中国有生育史的绝经后女性末次生育年龄与中风及其亚型关联中的社会经济差异：一项前瞻性队列研究

Socioeconomic disparities in the associations of age at last live birth with stroke and its subtypes among Chinese parous postmenopausal women: A prospective cohort study.

作者信息

Shan Shiyi, Sun Weidi, Wu Jing, Hou Leying, Luo Zeyu, Zhou Jiali, Ying Jiayao, Song Peige

机构信息

Center for Clinical Big Data and Statistics of the Second Affiliated Hospital Zhejiang University School of Medicine, School of Public Health Zhejiang University School of Medicine, China.

出版信息

Exp Gerontol. 2025 Aug;207:112791. doi: 10.1016/j.exger.2025.112791. Epub 2025 May 29.

DOI:10.1016/j.exger.2025.112791

PMID:40447121

Abstract

BACKGROUND

As a pivotal reproductive factor, age at last live birth (ALLB) plays a critical role in a woman's health trajectory, including the risk of cardiovascular diseases.

METHODS

In this prospective cohort study from the China Kadoorie Biobank (CKB), 148,456 parous postmenopausal women were included. ALLB was further classified equally into tertiles (<26 years, 26-29 years, and ≥30 years). Total stroke and its three subtypes (ischemic stroke [IS], intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) were identified as outcomes. Cox proportional hazard regression was performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the associations of ALLB with incident stroke and its subtypes. Latent class analysis (LCA) was employed to explore underlying socioeconomic status (SES) classes within women in urban and rural areas, and SES-stratified analysis was conducted. Population attributable fraction (PAF) was estimated to assess the impact of later ALLB on stroke at the population level.

RESULTS

Compared with women with ALLB of <26 years, women with later ALLB (26-29 years and ≥ 30 years) faced a higher risk of stroke, with the highest fully adjusted HRs (aHRs) observed in women whose ALLB was ≥30 years (total stroke: 3.88, 95 % CI 3.71-4.07; IS: 5.33, 95 % CI 5.05-5.63; ICH: 3.79, 95 % CI 3.36-4.29; SAH: 4.93, 95 % CI 3.41-7.12). The strongest associations were found among rural-low-SES participants with total stroke and IS, with aHRs of 5.61 (95 % CI 5.12-6.16) and 7.28 (95 % CI 6.51-8.14) for an ALLB of ≥30 years. The highest PAF of total stroke with ALLB ≥26 years was observed in rural-middle-SES individuals, with value of 59.15 % (95 % CI 56.80-61.48).

CONCLUSION

Later ALLB was associated with an increased risk of stroke among Chinese parous postmenopausal women, notably in lower socioeconomic rural populations.

摘要

背景

作为一个关键的生殖因素，末次活产年龄（ALLB）在女性的健康轨迹中起着至关重要的作用，包括心血管疾病风险。

方法

在这项来自中国嘉道理生物银行（CKB）的前瞻性队列研究中，纳入了148456名已生育的绝经后女性。ALLB进一步被等分为三个三分位数组（<26岁、26 - 29岁和≥30岁）。将总卒中及其三种亚型（缺血性卒中[IS]、脑出血[ICH]和蛛网膜下腔出血[SAH]）确定为研究结局。采用Cox比例风险回归来估计ALLB与新发卒中及其亚型之间关联的风险比（HRs）和95%置信区间（CIs）。采用潜在类别分析（LCA）来探索城乡女性潜在的社会经济地位（SES）类别，并进行了SES分层分析。估计人群归因分数（PAF）以评估较高的ALLB对人群层面卒中的影响。

结果

与末次活产年龄<26岁的女性相比，ALLB较大（26 - 29岁和≥30岁）的女性面临更高的卒中风险，在ALLB≥30岁的女性中观察到最高的完全调整后风险比（aHRs）（总卒中：3.88，95%CI 3.71 - 4.07；IS：5.33，95%CI 5.05 - 5.63；ICH：3.79，95%CI 3.36 - 4.29；SAH：4.93，95%CI 3.41 - 7.12）。在农村低SES参与者中，总卒中和IS的关联最强，ALLB≥30岁时的aHRs分别为5.61（95%CI 5.12 - 6.16）和7.28（95%CI 6.51 - 8.14）。在农村中SES个体中观察到ALLB≥26岁时总卒中的最高PAF，值为59.15%（95%CI 56.80 - 61.48）。