Elsevier

Maturitas

Volume 125, July 2019, Pages 70-80
Maturitas

Female reproductive factors and the likelihood of reaching the age of 90 years. The Netherlands Cohort Study

https://doi.org/10.1016/j.maturitas.2019.04.213Get rights and content

Highlights

  • Age at menarche and menopause were not associated with reaching 90 years of age.

  • A later age at first childbirth was positively associated with achieving longevity.

  • Use of hormone replacement therapy was positively associated with achieving longevity in women with early menopause.

Abstract

Objectives

The aim of this study was to prospectively assess the relationship between several reproductive factors in women and the likelihood of reaching the age of 90 years (achieving longevity).

Study design

For this study, data from the oldest birth cohort (1916-17) of the prospective Netherlands Cohort Study (NLCS) were used. These participants filled in a baseline questionnaire in 1986 (at age 68-70 years). Follow-up for vital status information until the age of 90 years (2006-07) was >99.9% complete.

Main outcome measures

Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 2,697 women with complete exposure and co-variable data to calculate risk ratios (RR) of reaching age 90.

Results

No associations were observed between the likelihood of reaching the age of 90 years, and age at menarche, age at menopause, parity, menstrual lifespan, and oral contraceptive use after adjustment for potential confounders. A later age at first childbirth pointed towards a higher chance of achieving longevity (age ≥30 vs. 20-24; RR,1.17; 95%CI,0.98-1.39). Ever-use of hormone replacement therapy (HRT) was significantly associated with a higher chance of achieving longevity compared with never HRT-users, but only in women who had had an early menopause (<50 years)(RR,1.32; 95% CI, 1.07-1.61).

Conclusion

Age at first childbirth, and ever-use of HRT in women with an early menopause (<50 years) were associated with the likelihood of reaching the age of 90 years.

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.

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