| BackgroundChronic disease is the leading cause of death worldwide.It was reported that the mortality of chronic disease was 533.0 per 100,000 person-years among Chinese in 2012,accounting for 86.6 percent of all deaths.Chronic disease has become a major public health problem.Therefore,exploring the main risk factors for chronic disease,developing appropriate prevention and control strategies,and intervening as soon as possible are important approach for reducing the morbidity and mortality of chronic disease.The prevalence of chronic disease varies in men and women.It was reported that the chronic disease rate is higher in women than in men both in rural areas and urbal areas in China and increase sharply among women above 45 years old.Unhealthy diet,high blood pressure,tobacco smoking,alcohol drinking,abnormal glucose metabolism,air pollution and physical inactivity are the main risk factors for chronic disease.However,the sex differences in chronic disease incidence and the sharply increase in middle aged and older women can not be explained by these risk factors shared by men and women,suggesting there may be other specific risk factors for women.Estrogen milieux and metabolism change with the onset of menarche,menstruation,pregnancy,breastfeeding and menopause in women’s reproductive life.However,there is few study on the topic that wheather these changes had adverse influence on women’s health.The aim of our study was to explore the association between reproductive factors including parity and menopausal age and chronic disease(hypertension,diabetes,coronary heart disease and stroke)among middle-aged and older Chinese women basing on the data of the first follow up of Dongfeng-Tongji cohort study.Part 1 Association between parity and risk of hypertension,diabetes,coronary heart disease and stroke in womenObjective:Inorder to meet the needs of fetal growth,the maternal hormone and metabolism changes substantially during pregnancy.Repeated pregnancy may aggravate the change and had adverse effect on women’s health.Studies among Caucasian suggested that parity was associated with risk of chronic disease,but little is known about Chinese women.The purpose of this study was to examine whether parity is associated with hypertension,diabetes,coronary heart disease(CHD)and stroke in middle-aged and older Chinese women.Methods:Cross-sectional analysis was conducted based on data from the first follow-up of the Dongfeng-Tongji cohort study.A total of 20,353 women who completed the study questionnaires,underwent medical examinations and provided blood samples,were included in the analysis.Parity was dived into four groups(1,2,3,>4)basing on the self-reported information.Logistic regression models were used to estimate the odds ratios(ORs)and 95%confidence intervals(CIs).Results:1.Characteristics of the subjectsThere were 20,353 women included in our study.The mean age of the subjects was 62.17 ± 8.8 years.The mean parity was 1.92 ± 1.09.2.Parity and hypertensionThe adjusted prevalence of hypertension for women with one,two,three,and four or more live births were 57.62%,58.19%,59.09%and 54.60%,respectively.After adjustment for the potential confounders,no association was observed between parity and the presence of hypertension.3.Parity and diabetesThe adjusted prevalence of diabetes for women with one,two,three,and four or more live births were 15.89%,20.29%,21.90%and 21.34%,respectively.Parity was positively associated with the presence of diabetes(P for trend<0.05).Compared with women with one live birth,women with two,three,and four or more live births had 1.38(OR,1.38;95%CI,1.23～1.55),1.54(OR,1.54;95%CI,1.32～1.79)and 1.48(OR,1.48;95%CI,1.22～1.80)times higher presence of diabetes,respectively.There was a significant interaction between parity and education(hypertension)for the presence of diabetes(P for interaction<0.05).4.Parity and CHDThe adjusted prevalence of CHD for women with one,two,three,and four or more live birth were 11.44%,15.52%,15.65%and 14.89%,respectively.Parity was positively associated with the presence of CHD.Compared with women with one live birth,women with two,three,and four or more live births had 1.49(OR,1.49;95%CI,1.30～1.71),1.52(OR,1.52;95%CI,1.28～1.80)and 1.41(OR,1.41;95%CI,1.14～1.75)times higher presence of CHD,respectively.There was a significant interaction between parity and education for the presence of CHD(P for interaction<0.001).5.Parity and strokeThe adjusted prevalence of stroke for women with one,two,three,and four or more live births were 1.87%,2.96%,3.62%and 3.54%,respectively.Parity was positively associated with the presence