1
|
Knight AK, Spencer JB, Smith AK. DNA methylation as a window into female reproductive aging. Epigenomics 2024; 16:175-188. [PMID: 38131149 PMCID: PMC10841041 DOI: 10.2217/epi-2023-0298] [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: 08/24/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
People with ovaries experience reproductive aging as their reproductive function and system declines. This has significant implications for both fertility and long-term health, with people experiencing an increased risk of cardiometabolic disorders after menopause. Reproductive aging can be assessed through markers of ovarian reserve, response to fertility treatment or molecular biomarkers, including DNA methylation. Changes in DNA methylation with age associate with poorer reproductive outcomes, and epigenome-wide studies can provide insight into genes and pathways involved. DNA methylation-based epigenetic clocks can quantify biological age in reproductive tissues and systemically. This review provides an overview of hallmarks and theories of aging in the context of the reproductive system, and then focuses on studies of DNA methylation in reproductive tissues.
Collapse
Affiliation(s)
- Anna K Knight
- Research Division, Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jessica B Spencer
- Reproductive Endocrinology & Infertility Division, Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Alicia K Smith
- Research Division, Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Reproductive Endocrinology & Infertility Division, Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| |
Collapse
|
2
|
Girschik C, Stolpe S, Kowall B. Association between number of children and incident heart disease and stroke in parents - results from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Public Health 2023; 23:2324. [PMID: 37996848 PMCID: PMC10668373 DOI: 10.1186/s12889-023-17254-7] [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: 03/24/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND In former studies, parity was associated with adverse cardiovascular outcomes in parents. This study aims to extend the limited existing data regarding the association between the number of children and heart disease and/or stroke in a large longitudinal study in different European countries in both men and women. METHODS For 42 075 subjects (18 080 men, 23 995 women; median age 58 years (interquartile range: 53 to 65)) from 19 European countries and Israel in the Survey of Health, Ageing and Retirement in Europe (SHARE), odds ratios (OR) for the association between number of children and incident self-reported heart disease and/or stroke (HDS) were estimated using logistic regression analyses. Persons with one or two children were used as reference. The final model was adjusted for baseline age, sex, education, region, and marital status. All analyses were stratified by sex. RESULTS Women with seven or more children had the highest OR for the association between the number of children and incident HDS (OR = 2.12 [95% CI: 1.51 to 2.98]), while men with six children showed the highest OR (OR = 1.62 [1.13 to 2.33]). Stratified by education, across all education levels, men and women with five or more children had the highest ORs for this association. The highest OR was observed in both women and men in the group with primary education (OR = 1.66 [1.29 to 2.15] and OR = 1.60 [1.19 to 2.14], respectively). Stratified by region, both men and women with five or more children showed the highest ORs in Southern Europe (OR = 2.07 [1.52 to 2.82] and OR = 1.75 [1.25 to 2.44], respectively). CONCLUSION In this long-term follow-up study in various countries in Europe and Israel we found a positive association between number of children and incident HDS. This association was more pronounced in lower educated subjects and showed regional variations.
Collapse
Affiliation(s)
- Carolin Girschik
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Susanne Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Bernd Kowall
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany
| |
Collapse
|
3
|
Dudeney E, Coates R, Ayers S, McCabe R. Measures of suicidality in perinatal women: A systematic review. J Affect Disord 2023; 324:210-231. [PMID: 36584713 DOI: 10.1016/j.jad.2022.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
Collapse
Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK.
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rose McCabe
- Centre for Mental Health Research, School of Health and Psychological Sciences, University of London, UK
| |
Collapse
|
4
|
A Prospective Study of Severe Acute Maternal Morbidity and Maternal Near Miss in a Tertiary Care Hospital. J Obstet Gynaecol India 2022; 72:19-25. [PMID: 35928071 PMCID: PMC9343556 DOI: 10.1007/s13224-021-01514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022] Open
Abstract
Background The identification of severe cases of maternal morbidity has emerged as an approach to mitigating maternal deaths. The main objective of the study was to analyse the causes of (severe acute maternal morbidity) SAMM and maternal (near miss) NM among pregnant women and the associated risk factors. Methods The study was conducted on pregnant women (n = 300) who were diagnosed as SAMM (n = 269) and NM (n = 31). Patient details including age, parity, gestational age at admission, antenatal history, morbidity conditions, mode of delivery, and ICU admission with life-saving medical and surgical interventions were recorded. Multinomial logistic regression analysis was performed to assess the risk factors associated with SAMM and NM. Results The most common cause of maternal death was hemorrhage. The maternal NM incidence ratio was 11.58/1000 live births, maternal NM mortality ratio was 2.5:1, and the mortality index was 3.8% with SAMM and NM and 27% with life-threatening complications.Women with low education status, multiparity, third trimester and postpartum period, suboptimal antenatal visits, and a lack of awareness were at increased risk of SAMM and NM. Conclusion This study adds on to the existing knowledge of SAMM and NM highlighting the need of early diagnosis and need of overall improvement in quality critical care management for maternal health and its timely accessibility to substantially reduce maternal deaths. Active management of third-stage of labor, early recognition and emergency management of severe hypertension widely contribute toward reducing the number of both SAMM and NM.
Collapse
|
5
|
Pihlman J, Magnussen CG, Rovio SP, Pahkala K, Jokinen E, Laitinen TP, Hutri-Kähönen N, Tossavainen P, Taittonen L, Kähönen M, Viikari JSA, Raitakari OT, Juonala M, Nuotio J. Association between Number of Siblings and Cardiovascular Risk Factors in Childhood and in Adulthood: The Cardiovascular Risk in Young Finns Study. J Pediatr 2021; 237:87-95.e1. [PMID: 34087153 DOI: 10.1016/j.jpeds.2021.05.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/19/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the association of number of siblings on cardiovascular risk factors in childhood and in adulthood. STUDY DESIGN In total, 3554 participants (51% female) from the Cardiovascular Risk in Young Finns Study with cardiovascular disease risk factor data at baseline 1980 (age 3-18 years) and 2491 participants with longitudinal risk factor data at the 2011 follow-up. Participants were categorized by number of siblings at baseline (0, 1, or more than 1). Risk factors (body mass index, physical activity, hypertension, dyslipidemia, and overweight, and metabolic syndrome) in childhood and in adulthood were used as outcomes. Analyses were adjusted for age and sex. RESULTS In childhood, participants without siblings had higher body mass index (18.2 kg/m2, 95% CI 18.0-18.3) than those with 1 sibling (17.9 kg/m2, 95% CI 17.8-18.0) or more than 1 sibling (17.8 kg/m2, 95% CI 17.7-17.9). Childhood physical activity index was lower among participants without siblings (SD -0.08, 95% CI -0.16-0.00) compared with participants with 1 sibling (SD 0.06, 95%CI 0.01-0.11) or more than 1 sibling (SD -0.02, 95% CI -0.07-0.03). OR for adulthood hypertension was lower among participants with 1 sibling (OR 0.73, 95% CI 0.54-0.98) and more than 1 sibling (OR 0.71, 95% CI 0.52-0.97) compared with participants with no siblings. OR for obesity was lower among participants with 1 sibling (OR 0.72, 95% CI 0.54-0.95) and more than 1 sibling (OR 0.75, 95% CI 0.56-1.01) compared with those with no siblings. CONCLUSIONS Children without siblings had poorer cardiovascular risk factor levels in childhood and in adulthood. The number of siblings could help identify individuals at increased risk that might benefit from early intervention.
