title: Disease history and risk of comorbidity in women's life course: a comprehensive analysis of the Japan Nurses' Health Study baseline survey.
abstract: OBJECTIVE
  To classify diseases based on age at peak incidence to identify risk factors for later disease in women's life course.
  
  
  METHODS
  A cross-sectional baseline survey of participants in the Japan Nurses' Health Study.
  
  
  METHODS
  A nationwide prospective cohort study on the health of Japanese nurses. The baseline survey was conducted between 2001 and 2007 (n=49,927).
  
  
  METHODS
  Age at peak incidence for 20 diseases from a survey of Japanese women was estimated using the Kaplan-Meier method with the Kernel smoothing technique. The incidence rate and peak incidence for diseases whose peak incidence occurred before the age of 45 years or before the perimenopausal period were selected as early-onset diseases. The OR and 95% CI were estimated to examine the risk of comorbidity between early-onset and other diseases.
  
  
  RESULTS
  Four early-onset diseases (endometriosis, anaemia, migraine headache and uterine myoma) were significantly correlated with one another. Late-onset diseases significantly associated (OR>2) with early-onset diseases included comorbid endometriosis with ovarian cancer (3.65 (2.16 to 6.19)), endometrial cancer (2.40 (1.14 to 5.04)) and cerebral infarction (2.10 (1.15 to 3.85)); comorbid anaemia with gastric cancer (3.69 (2.68 to 5.08)); comorbid migraine with transient ischaemic attack (3.06 (2.29 to 4.09)), osteoporosis (2.11 (1.71 to 2.62)), cerebral infarction (2.04 (1.26 to 3.30)) and angina pectoris (2.00 (1.49 to 2.67)); and comorbid uterine myoma with colorectal cancer (2.31 (1.48 to 3.61)).
  
  
  CONCLUSIONS
  While there were significant associations between four early-onset diseases, women with a history of one or more of the early-onset diseases had a higher risk of other diseases later in their life course. Understanding the history of early-onset diseases in women may help reduce the subsequent risk of chronic diseases in later life.
authors.affiliation: Unit of Community Health Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Unit of Community Health Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Reproductive Technology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yasui
authors.affiliation: Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Katanoda
authors.affiliation: Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: Department of Environmental Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
authors.affiliation: Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Wakatsuki
authors.affiliation: Department of Comprehensive Reproductive Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Mizunuma
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007889:Leiomyoma / Q000453:epidemiology*; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology*; D009726:Nurses / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016387:Women's Health
keywords: Comorbidity; early-onset diseases; life-course approach; women’s health