Lawn Rebecca B, Nishimi Kristen M, Kim Yongjoo, Jung Sun Jae, Roberts Andrea L, Sumner Jennifer A, Thurston Rebecca C, Chibnik Lori B, Rimm Eric B, Ratanatharathorn Andrew D, Jha Shaili C, Koenen Karestan C, Tworoger Shelley S, Kubzansky Laura D
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2021 Mar;30(3):492-498. doi: 10.1158/1055-9965.EPI-20-1227. Epub 2020 Dec 21.
Posttraumatic stress disorder (PTSD) is associated with higher risk of certain chronic diseases, including ovarian cancer, but underlying mechanisms remain unclear. Although prior work has linked menopausal hormone therapy (MHT) use with elevated ovarian cancer risk, little research considers PTSD to likelihood of MHT use. We examined whether PTSD was prospectively associated with greater likelihood of initiating MHT use over 26 years.
Using data from the Nurses' Health Study II, with trauma and PTSD (symptoms and onset date) assessed by screener in 2008 and MHT assessed via biennial survey (from 1989), we performed Cox proportional regression models with women contributing person-years from age 36 years. Relevant covariates were assessed at biennial surveys. We considered potential effect modification by race/ethnicity, age at baseline, and period (1989-2002 vs. 2003-2015).
Over follow-up, 22,352 of 43,025 women reported initiating MHT use. For example, compared with women with no trauma, the HR for initiating MHT was 1.18 for those with trauma/1-3 PTSD symptoms [95% confidence interval (CI), 1.13-1.22] and 1.31 for those with trauma/4-7 PTSD symptoms (95% CI, 1.25-1.36; trend < 0.001), adjusting for sociodemographic factors. Associations were maintained when adjusting for reproductive factors and health conditions. We found evidence of effect modification by age at baseline.
Trauma and number of PTSD symptoms were associated with greater likelihood of initiating MHT use in a dose-response manner.
MHT may be a pathway linking PTSD to altered chronic disease risk. It is important to understand why women with PTSD initiate MHT use.
创伤后应激障碍（PTSD）与某些慢性疾病的较高风险相关，包括卵巢癌，但其潜在机制仍不清楚。尽管先前的研究将更年期激素疗法（MHT）的使用与卵巢癌风险升高联系起来，但很少有研究考虑PTSD与MHT使用可能性之间的关系。我们研究了PTSD在26年期间是否与开始使用MHT的可能性增加存在前瞻性关联。
利用护士健康研究II的数据，通过2008年筛查评估创伤和PTSD（症状及发病日期），并通过两年一次的调查（从1989年开始）评估MHT，我们对36岁及以上女性的人年数据进行了Cox比例回归模型分析。相关协变量在两年一次的调查中进行评估。我们考虑了种族/民族、基线年龄和时期（1989 - 2002年与2003 - 2015年）的潜在效应修正。
在随访期间，43,025名女性中有22,352名报告开始使用MHT。例如，与没有创伤的女性相比，有创伤/1 - 3个PTSD症状的女性开始使用MHT的风险比（HR）为1.18 [95%置信区间（CI），1.13 - 1.22]，有创伤/4 - 7个PTSD症状的女性为1.31（95% CI，1.25 - 1.36；趋势< 0.001），对社会人口学因素进行了调整。在对生殖因素和健康状况进行调整后，关联依然存在。我们发现了基线年龄的效应修正证据。
创伤和PTSD症状数量与开始使用MHT的可能性增加呈剂量反应关系。
MHT可能是将PTSD与改变的慢性疾病风险联系起来的一条途径。了解患有PTSD的女性开始使用MHT的原因很重要。