Collapse
Affiliation(s)
- Jukka Pihlman
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
| | - Costan G Magnussen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Suvi P Rovio
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Katja Pahkala
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Paavo Nurmi Center, Sports and Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
| | - Eero Jokinen
- Department of Paediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Leena Taittonen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland; Vaasa Central Hospital, Vaasa, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma S A Viikari
- Department of Internal Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Joel Nuotio
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Dehara M, Wells MB, Sjöqvist H, Kosidou K, Dalman C, Sörberg Wallin A. Parenthood is associated with lower suicide risk: a register-based cohort study of 1.5 million Swedes. Acta Psychiatr Scand 2021; 143:206-215. [PMID: 33011972 PMCID: PMC7983926 DOI: 10.1111/acps.13240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether parenthood among 25- to 44-year-olds is associated with a lower suicide rate in men and women in Sweden, and whether this is explained by selection into parenthood. METHODS In total, 1,582,360 Swedish women and men, born between 1967 and 1985, and childless at their 25th birthday, were followed from 1992 to 2011. All data originated from linkage to national Swedish registers. Cox regression models were used with time-varying parenthood status to estimate adjusted hazard ratios and 95% confidence intervals (aHR;CI) for suicide. RESULTS Having one, two, three or more children was associated with 64%, 79% and 78% lower suicide rate, respectively, compared with having no children, in models with basic adjustments. When a wide range of indicators of selection into parenthood were taken into account, the suicide rate was 58% lower in parents with one child and 70% lower in parents with two or more children compared with childless individuals (aHR 0.42 [95% CI 0.36-0.48]; 0.30 [95% CI 0.25-0.35]; 0.30 [95% CI 0.21-0.42]). In fathers with one, two, three or more children suicide rate was 54%, 64% and 59% lower, respectively, compared with non-fathers whereas in mothers was 70%, 83% and 93% lower, respectively, compared with non-mothers. CONCLUSION Parenthood among 25-to 44-year-olds is associated with a lower suicide risk in both men and women but to a larger extent among women, and particularly in parents with two or more children. Although selection into parenthood is possible, a protective effect of parenthood on suicide is likely in both men and women.
Collapse
Affiliation(s)
- Marina Dehara
- Clinical Epidemiology DivisionDepartment of Medicine SolnaKarolinska InstitutetStockholmSweden,Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Michael B. Wells
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Hugo Sjöqvist
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Kyriaki Kosidou
- Department of Global Public HealthKarolinska InstitutetStockholmSweden,Centre for Epidemiology and Community MedicineRegion StockholmStockholmSweden
| | - Christina Dalman
- Department of Global Public HealthKarolinska InstitutetStockholmSweden,Centre for Epidemiology and Community MedicineRegion StockholmStockholmSweden
| | | |
Collapse
|
8
|
Moazzeni SS, Toreyhi H, Asgari S, Azizi F, Tehrani FR, Hadaegh F. Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up. BMC Pregnancy Childbirth 2021; 21:28. [PMID: 33413159 PMCID: PMC7792076 DOI: 10.1186/s12884-020-03499-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women. Methods In this population-based cohort study, which included 3929 women and 2571 men aged ≥30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors. Results During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariable analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01–1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97–3.56, p-value = 0.061). Among men, in comparison with participants who had 1 child, multivariable HRs of having 2, 3, and ≥ 4 children were 1.97 (1.24–3.12), 2.08 (1.31–3.31), and 2.08 (1.30–3.34), respectively. Conclusion To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03499-2.
Collapse
Affiliation(s)
- Seyyed Saeed Moazzeni
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders 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
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
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]
|
10
|
Female reproductive factors and risk of external causes of death among women: The Japan Public Health Center-based Prospective Study (JPHC Study). Sci Rep 2019; 9:14329. [PMID: 31586153 PMCID: PMC6778214 DOI: 10.1038/s41598-019-50890-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023] Open
Abstract
Although empirical data suggest a possible link between female reproductive events and risk of nonfatal accidents and suicidal behaviors, evidence to determine these effects on mortality is scarce. This study investigated the association between female reproductive factors and the risk of external causes of death among middle-aged Japanese women. We used a population-based cohort study consisting of 71 698 women residing in 11 public health center areas across Japan between 1990 and 1994. Multivariable-adjusted Cox proportional hazard regression models were used to estimate hazard ratios (HRs) of the risk of all external causes, suicide, and accidents according to female reproductive factors at the baseline survey. During 1 028 583 person-years of follow-up for 49 279 eligible subjects (average 20.9 years), we identified 328 deaths by all injuries. Among parous women, ever versus never breastfeeding [0.67 (95% CI: 0.49–0.92)] was associated with a decreased risk of all injuries. Risk of suicide was inversely associated with ever versus never parity [0.53 (95% CI: 0.32–0.88)]. A lower risk of death by accidents was seen in ever breastfeeding [0.63 (95% CI: 0.40–0.97)] compared to never breastfeeding. This study suggests that parity and breastfeeding are associated with reduced risk of death by all external causes, suicide and/or accidents among Japanese women.
Collapse
|
11
|
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
| |
Collapse
|
12
|
The association between intake of dietary lycopene and other carotenoids and gestational diabetes mellitus risk during mid-trimester: a cross-sectional study. Br J Nutr 2019; 121:1405-1412. [DOI: 10.1017/s0007114519000606] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractThis study aimed to determine whether increased carotenoids intake was associated with reduced risk of gestational diabetes mellitus (GDM). We performed a cross-sectional analysis using data from Tongji Maternal and Child Health Cohort study. The dietary carotenoids intake of 1978 pregnant women was assessed using a researcher-administered FFQ before undertaking an oral glucose tolerance test at 24–28 weeks. Multivariate logistic and linear regression analyses were used to obtain the effect estimates. Participants in the highest quartile of lycopene intake showed a lower risk of GDM (OR 0·50; 95 % CI 0·29, 0·86; Pfor trend = 0·007) compared with those in the lowest quartile; each 1 mg increase in lycopene consumption was associated with a 5 % (95 % CI 0·91, 0·99; Pfor trend = 0·020) decrease in GDM risk. No significant association was found between α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin intake and GDM risk. Multiple linear regression analysis suggested an inverse association between lycopene intake and fasting blood glucose (FBG) (Pfor trend < 0·001); each 1 mg increase in lycopene intake was associated with 0·005 (95 % CI 0·002, 0·007; Pfor trend < 0·001) mmol/l decrease in FBG. Interaction analysis indicated consistent effect on each age or pre-BMI subgroup; however, a stronger protective effect of lycopene intake against GDM was observed among primigravid women (OR 0·20; 95 % CI 0·07, 0·55 in the highest v. the lowest quartile of intake; Pfor interaction = 0·036). In conclusion, dietary lycopene intake was mainly assumed via reducing FBG to decrease GDM risk, and the protection was relatively increased among primigravid women.
