Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Fertility Clinic, Department of Obstetrics/Gynecology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.
Am J Epidemiol. 2018 Sep 1;187(9):1889-1895. doi: 10.1093/aje/kwy085.
In previous studies, investigators have reported reduced mortality among women undergoing assisted reproductive technology (ART) treatment, possibly related to selection of healthy women into ART treatment. Our aim in this study was to explore the impact of relevant selection factors on the association between ART treatment and mortality and to explore effect modification by parity. Women treated with ART in fertility clinics in Denmark during 1994-2009 (n = 42,897) were age-matched with untreated women from the background population (n = 204,514) and followed until December 31, 2010. With adjustment for relevant confounders, the risk of death was lower among ART-treated women during the first 2 years after ART treatment (hazard ratio (HR) = 0.68, 95% confidence interval (CI): 0.63, 0.74), but there was no apparent difference after 10 years (HR = 0.92, 95% CI: 0.79, 1.07). Having children prior to ART treatment was associated with markedly reduced mortality (HR = 0.45, 95% CI: 0.38, 0.53), possibly due to better health among fertile women. While the frequencies of previous medical and psychiatric diagnoses among ART-treated and untreated women were similar, differences in disease severity could explain the reduced mortality among ART-treated women, as poor prognosis would make initiation of ART treatment unlikely. The survival advantage among ART-treated women is likely a selection phenomenon rather than a biological phenomenon.
在之前的研究中，研究人员报告称，接受辅助生殖技术（ART）治疗的女性死亡率降低，这可能与健康女性选择接受 ART 治疗有关。我们在这项研究中的目的是探讨相关选择因素对 ART 治疗与死亡率之间关联的影响，并探讨生育史对这种关联的修饰作用。1994 年至 2009 年期间，丹麦生育诊所接受 ART 治疗的女性（n=42897）与背景人群中未经治疗的女性（n=204514）按年龄匹配，并随访至 2010 年 12 月 31 日。在调整了相关混杂因素后，ART 治疗后 2 年内，ART 治疗女性的死亡风险较低（风险比（HR）=0.68，95%置信区间（CI）：0.63，0.74），但 10 年后差异不明显（HR=0.92，95%CI：0.79，1.07）。在接受 ART 治疗之前有孩子与死亡率显著降低相关（HR=0.45，95%CI：0.38，0.53），这可能是因为有生育能力的女性健康状况更好。虽然 ART 治疗组和未治疗组女性的既往医疗和精神科诊断频率相似，但疾病严重程度的差异可能解释了 ART 治疗女性死亡率降低的原因，因为不良预后可能使启动 ART 治疗不太可能。ART 治疗女性的生存优势可能是一种选择现象，而不是一种生物学现象。
