/married) increases risk of accidental/suicide death for men (but not for women), whereas having dependent children is associated with lower risk of preventable mortality for women but less so for men. We also find that the protective effect of partners is larger for men with low SEP than for high SEP men. Findings support life history predictions and suggest that individuals respond to variation in fitness costs linked to their mating and parenting status.
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Affiliation(s)
- Caroline Uggla
- Department of Anthropology, University College London, UK
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Silva VDL, Cesse EÂP, Albuquerque MDFPMD. Social determinants of death among the elderly: a systematic literature review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17 Suppl 2:178-93. [DOI: 10.1590/1809-4503201400060015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/12/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: This study aims at working on a systematic review of articles published on social determinants associated with the elderly mortality. METHODS: We searched articles published in Portuguese, English and Spanish language periodicals from January 1st 2007 to December 31st 2009, by means of Lilacs and Pubmed databases. Twenty cohort studies were identified, having most of them been developed in European, North-American and Asian countries. RESULTS: The articles analysed provided determinant social factors significantly associated with the elderly mortality: urban/rural and intercontinental variation, be part of ethnic minorities, financial stress, living conditions, schooling, social participation, gender and race discrimination, smoking, alcoholism, physical activities, instrumental activities of daily living, leisure, marital status, equality and healthy lifestyle. CONCLUSION: Mortality amongst the elderly is influenced by social determinants in many levels of reach, from determinants linked to lifestyle to socioeconomic macro-determinants. The actions on these determinants must be guided by the intersectorial perspective and regarded as a priority in the health sector, seeking to provide extended longevity with good quality of life for the population.
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Andersson G, Sobolev B. Small Effects of Selective Migration and Selective Survival in Retrospective Studies of Fertility: Faibles effets de sélection de la migration et de la mortalité sur la fécondité dans les études rétrospectives. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2013; 29:345-354. [PMID: 23956481 PMCID: PMC3744385 DOI: 10.1007/s10680-013-9293-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 11/24/2012] [Indexed: 11/27/2022]
Abstract
In this study, we assess the accuracy of fertility estimates that stem from the retrospective information that can be derived from an existing cross-sectional population. Swedish population registers contain information on the childbearing of all people ever registered as living in Sweden, and thus allow us to avoid problems of selectivity by the virtue of survival or nonemigration when estimating the fertility measures for previous calendar periods. We calculate two types of fertility rates for each year in 1961-1999: (i) rates that are based on the population that was living in Sweden at the end of 1999, and (ii) rates that also include information on people who had died or emigrated before the turn of the twentieth century. We find that the omission of information on individuals who had emigrated or died, as the situation would be in any demographic survey, most often have negligible effects on fertility measures. However, first-birth rates of immigrants gradually become more biased as we move back in time from 1999 so that they increasingly tend to over-estimate the true fertility of that population.
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Affiliation(s)
- Gunnar Andersson
- Department of Sociology, Stockholm University Demography Unit, SE-106 91 Stockholm, Sweden
| | - Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Dior UP, Hochner H, Friedlander Y, Calderon-Margalit R, Jaffe D, Burger A, Avgil M, Manor O, Elchalal U. Association between number of children and mortality of mothers: results of a 37-year follow-up study. Ann Epidemiol 2012. [PMID: 23176782 DOI: 10.1016/j.annepidem.2012.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the association between parity and long-term, all-cause mortality and mortality owing to specific causes in women. METHODS This prospective population-based study included 40,454 mothers who gave birth in Western Jerusalem, Israel, to 125,842 children and were followed for an average of 37 years after the birth of their first child. Cox proportional hazards models were used to evaluate long-term total and specific-cause mortality of women by their parity. RESULTS We found a U-shaped relationship between the number of offspring and risk of all-cause mortality in mothers. After adjustment for sociodemographic characteristics and maternal health and obstetric conditions, higher mortality rates were observed for mothers of 1 child (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.04-1.4), mothers of 5 to 9 children (HR, 1.21; 95% CI, 1.09-1.33), and mothers of 10 or more children (HR, 1.49; 95% CI, 1.12-1.99) compared with mothers of 2 to 4 children. Mortality risk from specific causes including coronary disease, circulatory disease, and cancer were increased for multiparous women. CONCLUSIONS In this long-term follow-up study, there was an association between number of children and mortality risk for mothers. These findings suggest that maternal pregnancies and postnatal characteristics as reflected by number of children may have consequences for long-term maternal health.