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Solanke BL, Banjo OO, Oyinloye BO, Asa SS. Maternal grand multiparity and intention to use modern contraceptives in Nigeria. BMC Public Health 2018; 18:1207. [PMID: 30373559 PMCID: PMC6206733 DOI: 10.1186/s12889-018-6130-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Grand multiparity and low contraceptive prevalence are dominant among Nigerian women. These elevate the risk of unintended pregnancies, high-risk fertility and adverse maternal and child health outcomes among women in the country, particularly grand multiparous women. Studies have examined predictors of intention to use modern contraceptives among women of reproductive age. However, these studies did not ascertain the extent to which grand multiparity is associated with intention to use modern contraceptives. This study examined association between grand multiparity and intention to use modern contraceptives in Nigeria. METHODS The study pooled data from 2003 to 2013 Nigeria Demographic and Health Surveys. The weighted sample size analysed was 34,302 women. The outcome variable was intention to use contraceptive. The main explanatory variable was parity with specific attention to grand multiparity. Unadjusted multinomial logistic regression coefficients were used to examine association between specific explanatory or control variables and intention to use contraceptives while the adjusted multinomial logistic regression was applied to further examine associated factors of intention to use contraceptives relative to being uncertain about future contraceptive use. Four multinomial logistic regression models were fitted using Stata 14. RESULTS More than half of respondents do not intend to use contraceptives, while less than one-fifth of respondents intend to use contraceptives in the future. Across the four fitted models, the relative risks of intention to use compared with being uncertain about future contraceptive use were significantly lower among grand multiparous women. Results further revealed pregnancy termination, fertility planning status, exposure to mass media family planning messages, knowledge of modern contraceptives, ideal family size, remarriage, household power relations, and maternal education as other key factors influencing expected risk of intention to use contraceptives relative to being uncertain about future contraceptive use. CONCLUSION Maternal grand multiparity is significantly associated with intention to use contraceptives among women in Nigeria. The development of a specific population and health programme to target grand multiparous women is imperative in the country. Such programme could be integrated into existing national family planning programme through specific contraceptive education, counselling and information for high parous women.
Collapse
Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Bosede Odunola Oyinloye
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Soladoye Sunday Asa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
15
|
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]
|
16
|
Number of Offspring and Cardiovascular Disease Risk in Men and Women: The Role of Shared Lifestyle Characteristics. Epidemiology 2018; 28:880-888. [PMID: 28696997 PMCID: PMC5625954 DOI: 10.1097/ede.0000000000000712] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Previous studies of the number of offspring and cardiovascular disease (CVD) report conflicting findings. We re-examined this association in both sexes to clarify the role of the cardiometabolic changes that women experience during pregnancy versus shared lifestyle characteristics. Methods: We studied 180,626 women and 133,259 men participating in the UK Biobank cohort who were free of CVD at baseline. CVD events were obtained from hospital and death registers. Analyses were conducted using Cox proportional hazards regression. Results: The incidence rates of overall CVD were six per 1000 person-years for women and nine per 1000 person-years for men. Number of children showed an association with risk of CVD among women; the adjusted HR (95% CI) was 1.2 (1.1, 1.3) for one, 1.1 (1.0, 1.2) for two, 1.2 (1.1, 1.3) for three, and 1.2 (1.1, 1.4) for four or more as compared to none. Number of children was also associated with CVD among men; the adjusted HR (95% CI) was 1.1 (1.0, 1.2) for one, 1.0 (0.96, 1.1) for two, 1.1 (1.0, 1.2) for three, and 1.1 (1.0, 1.3) for four or more as compared to none. There was no evidence of heterogeneity in the associations between sexes (Pinteraction = 0.80). Number of offspring also showed similar associations with ischemic heart disease and hypertensive disorders in both sexes. Conclusions: We observed similar associations between number of offspring and CVD in both sexes. The association among women might therefore be largely explained by unobserved behavioral and lifestyle characteristics.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Reproductive Investment and Health Costs in Roma Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111337. [PMID: 29099752 PMCID: PMC5707976 DOI: 10.3390/ijerph14111337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/12/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022]
Abstract
In this paper, we examine whether variation in reproductive investment affects the health of Roma women using a dataset collected through original anthropological fieldwork among Roma women in Serbia. Data were collected in 2014–2016 in several Roma semi-urban settlements in central Serbia. The sample consisted of 468 Roma women, averaging 44 years of age. We collected demographic data (age, school levels, socioeconomic status), risk behaviors (smoking and alcohol consumption), marital status, and reproductive history variables (the timing of reproduction, the intensity of reproduction, reproductive effort and investment after birth), in addition to self-reported health, height, and weight. Data analyses showed that somatic, short-term costs of reproduction were revealed in this population, while evolutionary, long-term costs were unobservable—contrariwise, Roma women in poor health contributed more to the gene pool of the next generation than their healthy counterparts. Our findings appear to be consistent with simple trade-off models that suggest inverse relationships between reproductive effort and health. Thus, personal sacrifice—poor health as an outcome—seems crucial for greater reproductive success.
Collapse
|
19
|
Aggarwal SR, Herrington DM, Vladutiu CJ, Newman JC, Swett K, Gonzalez F, Kizer JR, Kominiarek MA, Tabb KM, Gallo LC, Talavera GA, Hurwitz BE, Rodriguez CJ. Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos. Open Heart 2017; 4:e000530. [PMID: 28674618 PMCID: PMC5471863 DOI: 10.1136/openhrt-2016-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education. Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.
Collapse
Affiliation(s)
| | | | | | - Jill C Newman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katrina Swett
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen M Tabb
- University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Linda C Gallo
- San Diego State University, San Diego, California, USA
| | | | | | | |
Collapse
|
20
|
Peters SAE, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Wang S, Yang L, Hu Y, Liu J, Wang T, Chen J, Peto R, Li L, Woodward M, Chen Z. Parenthood and the risk of cardiovascular diseases among 0.5 million men and women: findings from the China Kadoorie Biobank. Int J Epidemiol 2017; 46:180-189. [PMID: 27649806 PMCID: PMC5837253 DOI: 10.1093/ije/dyw144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background Women's parity has been associated with risk of cardiovascular disease (CVD). It is unclear, however, whether it reflects biological effects of childbearing or uncontrolled socio-economic and lifestyle factors associated with childrearing. We assessed the association between number of children and incident CVD outcomes separately in women and men. Methods In 2004-08, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 years from 10 diverse regions. During 7 years of follow-up, 24 432 incident cases of coronary heart disease (CHD) and 35 736 of stroke were recorded among 489 762 individuals without prior CVD. Multivariable Cox regression models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD and stroke associated with number of children. Results Overall, 98% of all participants had children and the mean number of children declined progressively from four in older participants to one or two in younger participants. Compared with childless women, women with children had an increased risk of CHD, but not of stroke [HR (95% CI): 1.14 (1.00; 1.30) and 1.03 (0.92; 1.16)]. Corresponding results for men were 1.20 (1.06; 1.35) and 1.13 (1.03; 1.24), respectively. In individuals with children, there was a log-linear association between number of children and CVD outcomes; in women, each additional child was associated with adjusted HRs of 1.02 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke, similar in magnitude to that in men [1.03 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke]. Conclusion In Chinese adults, the association between the number of children and risk of CHD and stroke was similar between men and women, suggesting that factors associated with parenthood and childrearing are more likely to affect the risk of CVD outcomes than factors associated with childbearing.
