目的:描述卵巢早衰(POI)和绝经早期患者多发病的患病率,与绝经平均年龄相比。
方法:前瞻性队列受试者:该前瞻性队列包括来自加拿大纵向衰老研究(CLSA)的绝经后女性个体。CLSA收集了2010年至2015年间50,000名年龄在45至85岁之间的加拿大人的横截面数据。
方法:原发性暴露为原发性卵巢功能不全(定义为绝经年龄小于40岁)。比较包括绝经平均年龄(年龄46至55岁),更年期提前(40-45岁),晚发性更年期(56-65岁),还有那些做了子宫切除术的人.
方法:主要结果是多发病率,被定义为两种或两种以上的慢性疾病。次要结果是严重的多患病(定义为三种或更多种慢性疾病)以及15种单独疾病的综合列表中特定慢性疾病的频率。我们使用逻辑回归和比值比评估了多发病率和绝经年龄之间的关联,置信区间设置为95%。针对已知的多发病率预测因子调整了赔率比,包括年龄,更年期激素治疗(MHT),教育,种族,自我报告的孤独,独自生活,BMI,吸烟习惯,营养风险,社会参与,和身体活动。
结果:共纳入12,339名绝经后参与者,其中374(3.0%)经历POI,1396(11.3%)经历了早期更年期。POI和绝经早期患者多发病的患病率分别为64.8%和51.1%。相比之下,在平均绝经年龄(年龄46~55岁)的个体中,只有43.9%的人患有多发病.与经历绝经平均年龄的人群相比,POI人群的多发病率OR为2.5(95%CI2.0-3.1)。在校正混杂因素后,这种关系得以维持(aOR2.0,95%CI:1.5-2.5)。与平均年龄组相比,POI组严重多发病的患病率也翻了一番(39.2%对21.1%)。缺血性心脏病的风险显着增加(aOR2.8,95%CI:1.7-4.7),POI组的胃溃疡(aOR1.6,95%CI:1.1-2.3)和骨质疏松症(aOR1.6,95%CI:1.2-2.1)。
结论:患有POI和早期绝经的个体与在平均年龄经历绝经的个体相比,多发病率增加。即使在调整了显著的多患病风险因素后,这种趋势仍然存在。
OBJECTIVE: To describe the prevalence of multimorbidity among individuals with premature ovarian insufficiency (POI) and early menopause, in comparison to average age of menopause.
METHODS: Prospective cohort SUBJECTS: This prospective cohort encompassed female postmenopausal individuals from the Canadian Longitudinal Study on Aging (CLSA). The CLSA collected cross-sectional data from 50,000 community-dwelling Canadians aged 45 to 85 between 2010 and 2015.
METHODS: The primary exposure was primary ovarian insufficiency (defined by onset of menopause younger than 40 years). Comparators included average age of menopause (age 46 to 55 years), early menopause (40-45 years), late onset menopause (56-65 years), and those who underwent a hysterectomy.
METHODS: The primary outcome was multimorbidity, which was defined as two or more chronic conditions. The secondary outcome was severe multimorbidity (defined as three or more chronic conditions) as well as frequencies of specific chronic conditions among a comprehensive list of 15 individual conditions. We assessed the association between multimorbidity and age at menopause using logistic regression and odds ratios, with confidence intervals set at 95%. Odds ratios were adjusted for known predictors of multimorbidity, including age, menopause hormone therapy (MHT), education, ethnicity, self-reported loneliness, living alone, BMI, smoking habits, nutritional risk, social participation, and physical activity.
RESULTS: A total of 12,339 postmenopausal participants were included, of which 374 (3.0%) experienced POI and 1396 (11.3%) experienced early menopause. The prevalence of multimorbidity was 64.8% and 51.1% among those with POI and early menopause respectively. In contrast, only 43.9% of individuals with average age of menopause (age 46 to 55 years) had multimorbidity. The OR for multimorbidity in the POI population was 2.5 (95% CI 2.0-3.1) in comparison to those who underwent the average age of menopause. This relationship was maintained after adjustment for confounders (aOR 2.0, 95% CI: 1.5-2.5). The prevalence of severe multimorbidity was also double in the POI group in comparison in the average age group (39.2% versus 21.1%). There was significantly increased risk of ischemic heart disease (aOR 2.8, 95% CI: 1.7-4.7), gastric ulcers (aOR 1.6, 95% CI: 1.1-2.3) and osteoporosis (aOR 1.6, 95% CI: 1.2-2.1) in the POI group.
CONCLUSIONS: Individuals with POI and early menopause experience increased multimorbidity in comparison to those undergoing menopause at an average age. This trend persists even after adjusting for significant multimorbidity risk factors.