of stroke.Compared with women with one live birth,women with two,three,and four or more live births had 1.62(OR,1.62;95%CI,1.22～2.15),1.99(OR,1.99;95%CI,1.40～2.83)and 1.98(OR,1.98;95%CI,1.29～3.04)times higher presence of stroke,respectively.There was a significant interaction between parity and education(diabetes)for the presence of stroke(P for interaction<0.05).Conclusion:Our findings showed that there was no association between parity and hypertension.Parity was a risk factor for diabetes,CHD and stroke,suggesting that women with multiparity should be given more monitoring to prevent the development of chronic disease.Part 2 Association between menopausal age and risk of hypertension,diabetes,coronary heart disease and stroke in womenObjective:Menopause status is a risk factor for chronic disease because of the loss of estrogen.But little is known about the relationship of menopausal age with chronic disease.Moreover,there was few study conducted among Chinese population.The aim of this study was to evaluate the association between menopausal age and the presence of hypertension,diabetes,CHD and stroke in middle-aged and older Chinese women.Methods:Cross-sectional analysis were conducted based on data from the first follow-up of the Dongfeng-Tongj i cohort study.A total of 16,744 women who completed the study questionnaires,underwent medical examinations and provided blood samples,were included in the analysis.Self-reported menopausal age were divided into three age groups(≤45,45-52,>52 years)based on the 10th and 90th percentile.Logistic regression models were used to estimate the odds ratios(ORs)and 95%confidence intervals(CIs).Women who were diagnosed with hypertension,diabetes,CHD and stroke before menopause were excluded in the separate analysis for the corresponding disease.Results:1.Characteristics of the subjectsThere were 16,744 women included in our study.The mean age of the subjects was 63.56 ± 8.31 years,and the mean menopausal age was 49.55 ± 3.33 years.2.Menopausal age and hypertensionA total of 14,449 women were included in the analysis.The adjusted prevalence of hypertension for menopause at ages<45,45-52,>52 years were 55.39%,53.37%and 50.33%.For each 1-year delay in menopausal age,the presence of hypertension was reduced by 2%(OR,0.98;95%CI,0.97-0.99).Compared with those whose menopausal age was 46-52 years,the presence of hypertension was reduced by 14%(OR,0.86;95%CI,0.77-0.97)for those with a later menopausal age(>52 years).There was a significant interaction between menopausal age and physical activity for the presence of hypertension(P for interaction = 0.030).3.Menopausal age and diaebtes A total of 16,255 women were included in the analysis.The adjusted prevalence of diabetes for menopause at ages<45,45-52,>52 years were 19.40%,17.06%and 15.49%.For each 1-year delay in menopausal age,the presence of diabetes was reduced by 2%(OR,0.98;95%CI,0.97～0.99).Compared with those whose menopausal age was 45-52 years,women with earlier menopausal age(<45 years)had 1.19(OR,1.19;95%CI,1.04～1.36)times higher presence of diabetes.4.Menopausal age and CHD A total of 16,240 women were included in the analysis.The adjusted prevalence of CHD for menopause at ages<45,45-52,>52 years were 15.10%,11.92%and 10.67%.For each 1-year delay in menopausal age,the presence of CHD was reduced by 5%(OR,0.95;95%CI,0.94～0.97).The presence of CHD was 1.37 times higher(OR,1.37;95%CI,1.17～1.61)for those with an earlier menopausal age(≤45 years)than those with menopause at 45-52 years.There was a significant interaction between menopausal age and age(BMI,education and history of contraceptive use)for the presence of CHD(P for interaction<0.05).5.Menopausal age and stroke A total of 16,663 women were included in the analysis.The adjusted prevalence of stroke for menopause at ages<45,45-52,>52 years were 4.38%,2.33%and 1.85%.For each 1-year delay in menopausal age,the presence of stroke was reduced by 6%(OR,0.94;95%CI,0.91～0.97).Women with earlier age at menopause(≤45 years)had 1.97 times higher(OR,1.97;95%CI,1.51～2.58)presence of stroke than those with menopause at 45-52 years.There was a significant interaction between menopausal age and history of miscarriage for the presence of stroke(P for interaction=0.018).Conclusion:Our findings suggested that menopausal age was negatively associated with hypertension,diabetes,CHD and stroke.Earlier age at menopause was a risk factor for diabetes,CHD and stroke,suggesting that women with earlier menopause should be given more intervention to reduce their risk of chronic disease. |
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