美国绝经后女性的自然或手术绝经年龄、全因死亡率和寿命。
Age at natural or surgical menopause, all-cause mortality, and lifespan among postmenopausal women in the United States.
机构信息
From the Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida.
Chiles Center, College of Public Health, University of South Florida, Tampa, FL.
出版信息
Menopause. 2024 Mar 1;31(3):176-185. doi: 10.1097/GME.0000000000002314.
OBJECTIVE
This study investigated the association of age at natural menopause with or without undergoing hysterectomy and/or bilateral oophorectomy after menopause and age at surgical menopause with all-cause mortality and lifespan in postmenopausal women.
METHODS
The data stemmed from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) and NHANES III (1988-1994), including 14,161 postmenopausal women over 40. Cox proportional hazard models were used to estimate unadjusted and adjusted hazard ratios (HRs) (95% confidence intervals [CIs]). We also used Cox proportional hazard models with penalized splines to depict the association between continuous age at menopause and all-cause mortality and nonparametric regression with smoothing splines to illustrate the association between age at menopause and lifespan in deceased participants.
RESULTS
The adjusted HRs (95% CIs) for age at natural menopause of <40, 40 to 44, and 55+ years in women without undergoing hysterectomy or bilateral oophorectomy after menopause were 1.48 (1.15-1.91), 1.16 (1.00-1.35), and 0.91 (0.77-1.07) compared with age at natural menopause of 45 to 54, respectively. The respective HRs (95% CIs) for age at surgical menopause were 1.39 (1.11-1.75), 1.09 (0.86-1.38), and 0.83 (0.53-1.32). However, no significant association was found between age at natural menopause and all-cause mortality among women undergoing hysterectomy and/or bilateral oophorectomy after menopause. When treated as continuous variables, age at natural menopause without undergoing hysterectomy or bilateral oophorectomy after menopause presented inverse and nonlinear associations with all-cause mortality, whereas age at surgical menopause was linearly inversely associated with all-cause mortality. The association between age at menopause and lifespan was linearly positive regardless of menopausal type.
CONCLUSION
Young age at menopause was associated with increased risks of all-cause mortality. The later menopause age was related to a longer lifespan.
目的
本研究旨在探讨自然绝经年龄（无论是否在绝经后接受子宫切除术和/或双侧卵巢切除术）与手术绝经年龄与绝经后女性全因死亡率和寿命的关系。
方法
数据来源于国家健康与营养调查（NHANES）（1999-2018 年）和 NHANES III（1988-1994 年），包括 14161 名 40 岁以上的绝经后女性。使用 Cox 比例风险模型估计未经调整和调整后的风险比（HR）（95%置信区间[CI]）。我们还使用带有惩罚样条的 Cox 比例风险模型来描绘绝经年龄与全因死亡率之间的连续关联，以及使用带有平滑样条的非参数回归来描绘绝经后死亡参与者的绝经年龄与寿命之间的关联。
结果
在未接受子宫切除术或双侧卵巢切除术的女性中，自然绝经年龄<40 岁、40-44 岁和 55 岁以上的调整后 HR（95%CI）分别为 1.48（1.15-1.91）、1.16（1.00-1.35）和 0.91（0.77-1.07），与 45-54 岁自然绝经年龄相比。手术绝经年龄的相应 HR（95%CI）分别为 1.39（1.11-1.75）、1.09（0.86-1.38）和 0.83（0.53-1.32）。然而，在绝经后接受子宫切除术和/或双侧卵巢切除术的女性中，自然绝经年龄与全因死亡率之间没有显著关联。当作为连续变量处理时，未接受子宫切除术或双侧卵巢切除术的女性自然绝经年龄与全因死亡率呈负相关且呈非线性关系，而手术绝经年龄与全因死亡率呈线性负相关。无论绝经类型如何，绝经年龄与寿命之间的关联均呈线性正相关。
结论
较年轻的绝经年龄与全因死亡率增加的风险相关。绝经年龄较晚与寿命延长有关。
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