Collapse
Affiliation(s)
- Sanne AE Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Yiping Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Iona Y Millwood
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Shaojie Wang
- Qingdao CDC NCDs Prevention and Control Department, Qingdao, Shandong, China
| | - Liqiu Yang
- Nangang CDC, Haerbin, Heilongjiang, China
| | - Yihe Hu
- Suzhou CDC NCDs Prevention and Control Department, Suzhou, Jiangsu, China
| | | | - Tao Wang
- Maiji CDC, Tianshui, Gansu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Chaoyang District, Beijing, China
| | - Richard Peto
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
- Department of Public Health, Beijing University, Beijing, China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, Australia and
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | |
Collapse
|
21
|
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]
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Peters SA, van der Schouw YT, Wood AM, Sweeting MJ, Moons KG, Weiderpass E, Arriola L, Benetou V, Boeing H, Bonnet F, Butt ST, Clavel-Chapelon F, Drake I, Gavrila D, Key TJ, Klinaki E, Krogh V, Kühn T, Lassale C, Masala G, Matullo G, Merritt M, Molina-Portillo E, Moreno-Iribas C, Nøst TH, Olsen A, Onland-Moret NC, Overvad K, Panico S, Redondo ML, Tjønneland A, Trichopoulou A, Tumino R, Turzanski-Fortner R, Tzoulaki I, Wennberg P, Winkvist A, Thompson SG, Di Angelantonio E, Riboli E, Wareham NJ, Danesh J, Butterworth AS. Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study. Eur J Prev Cardiol 2016; 23:1755-1765. [PMID: 27378766 PMCID: PMC6217919 DOI: 10.1177/2047487316658571] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/15/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE There is uncertainty about the direction and magnitude of the associations between parity, breastfeeding and the risk of coronary heart disease (CHD). We examined the separate and combined associations of parity and breastfeeding practices with the incidence of CHD later in life among women in a large, pan-European cohort study. METHODS Data were used from European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD, a case-cohort study nested within the EPIC prospective study of 520,000 participants from 10 countries. Information on reproductive history was available for 14,917 women, including 5138 incident cases of CHD. Using Prentice-weighted Cox regression separately for each country followed by a random-effects meta-analysis, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD, after adjustment for age, study centre and several socioeconomic and biological risk factors. RESULTS Compared with nulliparous women, the adjusted HR was 1.19 (95% CI: 1.01-1.41) among parous women; HRs were higher among women with more children (e.g., adjusted HR: 1.95 (95% CI: 1.19-3.20) for women with five or more children). Compared with women who did not breastfeed, the adjusted HR was 0.71 (95% CI: 0.52-0.98) among women who breastfed. For childbearing women who never breastfed, the adjusted HR was 1.58 (95% CI: 1.09-2.30) compared with nulliparous women, whereas for childbearing women who breastfed, the adjusted HR was 1.19 (95% CI: 0.99-1.43). CONCLUSION Having more children was associated with a higher risk of CHD later in life, whereas breastfeeding was associated with a lower CHD risk. Women who both had children and breastfed did have a non-significantly higher risk of CHD.
Collapse
Affiliation(s)
- Sanne Ae Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela M Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| | - Michael J Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, CIBERESP, Spain
| | - Vassiliki Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire Rennes, University of Rennes, Villejuif, France
| | - Salma T Butt
- Department of Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Françoise Clavel-Chapelon
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Institut Gustave Roussy, Villejuif, France
| | - Isabel Drake
- Department of Clinical Science, Lund University, Malmö, Sweden
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Camille Lassale
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Giuseppe Matullo
- Human Genetics Foundation, Turin, Italy Department of Medical Sciences, University of Turin, Italy
| | - Melissa Merritt
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Elena Molina-Portillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Conchi Moreno-Iribas
- Public Health Institute of Navarra, Pamplona, Spain Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain
| | - Therese H Nøst
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | | | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Antonia Trichopoulou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Italy
| | | | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Anna Winkvist
- Nutritional Research, Umeå University, Umeå, Sweden Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon G Thompson
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - John Danesh
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - Adam S Butterworth
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| |
Collapse
|
24
|
Parity, coronary heart disease and mortality in the old order Amish. Atherosclerosis 2016; 254:14-19. [PMID: 27680773 DOI: 10.1016/j.atherosclerosis.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/18/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Prior data on the association between parity and mortality are limited by the presence of sociodemographic confounders including cultural norms of parity. Our objective was to determine the association between parity and mortality in the Amish, a socioeconomically homogenous group with large numbers of children per family. METHODS We conducted a population-based cohort study among 518 Old Order Amish women enrolled in a cardiovascular awareness program. The mean length of follow-up for mortality was 13.52 years. We determined the adjusted associations between parity and obesity, prevalent coronary heart disease and mortality. RESULTS The mean number of total births per woman was 6.7 ± 3.6 with a mode of 8. No significant association was observed between parity and all-cause mortality when adjusted for age (HR 1.00 per additional birth; 95% CI 0.96-1.05; p = 0.85) or in multivariate analysis (HR 1.00, 95% CI 0.95-1.05; p = 0.95). There was also no association of parity in age- or multivariable adjusted models with prevalent diabetes, hypertension or coronary heart disease. Despite the lack of effect of parity on mortality, a significant association of ten or more births was observed with higher body mass index (BMI) compared to the referent group of 8-9 total births. CONCLUSIONS In a highly homogeneous population with high rates of parity, no association between overall mortality and parity was observed. Ten or more births were significantly associated with a higher BMI but not with overall mortality.
Collapse
|
25
|
Rahman M, Yunus FM, Shah R, Jhohura FT, Mistry SK, Quayyum T, Aktar B, Afsana K. A Controlled Before-and-After Perspective on the Improving Maternal, Neonatal, and Child Survival Program in Rural Bangladesh: An Impact Analysis. PLoS One 2016; 11:e0161647. [PMID: 27583478 PMCID: PMC5008808 DOI: 10.1371/journal.pone.0161647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/09/2016] [Indexed: 12/26/2022] Open
Abstract
Objectives We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh. Methods Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared before-and-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider. Findings Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and -20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother’s knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm. Conclusion Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.
Collapse
Affiliation(s)
- Mahfuzar Rahman
- Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
- * E-mail:
| | - Fakir Md. Yunus
- Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
| | - Rasheduzzaman Shah
- Department of Global Health, Save the Children USA, Washington, DC, United States of America
| | - Fatema Tuz Jhohura
- Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
| | - Sabuj Kanti Mistry
- Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
| | - Tasmeen Quayyum
- Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
| | - Bachera Aktar
- Health, Nutrition, and Population Programme, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
| | - Kaosar Afsana
- Health, Nutrition, and Population Programme, BRAC, BRAC Centre, 75 Mohakhali, Dhaka, Bangladesh
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
| | | | - Pekka Martikainen
- a University of Helsinki.,b University of Stockholm / Karolinska Institute.,c Max Planck Institute for Demographic Research
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Chen J, Gong TT, Wu QJ. Parity and gastric cancer risk: a systematic review and dose-response meta-analysis of prospective cohort studies. Sci Rep 2016; 6:18766. [PMID: 26727146 PMCID: PMC4698715 DOI: 10.1038/srep18766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/26/2015] [Indexed: 12/19/2022] Open
Abstract
We performed this meta-analysis of epidemiological studies to comprehensively assess the association between parity and gastric cancer risk, because previous studies have shown conflicting results regarding this topic. Relevant prospective studies were identified by searching the following databases: PubMed, EMBASE, and Web of Science, and random-effects models were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs). Our search yielded 10 prospective cohort studies involving a total of 6624 gastric cancer cases and 5,559,695 non-cases. The SRRs for ever parity vs. nulliparous and highest vs. lowest parity number were 0.96 (95%CI = 0.87–1.05, I2 = 0%) and 1.03 (95%CI = 0.94–1.13, I2 = 0%), respectively. Additionally, the SRR for an increment of one live birth was 1.00 (95%CI = 0.97–1.03, I2 = 18.6%). These non-significant associations were observed in all subgroups as stratified by the number of gastric cases, follow-up years, geographic location, menopausal status, anatomic subsite of gastric cancer, and adjustment for potential confounders, as well as in sensitivity analyses. Our meta-analysis found no significant association between parity and gastric cancer risk. However, further studies should be conducted to validate our findings and could provide more detailed results by stratifying their findings by Lauren’s subtype, histology, and anatomic site, as well as fully adjusting for potential confounding factors.
