Health symptoms during midlife in relation to menopausal transition: British prospective cohort study

Objective To characterise symptoms experienced by women during the transition into natural menopause, to classify women into distinct symptom profiles or trajectories, and to relate these profiles to sociodemographic factors and health behaviours

Estimating the prevalence of dementia using multiple linked administrative health records and capture–recapture methodology

Obtaining population-level estimates of the incidence and prevalence of dementia is challenging due to under-diagnosis and under-reporting. We investigated the feasibility of using multiple linked datasets and capture-recapture techniques to estimate rates of dementia among women in Australia.This work is based on the Australian Longitudinal Study on Women's Health. A random sample of 12,432 women born in 1921-1926 was recruited in 1996. Over 16\ua0years of follow-up records of dementia were obtained from five sources: three-yearly self-reported surveys; clinical assessments for aged care assistance; death certificates; pharmaceutical prescriptions filled; and, in three Australian States only, hospital in-patient records.A total of 2534 women had a record of dementia in at least one of the data sources. The aged care assessments included dementia records for 79.3% of these women, while pharmaceutical data included 34.6%, death certificates 31.0% and survey data 18.5%. In the States where hospital data were available this source included dementia records for 55.8% of the women. Using capture-recapture methods we estimated an additional 728 women with dementia had not been identified, increasing the 16\ua0year prevalence for the cohort from 20.4 to 26.0% (95% confidence interval [CI] 25.2, 26.8%).This study demonstrates that using routinely collected health data with record linkage and capture-recapture can produce plausible estimates for dementia prevalence and incidence at a population level

Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies

BACKGROUND: Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause. METHODS AND FINDINGS: A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause ( \u3c 40 (premature), 40-44 (early), 45-49, 50-51 (reference), and \u3e /=52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p \u3c 0.001) and early menopause (1.80; 1.66-1.95) (p \u3c 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p \u3c 0.001) and early (6.55; 5.04-8.52; p \u3c 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p \u3c 0.001) and 3-fold (3.01; 2.15-4.21; p \u3c 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias. CONCLUSIONS: The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause

Visualising and modelling changes in categorical variables in longitudinal studies

Background: Graphical techniques can provide visually compelling insights into complex data patterns. In this paper we present a type of lasagne plot showing changes in categorical variables for participants measured at regular intervals over time and propose statistical models to estimate distributions of marginal and transitional probabilities. Methods. The plot uses stacked bars to show the distribution of categorical variables at each time interval, with different colours to depict different categories and changes in colours showing trajectories of participants over time. The models are based on nominal logistic regression which is appropriate for both ordinal and nominal categorical variables. To illustrate the plots and models we analyse data on smoking status, body mass index (BMI) and physical activity level from a longitudinal study on women's health. To estimate marginal distributions we fit survey wave as an explanatory variable whereas for transitional distributions we fit status of participants (e.g. smoking status) at previous surveys. Results: For the illustrative data the marginal models showed BMI increasing, physical activity decreasing and smoking decreasing linearly over time at the population level. The plots and transition models showed smoking status to be highly predictable for individuals whereas BMI was only moderately predictable and physical activity was virtually unpredictable. Most of the predictive power was obtained from participant status at the previous survey. Predicted probabilities from the models mostly agreed with observed probabilities indicating adequate goodness-of-fit. Conclusions: The proposed form of lasagne plot provides a simple visual aid to show transitions in categorical variables over time in longitudinal studies. The suggested models complement the plot and allow formal testing and estimation of marginal and transitional distributions. These simple tools can provide valuable insights into categorical data on individuals measured at regular intervals over time

Factors associated with educational mobility in mid-age Australian women

The educational mobility of mid-age women is rarely studied. We analysed the baseline socio-economic position (SEP) and health factors associated with obtaining further education in 4117 mid-age Australian women between 1996 and 2010 (aged 45–50 at baseline, 62–67 at follow-up) from a population-based study. Women either unemployed or working part-time at baseline had higher odds of a stable low and middle education over time (ORs ranging from 1.61 to 3.86) versus educational mobility. Apart from obesity, characteristics that may signal an unhealthy lifestyle in early mid-life were not useful indicators of women's future educational mobility

Moderate agreement between self-reported stroke and hospital-recorded stroke in two cohorts of Australian women: a validation study

Background: Conflicting findings on the validity of self-reported stroke from existing studies creates uncertainty about the appropriateness of using self-reported stroke in epidemiological research. We aimed to compare self-reported stroke against hospital-recorded stroke, and investigate reasons for disagreement. Methods: We included participants from the Australian Longitudinal Study on Women's Health born in 1921-26 (n = 1556) and 1946-51 (n = 2119), who were living in New South Wales and who returned all survey questionnaires over a defined period of time. We determined agreement between self-reported and hospitalised stroke by calculating sensitivity, specificity and kappa statistics. We investigated whether characteristics including age, education, area of residence, country of birth, language spoken at home, recent mental health at survey completion and proxy completion of questionnaire were associated with disagreement, using logistic regression analysis to obtain odds ratios (ORs) with 95% confidence intervals (CIs). Results: Agreement between self-report and hospital-recorded stroke was fair in older women (kappa 0.35, 95% CI 0.25 to 0.46) and moderate in mid-aged women (0.56, 95% CI 0.37 to 0.75). There was a high proportion with unverified self-reported stroke, partly due to: reporting of transient ischaemic attacks; strokes occurring outside the period of interest; and possible reporting of stroke-like conditions. In the older cohort, a large proportion with unverified stroke had hospital records of other cerebrovascular disease. In both cohorts, higher education was associated with agreement, whereas recent poor mental health was associated with disagreement. Conclusion: Among women who returned survey questionnaires within the period of interest, validity of self-reported stroke was fair to moderate, but is probably underestimated. Agreement between self-report and hospital-recorded stroke was associated with individual characteristics. Where clinically verified stroke data are unavailable, self-report may be a reasonable alternative method of stroke ascertainment for some epidemiological studies

