Various reproductive factors impact COPD risk in women
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Key takeaways:
- The risk for COPD rose among women who started menstruation at age 11 years or younger vs. 13 years, as well as at age 16 years or older.
- A high risk was observed among those who experienced miscarriage or stillbirth.
Age at menstruation, age at menopause, number of children, miscarriage and stillbirth each impacted a woman’s risk for COPD, according to results published in Thorax.
“These findings can assist clinicians identifying women at higher risk of COPD, implementing timely prevention strategies and potentially reducing the disease burden in later life,” Gita D. Mishra, FAHMS, PhD, CStat, professor and NHMRC Leadership Fellow in the school of public health at The University of Queensland, told Healio.
Using three different cohorts, Mishra and colleagues assessed 283,070 women (median age, 54 years) to find out how several reproductive factors — age at menstruation, number of children, infertility, miscarriage, stillbirth and the age at menopause — each impact a woman’s risk for COPD.
For every analysis, researchers adjusted for several variables in cause-specific Cox regression models: birth year, race, education level, BMI and smoking pack years.
The median follow-up period was 11 years, during which COPD was found in 10,737 women (3.8%; median age, 63 years).
Compared with the age of 13 years for the start of menstruation, researchers found a heightened risk for COPD when menstruation started earlier at age 11 years or younger (HR = 1.17; 95% CI, 1.11-1.23) and later at age 16 years or older (HR = 1.24; 95% CI, 1.21-1.27). Mishra noted that this was a surprising finding.
Between women with children and women without children, the risk for COPD rose with children (HR = 1.13; 95% CI, 1.11-1.15), and having one child vs. two children meant a greater risk (HR = 1.18; 95% CI, 1.14-1.21).
Notably, having three or more children vs. two children also elevated the risk for this disease (3 children, HR = 1.14; 95% CI, 1.12-1.17; 4 children, HR = 1.34; 95% CI, 1.28-1.4), according to researchers.
Along with the above findings linking having children to a higher risk for COPD, being infertile also increased this risk in women (HR = 1.13; 95% CI, 1.1-1.16).
When assessing the link between miscarriages and COPD, researchers found that the risk for COPD went up as the number of miscarriages went up (1 miscarriage vs. 0 miscarriages, HR = 1.08; 95% CI, 1.08-1.09; 2 miscarriages, HR = 1.28; 95% CI, 1.24-1.32; 3 miscarriages, HR = 1.36; 95% CI, 1.3-1.43).
This pattern was also true in the relationship between COPD and stillbirth, with more stillbirths raising a woman’s risk for COPD (1 stillbirth vs. 0 stillbirths, HR = 1.38; 95% CI, 1.25-1.53; 2 stillbirths, HR = 1.67; 95% CI, 1.32-2.1).
Lastly, researchers found a higher risk for COPD among women who started menopause when they were aged younger than 40 years vs. between the ages of 50 to 51 years (HR = 1.69; 95% CI, 1.63-1.75). Women who entered menopause between the ages of 40 and 44 years also had an elevated risk for this disease compared with the older age group (HR = 1.42; 95% CI, 1.38-1.47).
Researchers noted similar findings to the main analysis in a sensitivity analysis that only included women who did not have asthma and an analysis divided by smoking status, with the only exception being that the infertility finding was only true in the cohort of current smokers.
“Future studies are needed to understand the underlying mechanisms linking female reproductive histories and COPD,” Mishra told Healio. “This may include using detailed data on contraceptive medications and hormone replacement therapy (eg, type, dose, time and duration) to shed more light on the effect of exogenous estrogen on COPD.”
Mishra added that studies looking into whether the above findings could improve current COPD screening strategies are also needed.
Reference:
- Age when periods first start and early menopause linked to heightened COPD risk. https://www.bmj.com/company/newsroom/age-when-periods-first-start-and-early-menopause-linked-to-heightened-copd-risk/. Published Feb. 14, 2024. Accessed Feb. 14, 2024.