Female reproductive factors and the likelihood of reaching the age of 90 years. The Netherlands Cohort Study
Introduction
In recent history, women have had a survival advantage over men. Women are almost twice as likely to become a nonagenarian, as compared to men [1]. Estrogen exposure and reproductive processes in women have been considered as a potential explanation for the higher survival rates [2,3]. Based on findings from observational studies, exposure to endogenous steroid hormones has been hypothesized to reduce the risk for cardiovascular disease and -mortality, and to increase the risk for developing several types of cancer (incl. breast, endometrial, and ovarian cancer) [[4], [5], [6], [7]]. The use of exogenous steroid hormones showed no associations with all-cause, cancer, or cardiovascular mortality risk [[8], [9], [10]].
To date, the number of studies that have prospectively assessed the relationship between reproductive factors and longevity is limited [11,12]. Using a prospective cohort, here we aim to assess the relationship between several female reproductive factors and the likelihood of reaching longevity, defined as reaching the age of 90 years.
Section snippets
Population and study design
For this study data from the Netherlands Cohort Study (NLCS) was used. The NLCS was set up in 1986 as a large prospective cohort study [13]. Baseline data were collected from 62,573 women on lifestyle, dietary habits, reproductive history, and other cancer risk factors using a self-administered questionnaire. In addition, the cohort has been followed-up for mortality. This was done by record linkage to the Central Bureau for Genealogy (CBG) from September 1986 until 1995, and to the municipal
Results
Of the 2,697 women included in our analyses 34.4% survived to the age of 90 years. The mean ages at menarche and menopause were 13.4 year (range 9-22), and 48.4 year (range 24-65), respectively (Table 1). The percentage of women who gave birth to at least one child was 81.8%. The average number of childbirths among parous women was 3.6 (SD, 2.1), and the mean age at first birth was 27.8 years (SD, 4.5). Only 3.7% of the women had ever used OC, and among these the mean age at initiation was 46.7
Discussion
Using data from the Netherlands Cohort Study, no significant associations were observed between age at menarche, age at menopause, induction of menopause, parity, menstrual lifespan, and OC use in relation to the chance of reaching the age of 90 years. The age at which women had their first childbirth was borderline significantly associated with the chance of reaching longevity, where a higher age at first birth pointed towards a higher likelihood of reaching longevity. In women with an early
Contributors
Lloyd Brandts analyzed the data, prepared the tables and drafted the manuscript.
Frans W.A. van Poppel provided critical revisions for important intellectual content.
Piet A. van den Brandt designed the study, coordinated the data collection and analyses, and provided critical revisions for important intellectual content.
All authors conceptualized the paper, and read and approved the final version of the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
The NLCS has been approved by the institutional review boards of Maastricht University (Maastricht) and the Netherlands Organisation for Applied Scientific Research TNO (Zeist).
Provenance and peer review
This article has undergone peer review.
Research data (data sharing and collaboration)
There are no linked research data sets for this paper. The informed consent does not allow for data to be shared.
Acknowledgements
The authors wish to thank the participants of this study, Statistics Netherlands, and the Central Bureau for Genealogy (CBG) for providing data. We thank the staff of the Netherlands Cohort Study for the valuable contributions.
References (36)
- et al.
Meta-analysis of oral contraceptive use and risks of all-cause and cause-specific death
Int. J. Gynaecol. Obstet.
(2015) - et al.
A large-scale prospective cohort study on diet and cancer in the netherlands
J. Clin. Epidemiol.
(1990) - et al.
Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort Study
Maturitas
(2007) Reproduction at an advanced maternal age and maternal health
Fertil. Steril.
(2015)- et al.
Factors affecting mortality in a large cohort study with special reference to oral contraceptive use
Contraception
(2010) Statistics Netherlands (CBS), Prognose bevolking; geslacht en leeftijd, 2019-2060
(2018)- et al.
The epidemiology of longevity and exceptional survival
Epidemiol. Rev.
(2013) - et al.
Chapter 5: Sex Affects Health, Exploring the Biological Contributions to Human Health : Does Sex Matter?
(2001) - et al.
Relationships of age at menarche and menopause, and reproductive year with mortality from cardiovascular disease in Japanese postmenopausal women: the JACC study
J. Epidemiol.
(2006) - et al.
Modern reproductive patterns associated with estrogen receptor positive but not negative breast cancer susceptibility
Evolution, medicine, and public health
(2014)
Reproductive and hormonal factors in association with ovarian cancer in the Netherlands cohort study
Am. J. Epidemiol.
Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: a systematic review and meta-analysis
JAMA cardiology
Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials
JAMA
Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis
J. Clin. Endocrinol. Metab.
Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women’s Health Initiative
Menopause
Maternal Age at Childbirth and Parity as Predictors of Longevity Among Women in the United States: The Women’s Health Initiative
Am. J. Public Health
Sex-specific associations between smoking habits and reaching longevity: Netherlands Cohort Study
Geriatr Gerontol Int
Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study
BMC Med.
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