Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Am J Epidemiol. 2018 Apr 1;187(4):696-704. doi: 10.1093/aje/kwx292.
Menopause before 45 years of age affects roughly 5%-10% of women and is associated with a higher risk of adverse health conditions. Although smoking may increase the risk of early menopause, evidence is inconsistent, and data regarding smoking amount, duration, cessation, associated risks, and patterns over time are scant. We analyzed data of 116,429 nurses from the Nurses' Health Study II from 1989 through 2011 and used Cox proportional hazards models to estimate hazard ratios adjusted for confounders. Compared with never-smokers, current smokers (hazard ratio (HR) = 1.90, 95% confidence interval (CI): 1.71, 2.11) and former smokers (HR = 1.10, 95% CI: 1.00, 1.21) showed an increased risk of early menopause. Increased risks were observed among women who reported current smoking for 11-15 pack-years (HR = 1.72, 95% CI: 1.36, 2.18), 16-20 pack-years (HR = 1.72, 95% CI: 1.38, 2.14), and more than 20 pack-years (HR = 2.42, 95% CI: 2.11, 2.77). Elevated risk was observed in former smokers who reported 11-15 pack-years (HR = 1.29, 95% CI: 1.07, 1.55), 16-20 pack-years (HR = 1.42, 95% CI: 1.13, 1.79), or more than 20 pack-years (HR = 1.54, 95% CI: 1.23, 1.93). Women who smoked 10 or fewer cigarettes/day but quit by age 25 had comparable risk to never-smokers (HR = 1.03, 95% CI: 0.91, 1.17). A dose-response relationship between smoking and early natural menopause risk, as well as reduced risk among quitters, may provide insights into the mechanisms of cigarette smoking in reproductive health.
绝经年龄早于 45 岁影响了大约 5%-10%的女性，且与更高的不良健康状况风险相关。尽管吸烟可能会增加绝经提前的风险，但证据并不一致，且关于吸烟量、吸烟持续时间、戒烟、相关风险以及随时间变化的模式的数据十分匮乏。我们分析了自 1989 年至 2011 年护士健康研究 II 中 116429 名护士的数据，使用 Cox 比例风险模型，根据混杂因素调整了风险比。与从不吸烟者相比，当前吸烟者（风险比（HR）=1.90，95%置信区间（CI）：1.71，2.11）和前吸烟者（HR=1.10，95%CI：1.00，1.21）绝经提前的风险增加。在报告吸烟 11-15 包年（HR=1.72，95%CI：1.36，2.18）、16-20 包年（HR=1.72，95%CI：1.38，2.14）和超过 20 包年（HR=2.42，95%CI：2.11，2.77）的女性中，观察到了更高的风险。在报告吸烟 11-15 包年（HR=1.29，95%CI：1.07，1.55）、16-20 包年（HR=1.42，95%CI：1.13，1.79）或超过 20 包年（HR=1.54，95%CI：1.23，1.93）的前吸烟者中也观察到了升高的风险。每天吸烟 10 支或更少且在 25 岁前戒烟的女性与从不吸烟者的风险相当（HR=1.03，95%CI：0.91，1.17）。吸烟与绝经提前风险之间的剂量-反应关系，以及戒烟者风险降低，可能为吸烟对生殖健康影响的机制提供了新的见解。
