title: Age at natural menopause in relation to all-cause and cause-specific mortality in a follow-up study of US black women.
abstract: OBJECTIVE
  Early age at natural menopause has been associated with increased all-cause mortality in several studies, although the literature is not consistent. This relation has not been examined among African American women.
  
  
  METHODS
  Data were from the Black Women's Health Study, a follow-up study of African-American women enrolled in 1995. Among 11,212 women who were naturally menopausal at entry to the study or during follow-up through 2008, we assessed the relation of age at natural menopause to all-cause and cause-specific mortality. At baseline and biennially, participants reported on reproductive and medical history, including gynecologic surgeries and exogenous hormone use. Mortality data were obtained from the National Death Index. Multivariable Cox proportional hazard models were used to estimate mortality rate ratios (MRR) and 95% confidence intervals (CI) for categories of age at menopause.
  
  
  RESULTS
  Of 692 deaths identified during 91,829 person years of follow-up, 261 were due to cancer, 199 to cardiovascular diseases and 232 to other causes. Natural menopause before age 40 was associated with increased all-cause mortality (MRR=1.34, 95% CI 0.96-1.84, relative to menopause at 50-54 years; P-trend=0.04) and with the subcategories of death considered - cancer, cardiovascular disease, and all other causes. The associations were present among never and ever users of postmenopausal female hormones and among never and ever smokers.
  
  
  CONCLUSIONS
  In this large prospective cohort of African-American women, natural menopause before age 40 was associated with a higher rate of all-cause and cause-specific mortality. These findings provide support for the theory that natural menopause before age 40 may be a marker of accelerated somatic aging.
authors: Slone Epidemiology Center at Boston University, Boston, MA 02215, United States. lise@bu.edu
authors: Se
authors: S
authors: Li
authors: Lynn
authors: L
authors: Rosenberg
authors: Lauren A
authors: LA
authors: Wise
authors: Deborah A
authors: DA
authors: Boggs
authors: Michael
authors: M
authors: LaValley
authors: Julie R
authors: JR
authors: Palmer
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality*; D002423:Cause of Death; D015914:Estrogen Replacement Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008593:Menopause / Q000208:ethnology; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking; D014481:United States / Q000208:ethnology
references: Ethn Dis. 2006 Autumn;16(4):943-7
references: 17061751
references: Annu Rev Anthropol. 1994;23:231-53
references: 12319160
references: Eur J Obstet Gynecol Reprod Biol. 1978 Aug;8(4):187-93
references: 264163
references: Epidemiology. 2005 Jul;16(4):556-62
references: 15951675
references: Am J Public Health. 1989 Jun;79(6):709-14
references: 2729468
references: J Clin Epidemiol. 1997 Apr;50(4):475-9
references: 9179106
references: Am J Epidemiol. 1997 Mar 15;145(6):536-45
references: 9063344
references: Epidemiology. 2005 May;16(3):346-54
references: 15824551
references: Int J Cancer. 1990 Nov 15;46(5):796-800
references: 2228308
references: Epidemiology. 1990 Jan;1(1):58-64
references: 2081241
references: Am J Epidemiol. 2003 May 15;157(10):923-9
references: 12746245
references: Lancet Neurol. 2012 Jan;11(1):82-91
references: 22172623
references: J Am Med Womens Assoc (1972). 1995 Mar-Apr;50(2):56-8
references: 7722208
references: Am J Clin Nutr. 2011 Jul;94(1):86-94
references: 21593501
references: Am J Epidemiol. 2001 May 1;153(9):865-74
references: 11323317
references: Am J Epidemiol. 2011 May 1;173(9):1078-84
references: 21422059
references: Maturitas. 1998 Oct 12;30(2):119-25
references: 9871906
references: Lancet. 1999 Feb 13;353(9152):571-80
references: 10028999
references: J Epidemiol. 2006 Sep;16(5):177-84
references: 16951536
references: World Health Organ Tech Rep Ser. 1995;854:1-452
references: 8594834
references: Hum Nat. 1991 Dec;2(4):313-50
references: 24222339
references: Maturitas. 2010 Feb;65(2):161-6
references: 19733988
references: Obstet Gynecol. 1998 Mar;91(3):454-8
references: 9491877
references: Am J Epidemiol. 2005 Dec 1;162(11):1089-97
references: 16221806
references: Maturitas. 2007 Apr 20;56(4):411-9
references: 17161927
references: Arch Intern Med. 1999 May 24;159(10):1061-6
references: 10335682
references: Am J Epidemiol. 1999 Nov 1;150(9):904-9
references: 10547135
references: Am J Epidemiol. 2001 Jun 15;153(12):1159-65
references: 11415950
references: Am J Epidemiol. 1997 Jan 15;145(2):124-33
references: 9006309
references: J Clin Epidemiol. 1999 Apr;52(4):303-7
references: 10235170