Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study

BMC Medicine

Marc J. Gunter³  Amanda J. Cross³  Teresa Norat³  Petra A. Wark³  Pietro Ferrari⁵  Paul Brennan⁵  Timothy J. Key^2,21  Nicholas J. Wareham¹  Eva Lundin^2,20  Annika Idahl^2,28  Salma Butt⁴  Åsa Olsson⁴  Aurelio Barricarte^2,24  Lluís Cirera^1,10  Miren Dorronsoro^2,23  Nerea Larrañaga^2,25  Esther Molina-Montes⁶  Antonio Agudo⁹  J. Ramón Quirós^1,18  Elisabete Weiderpass^1,13  Aurelie Nakamura⁷  Eiliv Lund⁷  Petra H. Peeters^2,26  H. Bas Bueno-de-Mesquita^2,22  Salvatore Panico^1,19  Carlotta Sacerdote^1,14  Rosario Tumino²  Sabina Sieri^1,12  Domenico Palli^1,17  Dimitrios Trichopoulos^3,30  Pagona Lagiou^2,27  Antonia Trichopoulou^3,30  Heiner Boeing^1,11  Verena A. Katzke^1,15  Renée T. Fortner^1,15  Françoise Clavel-Chapelon^1,16  Laureen Dartois^1,16  Laure Dossus^1,16  Kim Overvad⁸  Anja Olsen^2,29  Anne Tjønneland^2,29  Mai Kadi³  Neil Murphy³  Elio Riboli³  Melissa A. Merritt³ 

[1] MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;Cancer Registry and Histopathology Unit, “Civic – M.P.Arezzo” Hospital, ASP, Via Dante N° 109, Ragusa, 97100, Italy;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK;Institute of Clinical Sciences, Malmö and Department of Surgery, Lund University, Skane University Hospital, Malmö, SE-205 02, Sweden;International Agency for Research on Cancer, 150 Cours Albert-Thomas, Lyon, 69372, Cedex 08, France;CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid, 28029, Spain;Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika N-9037, Tromsø, Norway;Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2 – Building 1260, Aarhus, DK-8000, Denmark;Unit of Nutrition and Cancer, IDIBELL, Catalan Institute of Oncology-ICO, L’Hospitalet de Llobregat, Barcelona 08908, Spain;Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Ronda de Levante 11, Murcia, 30008, Spain;Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, Nuthetal, 14558, Germany;Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, Milan, 20133, Italy;Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki FI-00290, Finland;Unit of Cancer Epidemiology, Citta’ della Salute e della Scienza Hospital- University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, Turin, 10126, Italy;Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany;Institut Gustave Roussy, Villejuif, F-94805, France;Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Ponte Nuovo Palazzina 28 A “Mario Fiori”, Via delle Oblate 4, Florence, 50141, Italy;Public Health Directorate, Asturias, Ciriaco Miguel Vigil St, 9, Oviedo, 33006, Spain;Dipartimento di Medicina Clinica e Chirurgia, Federico II University, via Pansini 5, Naples, 80131, Italy;Department of Medical Biosciences, Pathology, Umeå University, Umeå, SE-901 87, Sweden;Cancer Epidemiology Unit, Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Oxford OX3 7LF, UK;Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia;Public Health Direction and Biodonostia-Ciberesp, Basque Regional Health Department, Vitoria, 01010, Spain;Navarre Public Health Institute, Leyre 15, Pamplona, 31003, Spain;Public Health Division of Gipuzkoa, BIODonostia Research Institute, Basque Health Department, Avenida de Navarra, Donostia San Sebastian, 4-20013, Spain;Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Huispost Str. 6.131, Utrecht, 3508, GA, The Netherlands;Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston 02115, MA, USA;Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, SE-901 87, Sweden;Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, DK-2100, Denmark;Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece

关键词: Parity;    Oral contraceptives;    Mortality;    Breastfeeding;    Age at menopause;    Age at menarche;   

Others  :  1231074
DOI  :  10.1186/s12916-015-0484-3

 received in 2015-05-20, accepted in 2015-09-09,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Merritt et al.

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