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Affiliation(s)
- Uri P Dior
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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Simons LA, Simons J, Friedlander Y, McCallum J. Childbearing history and late-life mortality: the Dubbo study of Australian elderly. Age Ageing 2012; 41:523-8. [PMID: 22459707 DOI: 10.1093/ageing/afs016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE to examine the association of parity with mortality in later life. DESIGN a longitudinal, community-based study. SETTING semi-rural town of Dubbo, NSW, Australia. SUBJECTS a total of 1,571 women and 1,233 men 60 years and older first examined in 1988-89. OUTCOME MEASURES all-cause and cause-specific mortality rates analysed over 16-year follow-up. Hazard ratios obtained from proportional hazards models employing conventional predictors, potential confounders and measure of parity. RESULTS increasing parity in women was weakly associated with overweight, diabetes and hypertension. All-cause mortality fell progressively with increasing parity in women (hazard ratio and 95% confidence intervals): childless, 1.00; 1 child, 1.03 (0.75-1.43); 2 children, 0.83 (0.61-1.11); 3 children, 0.80 (0.60-1.08); 4 children, 0.91 (0.66-1.25); 5 children, 0.70 (0.49-1.01); 6+ children, 0.60 (0.43-0.85) (trend for parity P<0.002). This result was similar whether or not hypertension, diabetes and overweight were included in multivariate models adjusting for social variables and other confounders. The reduction in all-cause mortality was accompanied by a parallel reduction in deaths from cancer and respiratory conditions, while coronary heart disease mortality increased 60-111% in all parous women. CONCLUSION there was increased all-cause mortality in later life in childless women, accompanied by reduced mortality as parity increased. Underlying mechanisms are unclear but findings may have public health importance.
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Affiliation(s)
- Leon A Simons
- Lipid Department, St Vincent's Hospital, University of NSW, Sydney, New South Wales, Australia.
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Tamakoshi A, Ikeda A, Fujino Y, Tamakoshi K, Iso H. Multiple roles and all-cause mortality: the Japan Collaborative Cohort Study. Eur J Public Health 2012; 23:158-64. [PMID: 22241757 DOI: 10.1093/eurpub/ckr194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two contrasting perspectives on the effects of multiple roles; the 'role overload hypothesis' and the 'role enhancement model', have been proposed to predict variations in health. The aim of this study was to evaluate the impact of multiple roles on all-cause mortality in Japan where gender roles are currently changing. METHODS A total of 76,758 individuals from the Japan Collaborative Cohort Study were followed for an average of 15.7 years. Hazard ratios (HRs) with 95% confidence intervals were calculated from proportional hazard models to estimate the risk of all-cause mortality according to multiple roles (spouse, parent and worker, and combinations of these roles). RESULTS After adjusting for potential confounding factors, the risks of all-cause mortality were elevated among men and women without a role. The number of roles was also associated with all-cause mortality risk, showing the highest risk values among those with no roles compared with those with triple roles (HR: 1.66 in men and 1.78 in women). The impact of the lack of a role was generally greater in men than in women and also in the middle-aged than in the elderly. CONCLUSION A beneficial effect of multiple roles was suggested among Japanese. The fewer roles they had, the higher all-cause mortality risks were observed. The risk values of those with fewer roles were generally higher in men than in women and also in the middle-aged than in the elderly, partially explained by greater role overload in middle-aged women than other groups in Japan.
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Affiliation(s)
- Akiko Tamakoshi
- Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan.
