title: Type and timing of menopause and later life mortality among women in the Iowa Established Populations for theEpidemiological Study of the Elderly (EPESE) cohort.
abstract: BACKGROUND
  The relationship between menopausal characteristics and later life mortality is unclear. We tested the hypotheses that women with surgical menopause would have increased all-cause and cardiovascular mortality compared with women with natural menopause, and that women with earlier ages at natural or surgical menopause would have greater all-cause and cardiovascular mortality than women with later ages at menopause.
  
  
  METHODS
  Women who participated in the Iowa cohort of the Established Populations for the Epidemiologic Study of the Elderly (n=1684) reported menopausal characteristics and potential confounding variables at baseline and were followed up for up to 24 years. Participants were aged 65 years or older at baseline and lived in rural areas. We used survival analysis to examine the relationships between menopausal characteristics and all-cause and cardiovascular mortality.
  
  
  RESULTS
  A total of 1477 women (87.7% of respondents) died during the study interval. Women with an age at natural menopause ≥55 years had increased all-cause and cardiovascular disease mortality compared with women who had natural menopause at younger ages. Type of menopause and age at surgical menopause were not related to mortality. These patterns persisted after adjustment for potential confounding variables.
  
  
  CONCLUSIONS
  Among an older group of women from a rural area of the United States, later age at natural menopause was related to increased all-cause and cardiovascular mortality. Monitoring the cardiovascular health of this group of older women may contribute to improved survival times.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA. setom@utmb.edu
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Tom
authors.forename: Rachel
authors.initials: R
authors.lastname: Cooper
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
mesh_terms: D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D000375:Aging; D002561:Cerebrovascular Disorders / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D015993:Life Tables; D008593:Menopause; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D012044:Regression Analysis; D012140:Respiratory Tract Diseases / Q000401:mortality; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016387:Women's Health