Collapse
Affiliation(s)
- Jing Chen
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
29
|
Grand multiparity and reproductive cancer in the Jerusalem Perinatal Study Cohort. Cancer Causes Control 2015; 27:237-47. [PMID: 26669321 DOI: 10.1007/s10552-015-0701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/24/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Grand multiparity is associated with reduced mortality from reproductive cancers. We aimed to separate the components of mortality, by measuring incidence of and survival after reproductive cancer onset in grand multiparous compared to other parous women. STUDY DESIGN We linked data from the population-based Jerusalem Perinatal Study Cohort, which included women aged 13-55 who delivered 1964-1976, with Israel's National Cancer Registry. We compared breast and gynecologic cancer risk and all-cause survival following a cancer diagnosis, among grand multiparae (GMPs = parity 5+, n = 8,246) versus women with parity 1-4 (n = 19,703), adjusting for reproductive and demographic variables. RESULTS Grand multiparae were at significantly lower risk of breast cancer than others (adjusted hazard ratio (HRadj) = 0.62, 95 % confidence interval (CI) 0.54-0.71), after controlling for age at first birth, education, and other covariates. This reduction was greater among GMPs whose first birth occurred after age 30 (p-interaction = 0.0001) and for cancer occurring before age 50 years (p = 0.002). In contrast, GMPs were at greater risk of death than women with parity <5, following a breast cancer diagnosis (HRadj = 1.69, CI 1.39-2.1). Ovarian, uterine, and cervical cancer incidence did not differ between the groups, but survival was reduced for GMPs with uterine cancer (HRadj = 2.48, CI 1.22-5.03). CONCLUSION Reduced reproductive cancer mortality reported among GMPs masks two opposing phenomena: decreased breast cancer risk and poorer survival after breast and uterine cancers. The latter unfavorable outcome suggests that tumors in GMPs may be particularly aggressive, having perhaps escaped protective mechanisms conferred by parity. This finding calls for heightened clinical attention in this group.
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
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.
Collapse
|
32
|
Sapir-Pichhadze R, Tinckam KJ, Laupacis A, Logan AG, Beyene J, Kim SJ. Immune Sensitization and Mortality in Wait-Listed Kidney Transplant Candidates. J Am Soc Nephrol 2015; 27:570-8. [PMID: 26054537 DOI: 10.1681/asn.2014090894] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 04/27/2015] [Indexed: 11/03/2022] Open
Abstract
Cardiovascular mortality is the leading cause of death in ESRD. Whereas innate and adaptive immunity have established roles in cardiovascular disease, the role of humoral immunity is unknown. We conducted a retrospective cohort study in first-time adult kidney transplant candidates (N=161,308) using data from the Scientific Registry of Transplant Recipients and the Centers for Medicare and Medicaid Services to evaluate whether anti-human leukocyte antigen antibodies, measured as panel reactive antibodies (PRAs), are related to mortality in ESRD. Relationships between time-varying PRAs and all-cause or cardiovascular mortality were assessed using Cox proportional hazards models. The analysis was repeated in subcohorts of candidates at lower risk for significant comorbidities, activated on the waiting list after 2007, or unsensitized at activation. Competing risks analyses were also conducted. Fully adjusted models showed increased hazard ratios (HRs [95% confidence intervals]) for all-cause mortality (HR, 1.02 [95% CI, 0.99 to 1.06]; HR, 1.11 [95% CI,1.07 to 1.16]; and HR,1.21 [95% CI,1.15 to 1.27]) and cardiovascular mortality (HR, 1.05 [95% CI,1.00 to 1.10]; HR,1.11 [95% CI,1.05 to 1.18]; and HR,1.21 [95% CI,1.12 to 1.31]) in PRA 1%-19%, PRA 20%-79%, and PRA 80%-100% categories compared with PRA 0%, respectively. Associations between PRA and the study outcomes were accentuated in competing risks models and in lower-risk patients and persisted in other subcohorts. Our findings suggest that PRA is an independent predictor of mortality in wait-listed kidney transplant candidates. The mechanisms by which PRA confers an incremental mortality risk in sensitized patients, and the role of transplantation in modifying this risk, warrant further study.
Collapse
Affiliation(s)
- Ruth Sapir-Pichhadze
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, and Division of Nephrology, Departments of Medicine and
| | - Kathryn J Tinckam
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Institute of Health Policy, Management, and Evaluation, and Li Ka Shing Knowledge Institute, and
| | - Alexander G Logan
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, and Division of Nephrology, Departments of Medicine and
| | - Joseph Beyene
- Institute of Health Policy, Management, and Evaluation, and Population Health Sciences Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, and Division of Nephrology, Departments of Medicine and Division of Nephrology and the Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada;
| |
Collapse
|
33
|
Salazar M, San Sebastian M. Violence against women and unintended pregnancies in Nicaragua: a population-based multilevel study. BMC WOMENS HEALTH 2014; 14:26. [PMID: 24521005 PMCID: PMC3925120 DOI: 10.1186/1472-6874-14-26] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/10/2014] [Indexed: 12/09/2023]
Abstract
BACKGROUND Despite an increased use of contraceptive methods by women, unintended pregnancies represent one of the most evident violations of women's sexual and reproductive rights around the world. This study aims to measure the association between individual and community exposure to different forms of violence against women (physical/sexual violence by the partner, sexual abuse by any person, or controlling behavior by the partner) and unintended pregnancies. METHODS Data from the 2006/2007 Nicaraguan Demographic and Health Survey were used. For the current study, 5347 women who reported a live birth in the five years prior to the survey and who were married or cohabitating at the time of the data collection were selected. Women's exposure to controlling behaviors by their partners was measured using six questions from the WHO Multi-Country Study on Women's Health and Domestic Violence against Women.Area-level variables were constructed by aggregating the individual level exposures to violence into an exposure measurement of the municipality as a whole (n = 142); which is the basic political division in Nicaragua. Multilevel logistic regression was used to analyze the data. RESULTS In total, 37.1% of the pregnancies were reported as unintended. After adjusting for all variables included in the model, individual exposure to controlling behavior by a partner (AOR = 1.28, 95% CrI = 1.13-1.44), ever exposure to sexual abuse (AOR = 1.31, 95% CrI = 1.03-1.62), and ever exposure to physical/sexual intimate partner violence (AOR = 1.44, 95% CrI = 1.24-1.66) were significantly associated with unintended pregnancies. Women who lived in municipalities in the highest tertile of controlling behavior by a partner had 1.25 times higher odds of reporting an unintended pregnancy than women living in municipalities in the lowest tertile (AOR = 1.25, 95% CrI = 1.03-1.48). CONCLUSIONS Nicaraguan women often experience unintended pregnancies, and the occurrence of unintended pregnancies is significantly associated with exposure to different forms of violence against women at both the individual and the municipality level. National policies aiming to facilitate women's ability to exercise their reproductive rights must include actions aimed at reducing women's exposures to violence against women.