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Hofman A, van Duijn CM, Franco OH, Ikram MA, Janssen HLA, Klaver CCW, Kuipers EJ, Nijsten TEC, Stricker BHC, Tiemeier H, Uitterlinden AG, Vernooij MW, Witteman JCM. The Rotterdam Study: 2012 objectives and design update. Eur J Epidemiol 2011; 26:657-86. [PMID: 21877163 PMCID: PMC3168750 DOI: 10.1007/s10654-011-9610-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 01/09/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Jacobsen BK, Knutsen SF, Oda K, Fraser GE. Parity and total, ischemic heart disease and stroke mortality. The Adventist Health Study, 1976-1988. Eur J Epidemiol 2011; 26:711-8. [PMID: 21701914 PMCID: PMC3186890 DOI: 10.1007/s10654-011-9598-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 06/11/2011] [Indexed: 11/30/2022]
Abstract
In a prospective study with information about life style and reproductive factors, we assessed the relationship between parity and total, ischemic heart disease, and stroke mortality. The large majority of the 19,688 California Seventh-day Adventist women included did not smoke or drink alcohol, 31 percent never ate meat and physical activity was relatively high. Cox proportional hazard analysis was conducted with parity as the main independent variable and with adjustment for a number of other possible confounders. During follow-up from 1976 through 1988, there were 3,122 deaths; 782 deaths from ischemic heart disease and 367 deaths due to stroke. There were no relationships between parity and total mortality (P-value for overall effect of parity = 0.32). Grand multiparous women (>4 children) had somewhat increased ischemic heart disease mortality (MRR = 1.45, 95% CI: 1.15, 1.84) before adjustment for educational level. After adjustment for educational level and marital status, there were no relationship with mortality from ischemic heart disease (P = 0.29) or stroke (P = 0.72). In parous women, there were, after adjustment for age at first delivery, some suggestions of an increased total mortality in women with one child. For ischemic heart disease and stroke mortality, no associations were found. Stratified and adjusted analyses confirmed these results. Thus, we found no consistent relationships between parity and total, ischemic heart disease or stroke mortality. However, a longer follow-up would have been helpful and the conclusions may be somewhat influenced by the lifestyle of the women included.
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Vandenheede H, Deboosere P, Gadeyne S, De Spiegelaere M. The associations between nationality, fertility history and diabetes-related mortality: a retrospective cohort study in the Brussels-Capital Region (2001-2005). J Public Health (Oxf) 2011; 34:100-7. [PMID: 21665909 DOI: 10.1093/pubmed/fdr045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The relationship between women's parity and diabetes mortality has been investigated in several studies, with mixed results. This study aims to establish if parity and age at first birth are associated with diabetes-related mortality and if these factors contribute to variations in diabetes-related mortality among women with different nationalities. METHODS Data of the 2001 census are linked to registration records of all deaths and emigrations (period 2001-2005). The study population comprises all female inhabitants of the Brussels-Capital Region aged 45-74 of either Belgian or North African nationality (n = 108 296). Age-standardized mortality rates (direct standardization) and mortality rate ratios (Poisson's regression) are computed. RESULTS Both parity and age at first birth are associated with diabetes-related mortality. Highest risks of dying from diabetes are observed among grandmultiparous women and teenage mothers. Differences in diabetes-related mortality according to nationality are observed. Age-standardized diabetes mortality rates are higher in North African [ASMR = 417.4/100,000; 95% confidence interval (CI) 227.2-607.7] than in Belgian women (ASMR = 184.0/100,000; 95% CI 157.3-210.8). Taking parity, age at first birth and education into account, these differences largely disappear. CONCLUSIONS Reproductive factors are associated with diabetes-related mortality and play an important part in the higher diabetes-related mortality of North African compared with Belgian women.
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Affiliation(s)
- Hadewijch Vandenheede
- Vrije Universiteit Brussel, Department of Social Research, Interface Demography, Brussels 1050, Belgium.
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Keizer R, Dykstra PA, van Lenthe FJ. Parity and men's mortality risks. Eur J Public Health 2011; 22:343-7. [DOI: 10.1093/eurpub/ckr024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The Shanghai Changfeng Study: a community-based prospective cohort study of chronic diseases among middle-aged and elderly: objectives and design. Eur J Epidemiol 2010; 25:885-93. [PMID: 21120588 DOI: 10.1007/s10654-010-9525-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 11/18/2010] [Indexed: 12/14/2022]
Abstract
The Shanghai Changfeng Study is a community-based prospective cohort study of chronic diseases ongoing since February 2009 in Shanghai, China. The study focuses on multiple chronic diseases, including obesity and metabolic syndrome, diabetes, osteoporosis, liver diseases, cardiovascular diseases and neurologic diseases. 15,000 subjects of 40 years or over are planned to be recruited. The rationale, objectives and design of this study are described in this paper.
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Tamakoshi A, Tamakoshi K, Lin Y, Mikami H, Inaba Y, Yagyu K, Kikuchi S. Number of children and all-cause mortality risk: results from the Japan Collaborative Cohort Study. Eur J Public Health 2010; 21:732-7. [DOI: 10.1093/eurpub/ckq175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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