The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.
The George Institute for Global Health, Imperial College London, London, United Kingdom.
PLoS Med. 2022 Apr 5;19(4):e1003955. doi: 10.1371/journal.pmed.1003955. eCollection 2022 Apr.
BACKGROUND: Women's reproductive factors have been associated with the risk of dementia; however, these findings remain uncertain. This study aimed to examine the risk of incident all-cause dementia associated with reproductive factors in women and the number of children in both sexes and whether the associations vary by age, socioeconomic status (SES), smoking status, and body mass index (BMI) in the UK Biobank. METHODS AND FINDINGS: A total of 273,240 women and 228,957 men without prevalent dementia from the UK Biobank were included in the analyses. Cox proportional hazard regressions estimated hazard ratios (HRs) for reproductive factors with incident all-cause dementia. Multiple adjusted models included age at study entry, SES, ethnicity, smoking status, systolic blood pressure, BMI, history of diabetes mellitus, total cholesterol, antihypertensive drugs, and lipid-lowering drugs. Over a median of 11.8 years follow-up, 1,866 dementia cases were recorded in women and 2,202 in men. Multiple adjusted HRs ((95% confidence intervals (CIs)), p-value) for dementia were 1.20 (1.08, 1.34) (p = 0.016) for menarche <12 years and 1.19 (1.07, 1.34) (p = 0.024) for menarche >14 years compared to 13 years; 0.85 (0.74, 0.98) (p = 0.026) for ever been pregnant; 1.43 (1.26, 1.62) (p < 0.001) for age at first live birth <21 compared to 25 to 26 years; 0.82 (0.71, 0.94) (p = 0.006) for each abortion; 1.32 (1.15, 1.51) (p = 0.008) for natural menopause at <47 compared to 50 years; 1.12 (1.01, 1.25) (p = 0.039) for hysterectomy; 2.35 (1.06, 5.23) (p = 0.037) for hysterectomy with previous oophorectomy; and 0.80 (0.72, 0.88) (p < 0.001) for oral contraceptive pills use. The U-shaped associations between the number of children and the risk of dementia were similar for both sexes: Compared with those with 2 children, for those without children, the multiple adjusted HR ((95% CIs), p-value) was 1.18 (1.04, 1.33) (p = 0.027) for women and 1.10 (0.98, 1.23) (p = 0.164) for men, and the women-to-men ratio of HRs was 1.09 (0.92, 1.28) (p = 0.403); for those with 4 or more children, the HR was 1.14 (0.98, 1.33) (p = 0.132) for women and 1.26 (1.10, 1.45) (p = 0.003) for men, and the women-to-men ratio of HRs was 0.93 (0.76, 1.14) (p = 0.530). There was evidence that hysterectomy (HR, 1.31 (1.09, 1.59), p = 0.013) and oophorectomy (HR, 1.39 (1.08, 1.78), p = 0.002) were associated with a higher risk of dementia among women of relatively lower SES only. Limitations of the study include potential residual confounding and self-reported measures of reproductive factors, as well as the limited representativeness of the UK Biobank population. CONCLUSIONS: In this study, we observed that some reproductive events related to shorter cumulative endogenous estrogen exposure in women were associated with higher dementia risk, and there was a similar association between the number of children and dementia risk between women and men.
背景:女性的生殖因素与痴呆风险相关,但这些发现仍不确定。本研究旨在探讨女性生殖因素与全因痴呆风险的关系,并研究在英国生物库中,男女两性的生育子女数与痴呆风险的关系,以及这种关联是否因年龄、社会经济状况(SES)、吸烟状况和体重指数(BMI)而有所不同。
方法和发现:本研究共纳入了 273240 名无痴呆症的女性和 228957 名男性,这些数据均来自英国生物库。使用 Cox 比例风险回归估计了生殖因素与全因痴呆风险的相关性。多因素调整模型包括研究入组时的年龄、SES、种族、吸烟状况、收缩压、BMI、糖尿病病史、总胆固醇、降压药和降脂药。在中位随访 11.8 年期间,女性中有 1866 例痴呆病例,男性中有 2202 例。多因素调整后的风险比(95%置信区间(CI)),p 值)为:初潮年龄<12 年的 HR 为 1.20(1.08,1.34)(p = 0.016),初潮年龄>14 年的 HR 为 1.19(1.07,1.34)(p = 0.024),13 岁为参照;曾怀孕的 HR 为 0.85(0.74,0.98)(p = 0.026);初产年龄<21 岁的 HR 为 1.43(1.26,1.62)(p<0.001),25 至 26 岁为参照;堕胎次数每增加一次的 HR 为 1.32(1.15,1.51)(p = 0.008);自然绝经年龄<47 岁的 HR 为 1.12(1.01,1.25)(p = 0.039),50 岁为参照;行子宫切除术的 HR 为 1.12(1.01,1.25)(p = 0.039);曾行子宫切除术伴卵巢切除术的 HR 为 2.35(1.06,5.23)(p = 0.037);使用口服避孕药的 HR 为 0.80(0.72,0.88)(p<0.001)。生育子女数与痴呆风险之间存在相似的 U 型关联,且这种关联在男女两性中均相似:与生育 2 个子女的女性相比,没有子女的女性的多因素调整 HR(95%CI,p 值)为 1.18(1.04,1.33)(p = 0.027),男性为 1.10(0.98,1.23)(p = 0.164),女性与男性的 HR 比值为 1.09(0.92,1.28)(p = 0.403);生育 4 个或更多子女的女性 HR 为 1.14(0.98,1.33)(p = 0.132),男性为 1.26(1.10,1.45)(p = 0.003),女性与男性的 HR 比值为 0.93(0.76,1.14)(p = 0.530)。有证据表明,子宫切除术(HR,1.31(1.09,1.59),p = 0.013)和卵巢切除术(HR,1.39(1.08,1.78),p = 0.002)与 SES 相对较低的女性痴呆风险增加相关。本研究的局限性包括潜在的残余混杂因素和生殖因素的自我报告测量,以及英国生物库人群的代表性有限。
结论:在本研究中,我们观察到一些与女性累积内源性雌激素暴露时间较短相关的生殖事件与更高的痴呆风险相关,并且女性和男性之间的生育子女数与痴呆风险之间存在相似的关联。
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