Collapse
Affiliation(s)
- Mariano Salazar
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 85 Umeå, Sweden.
| | | |
Collapse
|
34
|
Brekke HK, Bertz F, Rasmussen KM, Bosaeus I, Ellegård L, Winkvist A. Diet and exercise interventions among overweight and obese lactating women: randomized trial of effects on cardiovascular risk factors. PLoS One 2014; 9:e88250. [PMID: 24516621 PMCID: PMC3917884 DOI: 10.1371/journal.pone.0088250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/03/2014] [Indexed: 12/15/2022] Open
Abstract
Objective To examine the effects of Diet (D) and Exercise (E) interventions on cardiovascular fitness, waist circumference, blood lipids, glucose metabolism, inflammation markers, insulin-like growth factor 1 (IGF-1) and blood pressure in overweight and obese lactating women. Methods At 10–14 wk postpartum, 68 Swedish women with a self-reported pre-pregnancy BMI of 25–35 kg/m2 were randomized to a 12-wk behavior modification treatment with D, E, both or control using a 2×2 factorial design. The goal of D treatment was to reduce body weight by 0.5 kg/wk, accomplished by decreasing energy intake by 500 kcal/d and monitoring weight loss through self-weighing. The goal of E treatment was to perform 4 45-min walks per wk at 60–70% of max heart-rate using a heart-rate monitor. Effects were measured 12 wk and 1 y after randomization. General Linear Modeling was used to study main and interaction effects adjusted for baseline values of dependent variable. Results There was a significant main effect of the D treatment, decreasing waist circumference (P = 0.001), total cholesterol (P = 0.007), LDL-cholesterol (P = 0.003) and fasting insulin (P = 0.042), at the end of the 12-wk treatment. The decreased waist circumference (P<0.001) and insulin (P = 0.024) was sustained and HDL-cholesterol increased (P = 0.005) at the 1-y follow-up. No effects from the E treatment or any interaction effects were observed. Conclusions Dietary behavior modification that produced sustained weight loss among overweight and obese lactating women also improved risk factors for cardiovascular disease and type 2 diabetes. This intervention may not only reduce weight-related risks with future pregnancies but also long-term risk for metabolic disease. Trial registration ClinicalTrials.gov NCT01343238
Collapse
Affiliation(s)
- Hilde K. Brekke
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Fredrik Bertz
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kathleen M. Rasmussen
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United State of America
| | - Ingvar Bosaeus
- Department of Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
35
|
Kim E, Lee S, Lim S, Chung W. Relationship between the Suicidal Ideation of the Married Women and the Characteristics of Their Children. HEALTH POLICY AND MANAGEMENT 2013. [DOI: 10.4332/kjhpa.2013.23.4.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
36
|
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.
Collapse
Affiliation(s)
- Uri P Dior
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Fisher AD, Rastrelli G, Bandini E, Corona G, Balzi D, Melani C, Monami M, Matta V, Mannucci E, Maggi M. Metabolic and cardiovascular outcomes of fatherhood: results from a cohort of study in subjects with sexual dysfunction. J Sex Med 2012; 9:2785-94. [PMID: 22897516 DOI: 10.1111/j.1743-6109.2012.02865.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Previous cross-sectional and longitudinal studies reported a negative correlation between fatherhood and testosterone (T) levels, likely due to a centrally mediated downregulation of the hypothalamic-pituitary-gonadal axis. Moreover, epidemiological data indicate that fatherhood might affect metabolic and cardiovascular outcomes, although different results have been reported. Up to now, no studies have evaluated these associations in a population of men seeking treatment for sexual dysfunction (SD). AIM To explore biological and clinical correlates of number of children (NoC) and its possible associations with forthcoming major cardiovascular events (MACE) in a sample of men with SD. METHODS A consecutive series of 4,045 subjects (mean age 52 ± 13.1 years old) attending the Outpatient Clinic for SD was retrospectively studied. A subset of the previous sample (N = 1,687) was enrolled in a longitudinal study. MAIN OUTCOME MEASURES Information on MACE was obtained through the City of Florence Registry Office. RESULTS Among patients studied, 31.6% had no children, while 26.3% reported having one child, 33.4% two, and 8.8% three or more children. Although fatherhood was negatively related with follicle-stimulating hormone levels and positively with testis volume, we found a NoC-dependent, stepwise decrease in T plasma levels, not compensated by a concomitant increase in luteinizing hormone. NoC was associated with a worse metabolic and cardiovascular profile, as well as worse penile blood flows and a higher prevalence of metabolic syndrome (MetS). In the longitudinal study, after adjusting for confounders, NoC was independently associated with a higher incidence of MACE. However, when the presence of MetS was introduced as a further covariate, the association was no longer significant. CONCLUSIONS This study supports the hypothesis that bond maintenance contexts and fatherhood are associated with an adaptive downregulation of the gonadotropin-gonadal axis, even in a sample of men with SD. Moreover, our data suggest that NoC predicts MACE, most likely because of an unfavorable, lifestyle-dependent, parenthood-associated behavior.
Collapse
Affiliation(s)
- Alessandra D Fisher
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVE To determine whether parenthood predicts host resistance to the common cold among healthy volunteers experimentally exposed to a common cold virus. METHODS Participants were 795 healthy volunteers (age range = 18-55 years) enrolled in one of three viral-challenge studies conducted from 1993 to 2004. After reporting parenthood status, participants were quarantined, administered nasal drops containing one of four common cold viruses, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5 to 6 days after exposure. All analyses included controls for immunity to the experimental virus (prechallenge specific antibody titers), viral strain, season, age, sex, race/ethnicity, marital status, body mass, study, employment status, and education. RESULTS Parents were less likely to develop colds than nonparents were (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.31-0.73). This was true for both parents with one to two children (OR = 0.52, 95% CI = 0.33-0.83) and three or more children (OR = 0.39, 95% CI = 0.22-0.70). Parenthood was associated with a decreased risk of colds for both those with at least one child living at home (OR = 0.46, 95% CI = 0.24-0.87) and those whose children all lived away from home (OR = 0.27, 95% CI = 0.12-0.60). The relationship between parenthood and colds was not observed in parents aged 18 to 24 years but was pronounced among older parents. CONCLUSIONS Parenthood was associated with greater host resistance to common cold viruses.
