Cramer D W, Harlow B L, Xu H, Fraer C, Barbieri R
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Maturitas. 1995 Sep;22(2):79-87. doi: 10.1016/0378-5122(95)00928-e.
To examine potential confounders and dose-response data for the association between smoking and menopause, we used both a cross-sectional and case-controlled approach. In total, 10,606 middle-aged women residing in eastern Massachusetts were surveyed about their age at menopause and smoking history; 344 women (cases) with natural menopause prior to age 47 and 344 age-matched women (controls) who were still menstruating or who had a menopause after age 46 were selected for further study. Risk for menopause was assessed by Kaplan-Meier, Cox proportional hazards, or logistic regression models. From cross-sectional data on 8657 women aged 45-54, the hazards odds ratio for a natural menopause among women who ever smoked compared to non-smokers was 1.31 (95% C.L. 1.21-1.42) and among women who had accumulated 30 or more pack-years was 1.87 (95% C.L. 1.67-2.04) after adjustment for parity and weight. An additional potential confounder from the case-controlled study was lower educational attainment, and after adjustment for this variable, significant trends persisted for risk of early menopause associated with age began smoking (P = 0.03), years of smoking (P = 0.01) and pack-years of smoking (P = 0.03). This study demonstrates an association between smoking and early menopause in both cross-sectional and case-controlled data that is not confounded by parity, weight, socio-economic status, or nutritional variables.
为了研究吸烟与绝经之间关联的潜在混杂因素和剂量反应数据，我们采用了横断面研究和病例对照研究方法。总共对居住在马萨诸塞州东部的10606名中年女性进行了调查，询问她们的绝经年龄和吸烟史；选取了344名在47岁之前自然绝经的女性（病例组）和344名年龄匹配、仍在月经或46岁之后绝经的女性（对照组）进行进一步研究。通过Kaplan-Meier、Cox比例风险或逻辑回归模型评估绝经风险。从8657名45 - 54岁女性的横断面数据来看，在调整了产次和体重后，曾经吸烟的女性与不吸烟女性相比，自然绝经的风险比为1.31（95%置信区间1.21 - 1.42），累积吸烟量达到30包年及以上的女性该风险比为1.87（95%置信区间1.67 - 2.04）。病例对照研究中的另一个潜在混杂因素是教育程度较低，在对该变量进行调整后，与开始吸烟年龄（P = 0.03）、吸烟年限（P = 0.01）和吸烟包年数（P = 0.03）相关的早期绝经风险仍存在显著趋势。这项研究表明，在横断面研究和病例对照研究数据中，吸烟与早期绝经之间存在关联，且不受产次、体重、社会经济地位或营养变量的混杂影响。
