Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY.
BMJ. 2010 Mar 11;340:c927. doi: 10.1136/bmj.c927.
To see if the mortality risk among women who have used oral contraceptives differs from that of never users.
Prospective cohort study started in 1968 with mortality data supplied by participating general practitioners, National Health Service central registries, or both.
1400 general practices throughout the United Kingdom.
46 112 women observed for up to 39 years, resulting in 378 006 woman years of observation among never users of oral contraception and 819 175 among ever users.
Directly standardised adjusted relative risks between never and ever users for all cause and cause specific mortality.
1747 deaths occurred in never users of oral contraception and 2864 in ever users. Compared with never users, ever users of oral contraception had a significantly lower rate of death from any cause (adjusted relative risk 0.88, 95% confidence interval 0.82 to 0.93). They also had significantly lower rates of death from all cancers; large bowel/rectum, uterine body, and ovarian cancer; main gynaecological cancers combined; all circulatory disease; ischaemic heart disease; and all other diseases. They had higher rates of violent deaths. No association between overall mortality and duration of oral contraceptive use was observed, although some disease specific relations were apparent. An increased relative risk of death from any cause between ever users and never users was observed in women aged under 45 years who had stopped using oral contraceptives 5-9 years previously but not in those with more distant use. The estimated absolute reduction in all cause mortality among ever users of oral contraception was 52 per 100 000 woman years.
Oral contraception was not associated with an increased long term risk of death in this large UK cohort; indeed, a net benefit was apparent. The balance of risks and benefits, however, may vary globally, depending on patterns of oral contraception usage and background risk of disease.
观察使用口服避孕药的女性与从未使用者的死亡率风险是否存在差异。
1968 年开始进行的前瞻性队列研究，死亡率数据由参与的全科医生、英国国家卫生服务中心登记处或两者共同提供。
英国的 1400 家全科诊所。
观察了长达 39 年的 46112 名女性，其中从未使用过口服避孕药的观察了 378006 名女性年，而曾经使用过的观察了 819175 名女性年。
直接标准化调整后从未使用者和曾使用者之间所有原因和特定原因死亡率的相对风险。
从未使用者中有 1747 人死亡，曾使用者中有 2864 人死亡。与从未使用者相比，曾使用者的任何原因死亡率显著降低（调整后相对风险 0.88，95%置信区间 0.82 至 0.93）。他们的所有癌症、大肠/直肠、子宫体和卵巢癌、主要妇科癌症、所有循环系统疾病、缺血性心脏病和其他所有疾病的死亡率也显著降低。他们的暴力死亡发生率更高。尽管观察到一些特定疾病的关系，但未发现总体死亡率与口服避孕药使用时间之间存在关联。在 45 岁以下停止使用口服避孕药 5-9 年的女性中，曾使用者与从未使用者之间任何原因的死亡相对风险增加，但在使用时间更远的女性中则没有。曾使用者的口服避孕药每年可减少所有原因的死亡率 52 例/10 万女性年。
在这项大型英国队列研究中，口服避孕药与长期死亡风险增加无关；实际上，口服避孕药显然有净获益。然而，风险和收益的平衡可能会因全球口服避孕药使用模式和疾病背景风险的不同而有所不同。
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