Collapse
Affiliation(s)
- Rodlescia S. Sneed
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, Phone: (305) 785-9536, Fax: (412) 268-2798
| | - Sheldon Cohen
- Department of Psychology, Carnegie Mellon University
| | - Ronald B. Turner
- Department of Pediatrics, University of Virginia Health Science Center
| | - William J. Doyle
- Department of Otolaryngology, Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine
| |
Collapse
|
39
|
Reproductive risk factors for cardiovascular disease mortality among postmenopausal women in Korea. Menopause 2011; 18:1205-12. [DOI: 10.1097/gme.0b013e31821adb43] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Eisenberg ML, Park Y, Hollenbeck AR, Lipshultz LI, Schatzkin A, Pletcher MJ. Fatherhood and the risk of cardiovascular mortality in the NIH-AARP Diet and Health Study. Hum Reprod 2011; 26:3479-85. [PMID: 21946940 DOI: 10.1093/humrep/der305] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fertility potential and reproductive fitness may reflect a man's future health, given that over one-third of the male human genome is involved in reproduction. We sought to determine if offspring number predicts cardiovascular death in the US men. METHODS Using data from the NIH-AARP Diet and Health Study, 137,903 men (aged 50-71) without prior cardiovascular disease were followed-up for an average of 10.2 years. International Classification of Diseases, ninth edition, codes were used to establish the cause of death, and multivariable Cox proportional hazards modeling was used to estimate the association between offspring number and cardiovascular death while accounting for sociodemographic and lifestyle characteristics. RESULTS Almost all (92%) participants had fathered at least one child and 50% had three or more offspring. A total of 3082 men died of cardiovascular causes during follow-up for an age-adjusted incidence rate of 2.70 per 1000 person-years. Compared with fathers, after adjusting for sociodemographic and lifestyle factors, childless men had a 17% [hazard ratio (HR): 1.17; 95% confidence interval (CI): 1.03-1.32] increased risk of death from cardiovascular disease contracted in the study period, and this elevated risk appeared to extend also to men with only one child. In comparison with fathers of five or more children, adjusted relative hazards for cardiovascular mortality of this sort were 1.06 (95% CI: 0.92-1.22) for four children, 1.02 (0.90-1.16) for three children, 1.02 (0.90-1.16) for two children, 1.11 (0.95-1.30) for one child and 1.21 (1.03-1.41) for no children. CONCLUSIONS Married men who have no children have a higher risk of dying from cardiovascular disease contracted after the age of 50 than men with two or more children.
Collapse
Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5118, USA.
| | | | | | | | | | | |
Collapse
|
41
|
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.
Collapse
|
42
|
Abstract
OBJECTIVES The association between parity and risk of hemorrhagic stroke (HS) remains to be clarified. This study assessed the association of parity with the overall risk of HS and compared its contribution to intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS We used a database from a nationwide multicenter case-control study, in which 471 female cases with incident HS were matched at 1:2 with 942 community or hospital controls. A total of 459 HS cases and 918 controls with information on parity were included. Parity was categorized as 0-1, 2, 3, and >or=4. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated by conditional logistic regression. As potential confounders, age, history of hypertension, history of diabetes, family history of stroke, smoking status, alcohol consumption, educational status, age at menarche, and use of oral contraceptives were included in the models. RESULTS Compared with nullipara and unipara, women with parity of 2, 3, and >or=4 had significantly higher risk for total HS, ICH, and SAH, respectively. Each additional parity increased the ORs of HS (adjusted OR for total HS = 1.27 [95% CI 1.14-1.41]; adjusted OR for SAH = 1.34 [95% CI 1.13-1.58]; adjusted OR for ICH = 1.27 [95% CI 1.08-1.48]). Likelihood ratio test for trends showed a significantly increased risk with increasing parity for total HS and for both types of HS (p(trend) < 0.05 in all analyses). CONCLUSIONS Increased number of childbirths may be related to an increased risk of both intracerebral hemorrhage and subarachnoid hemorrhage.
Collapse
Affiliation(s)
- Sun-Young Jung
- Department of Preventive Medicine, Seoul National University College of Medicine, Republic of Korea
| | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND There are limited empirical data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. I conducted this study to examine whether there is an association between parity and risk of death from suicide among women. METHODS The study cohort consisted of 1,292,462 women in Taiwan who had a first live birth between Jan. 1, 1978, and Dec. 31, 1987. The women were followed up from the date of their first birth to Dec. 31, 2007. Their vital status was ascertained by means of linking records with data from a computerized mortality database. Cox proportional hazard regression models were used to estimate hazard ratios of death from suicide associated with parity. RESULTS There were 2252 deaths from suicide during 32 464 187 person-years of follow-up. Suicide-related mortality was 6.94 per 100,000 person-years. After adjustment for age at first birth, marital status, years of schooling and place of delivery, the adjusted hazard ratio was 0.61 (95% confidence interval [CI] 0.54-0.68) among women with two live births and 0.40 (95% CI 0.35-0.45) among those with three or more live births, compared with women who had one live birth. I observed a significantly decreasing trend in adjusted hazard ratios of suicide with increasing parity. INTERPRETATION This study provides evidence to support Durkheim's hypothesis that parenthood confers a protective effect against suicide.
Collapse
Affiliation(s)
- Chun-Yuh Yang
- Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
44
|
Yang L, Kuper H, Sandin S, Margolis KL, Chen Z, Adami HO, Weiderpass E. Reproductive history, oral contraceptive use, and the risk of ischemic and hemorrhagic stoke in a cohort study of middle-aged Swedish women. Stroke 2009; 40:1050-8. [PMID: 19211494 DOI: 10.1161/strokeaha.108.531913] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Controversy persists as to whether oral contraceptive (OC) use and reproductive history play a role in the etiology of stroke, particularly ischemic stroke. Our aim was to investigate this question in a cohort of middle-aged Swedish women. METHODS The Women's Lifestyle and Health Cohort Study included 49259 Swedish women, aged 30 to 49 years at baseline (1991 to 1992). Participants completed an extensive questionnaire and were traced through linkages to national registries until the end of 2004. RESULTS Among the 45699 women included in these analyses, there were 285 cases of incident stroke during follow-up (193 ischemic stroke, 72 hemorrhagic stroke, and 20 of unknown origin). Neither ischemic nor hemorrhagic stroke risk was related to OC use, duration, or type of OC use, even among women who were smokers or hypertensive. Though not statistically significant, risk of hemorrhagic stroke was elevated in women who started using OCs after the age of 30 (Hazard Ratio [HR] 2.3, 95% CI=0.8 to 6.8) and women recommended by a doctor to stop using OC for medical reasons (2.1, 0.9 to 5.0) compared with never users. Compared with nulliparous women, parous women had a statistically significant lower risk of hemorrhagic stroke (0.5, 0.2 to 0.8), but similar association was not found for ischemic stroke (0.9, 0.5 to 1.4). CONCLUSIONS There was no significant association of OC use with ischemic or hemorrhagic stroke, and the parity was associated with reduced risk of hemorrhagic stroke but not with ischemic stroke.
Collapse
Affiliation(s)
- Ling Yang
- Clinical Trials Service Unit, Richard Doll Building, Oxford, UK.
| | | | | | | | | | | | | |
Collapse
|
45
|
Jaffe DH, Neumark YD, Eisenbach Z, Manor O. Parity-related mortality: shape of association among middle-aged and elderly men and women. Eur J Epidemiol 2009; 24:9-16. [PMID: 19145406 DOI: 10.1007/s10654-008-9310-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 12/10/2008] [Indexed: 11/30/2022]
Abstract
Parity is associated with mortality among middle-aged women, while substantially less is known about this relationship for men and the elderly. Using the census-based Israel Longitudinal Mortality Study (ILMS) II (1995-2004) we sought to examine the parity-mortality relationship among men and women, middle-aged and elderly. In our study cohort of 71,733 married men and 62,822 married women ages 45-89 years at baseline, 19,437 deaths were reported. Mortality differentials by parity were assessed using Cox proportional hazard regression models adjusted stepwise for age, origin, education and number of rooms. Analyzes were carried out for middle-aged (45-64 years) and elderly (65-89 years) men and women separately. We observed a non-linear relationship between parity and mortality for all individuals even after adjustment for demographic and socio-economic variables. In fully adjusted models, for example, nulliparous middle-aged women experienced the highest mortality risks (hazard ratios [HR] = 1.57, 95% confidence intervals [CI] 1.24, 1.98) followed by those with one child (HR = 1.29, 95% CI 1.10, 1.51). These results were attenuated somewhat for nulliparous older women (HR = 1.25, 95% CI 1.11, 1.41). The detrimental effects of low and high parity on mortality among both men and women suggest a non pregnancy-related pathway that is likely mediated by biological and psychosocial factors and other lifestyle characteristics that have long-term consequences into older ages. Further research is warranted to examine the effects of parity by specific cause of death.