Depression and the incidence of urinary incontinence symptoms among young women: results from a prospective cohort study

Objective To examine the association of depressive symptoms with subsequent urinary incontinence (UI) symptoms among young women. Subjects and methods Data were from a cohort of 5391 young women (born 1973-1978) from the Australian Longitudinal Study on Women's Health. Generalised Estimating Equations (GEEs) were used to link depressive symptoms, and history of doctor diagnosed depression at Survey 2 (S2) in 2000 with the incidence of UI symptoms in subsequent surveys (from S3 in 2003 to S6 in 2012). Results 24% of women reported the incidence of UI over the nine-year study period, while the prevalence rose over time from 6.8% (at S2, aged 22-27 years) to 16.5% (at S6, aged 34-39). From univariable GEE analysis, women with depressive symptoms or a history of depression were more likely to report subsequent UI symptoms. This remained after adjusting for socio-demographic, body mass index, health behaviours and reproductive factors, with depressive symptoms associated with 37% higher odds (odds ratio 1.37, 95% CI 1.16 to 1.61) and history of depression with 42% higher odds (1.42, 1.17 to 1.74) of incidence of UI. Conclusions When woman seek treatment for UI symptoms, health professionals should consider her current or history of depression

Association between inflammatory potential of diet and risk of depression in middle-aged women: the Australian longitudinal study on women's health

Dietary factors and inflammation markers have been shown to play a role in the development of depression. However, there are very few studies that have explored the association between inflammatory potential of diet and risk of depression. In this study, we examined the association between the dietary inflammatory index (DII), which was developed specifically to measure the inflammatory potential of diet, and risk of depression in the middle-aged cohort of the Australian Longitudinal Study on Women's Health. A total of 6438 women with a mean age of 52·0 (sd 1·4) years at baseline were followed-up at five surveys over 12 years (2001-2013). Depression was defined as a score of ≥10 on the Center for Epidemiologic Studies Depression-10 scale. The DII score, a literature-derived, population-based dietary index that has been validated against several inflammatory markers, was computed on the basis of dietary intake assessed using a validated FFQ. Generalised estimating equations were used to estimate relative risk (RR) of depression according to DII score. Models were adjusted for energy intake, highest education completed, marital status, menopause status and symptoms, personal illness or injury, smoking status, physical activity, BMI and depression diagnosis or treatment. In total, 1156 women (18 %) had scores≥10 on the CESD scale over the course of 9 years. Women with the most anti-inflammatory diet had an approximately 20 % lower risk of developing depression compared with women with the most pro-inflammatory diet (RRDII quartile 1 v. 4: 0·81; 95 % CI 0·69, 0·96; P trend=0·03). These results suggest that an anti-inflammatory diet is associated with lower risk of depression in middle-aged Australian women

Uso delle Direzioni Coniugate negli algoritmi per l'Ottimizzazione Non Vincolata a grande dimensione

Both obesity and dysmenorrhea are prevalent among women. Few population-based longitudinal studies investigate the association between body mass index (BMI) and dysmenorrhea yielding mixed results, especially for obesity. This study aims to investigate the long-term association between BMI and dysmenorrhea.9,688 women from a prospective population-based cohort study were followed for 13 years. Data were collected through self-reported questionnaires. The longitudinal association between dysmenorrhea and BMI or BMI change was investigated by logistic regression analysis using generalized estimating equations to account for the repeated measures.When the women were aged 22 to 27 years, approximately 11% were obese, 7% underweight, and 25% reported dysmenorrhea. Compared to women with a normal weight, significantly higher odds of reporting dysmenorrhea were detected for both women who were underweight (odds ratio (OR) 1.34, 95% confidence interval (CI) 1.15, 1.57) and obese (OR 1.22, 95% CI 1.11, 1.35). Compared to women who remained at normal weight or overweight over time, significant risk was detected for women who: remained underweight or obese (OR 1.33, 95% CI 1.20, 1.48), were underweight despite weight gain (OR 1.33, 95% CI 1.12, 1.58), became underweight (OR 1.28, 95% CI 1.02, 1.61). However the higher risk among obese women disappeared when they lost weight (OR 1.06, 95% CI 0.85, 1.32).A U-shaped association was revealed between dysmenorrhea and BMI, revealing a higher risk of dysmenorrhea for both underweight and obese women. Maintaining a healthy weight over time may be important for women to have pain-free periods