Collapse
Affiliation(s)
- Dena H Jaffe
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, P.O. Box 12272, 91120 Jerusalem, Israel.
| | | | | | | |
Collapse
|
46
|
Murphy SJ, Kirsch JR, Zhang W, Grafe MR, West GA, del Zoppo GJ, Traystman RJ, Hum PD. Can gender differences be evaluated in a rhesus macaque (Macaca mulatta) model of focal cerebral ischemia? Comp Med 2008; 58:588-596. [PMID: 19149416 PMCID: PMC2629136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 05/22/2008] [Accepted: 07/12/2008] [Indexed: 05/27/2023]
Abstract
Gender differences, sex steroid effects, and sex-specific candidate therapeutics in ischemic stroke have been studied in rodents but not in nonhuman primates. In this feasibility study (n = 3 per group), we developed a model of transient focal cerebral ischemia in adult male and female rhesus macaques that consistently includes white matter injury. The animals also were used to determine whether gender-linked differences in histopathologic outcomes could be evaluated in this model in future, larger preclinical trials. Histologic brain pathology was evaluated at 4 d after 90 min of reversible occlusion of the middle cerebral artery (MCA). MCA occlusion was accomplished by using a transorbital approach and temporary placement of an aneurysm clip. Male and female rhesus macaques 7 to 11 y of age were studied. Baseline and intraischemic blood glucose, systolic blood pressure, heart rate, oxygen saturation, end-tidal CO2, and rectal temperatures were not different among groups. The variability in injury volume was comparable to that observed in human focal cerebrovascular ischemia and in other nonhuman primate models using proximal MCA occlusion. In this small sample, the volume of injury was not different between male and female subjects, but observed variability was higher in female caudate nucleus, putamen, and hemisphere. This report is the first to compare cerebral ischemic outcomes in female and male rhesus macaques. The female rhesus macaque ischemic stroke model could be used after rodent studies to provide preclinical data for clinical trials in women.
Collapse
Affiliation(s)
- Stephanie J Murphy
- Department of Anesthesiology and Peri-Operative Medicine, Oregon Health and Science University, Portland, Oregon, USA.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Tawfik HE, Cena J, Schulz R, Kaufman S. Role of oxidative stress in multiparity-induced endothelial dysfunction. Am J Physiol Heart Circ Physiol 2008; 295:H1736-42. [DOI: 10.1152/ajpheart.87.2008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multiparity is associated with increased risk of cardiovascular disease. We tested whether multiparity induces oxidative stress in rat vascular tissue. Coronary arteries and thoracic aorta were isolated from multiparous and age-matched virgin rats. Relaxation to ACh and sodium nitroprusside (SNP) was measured by wire myography. We also tested the effect of the superoxide dismutase mimetic MnTE2PyP (30 μM), the NADPH oxidase inhibitor apocynin (10 μM), and the peroxynitrite scavenger FeTPPs (10 μM) on ACh-mediated relaxation in coronary arteries. Vascular superoxide anion was measured using the luminol derivative L-012 and nitric oxide (NO) generation by the Griess reaction. Multiparity reduced maximal response and sensitivity to ACh in coronary arteries [maximal relaxation (Emax): multiparous 49 ± 3% vs. virgins 95% ± 3%; EC50: multiparous 135 ± 1 nM vs. virgins 60 ± 1 nM], and in aortic rings (Emax: multiparous 38 ± 3% vs. virgins 79 ± 4%; EC50: multiparous 160 ± 2 nM vs. virgins 90 ± 3 nM). Coronary arteries from the two groups relaxed similarly to SNP. Superoxide anions formation was significantly higher in both coronary arteries (2.8-fold increase) and aorta (4.1-fold increase) from multiparous rats compared with virgins. In multiparous rats, incubation with MnTE2PyP, apocynin, and FeTPPs improved maximal relaxation to ACh (MnTE2PyP: 74 ± 5%; vehicle: 41 ± 5%; apocynin: 73 ± 3% vs. vehicle: 41 ± 3%; FeTPPs: 72 ± 3% vs. vehicle: 46 ± 3%) and increased sensitivity (EC50: MnTE2PyP: 61 ± 0.5 nM vs. vehicle: 91 ± 1 nM; apocynin: 45 ± 3 nM vs. vehicle: 91 ± 6 nM; FeTPP: 131 ± 2 nM vs. vehicle: 185 ± 1 nM). Multiparity also reduced total nitrate/nitrite levels (multiparous: 2.5 ± 2 μmol/mg protein vs. virgins: 7 ± 1 μmol/mg protein) and endothelial nitric oxide synthase protein levels (multiparous: 0.53 ± 0.1 protein/actin vs. virgins: 1.0 ± 0.14 protein/actin). These data suggest that multiparity induces endothelial dysfunction through decreased NO bioavailability and increased reactive oxygen species formation.
Collapse
|
48
|
Hardy R, Lawlor DA, Black S, Wadsworth MEJ, Kuh D. Number of children and coronary heart disease risk factors in men and women from a British birth cohort. BJOG 2007; 114:721-30. [PMID: 17516964 DOI: 10.1111/j.1471-0528.2007.01324.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the association between number of children and coronary heart disease (CHD) risk factors in women and men. DESIGN Prospective cohort study. SETTING Britain. SAMPLE A total of 2977 individuals (51% women) from the Medical Research Council National Survey of Health and Development, a birth cohort study of individuals born in Britain in 1946 and followed up regularly throughout life. MAIN OUTCOME MEASURES Blood pressure, body mass index (BMI), waist to hip ratio (WHR), total, high-density lipoprotein and low-density lipoprotein cholesterol and triglyceride levels, and glycated haemoglobin (HbA1C) measured at age of 53 years. RESULTS Number of children showed no consistent relationship with CHD risk factors at age 53 years in either men or women, and no obvious and consistent sex differences were observed. Mean BMI (95% CI) increased with increasing numbers of children (P = 0.01) in women from 27.4 kg/m2 (26.6-28.2) in those with one child to 28.6 kg/m2 (27.6-29.6) in those with four or more children. WHR and type II diabetes in women and HbA1C in men were the only other risk factors exhibiting a linearly increasing trend with increasing number of children. These associations were largely explained by adjustment for behavioural and lifestyle variables. CONCLUSION Our findings suggest that any association between number of children and CHD risk factors is a result of lifestyle and behaviours associated with family life rather than being as result of the biological impact of pregnancy in women.
Collapse
Affiliation(s)
- R Hardy
- Medical Research Council National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free and University College Medical School, London, UK
| | | | | | | | | |
Collapse
|