Systematic exclusion at study commencement masks earlier menopause for Black women in the Study of Women's Health Across the Nation (SWAN).

BACKGROUND: Shorter average lifespans for minoritized populations are hypothesized to stem from 'weathering' or accelerated health declines among minoritized individuals due to systemic marginalization. However, evidence is mixed on whether racial/ethnic differences exist in reproductive ageing, potentially due to selection biases in cohort studies that may systematically exclude 'weathered' participants. This study examines racial/ethnic disparities in the age of menopause after accounting for differential selection 'into' (left truncation) and 'out of' (right censoring) a cohort of midlife women. METHODS: Using data from the Study of Women's Health Across the Nation (SWAN) cross-sectional screener (N = 15 695) and accompanying ∼20-year longitudinal cohort (N = 3302) (1995-2016), we adjusted for potential selection bias using inverse probability weighting (left truncation) to account for socio-demographic/health differences between the screening and cohort study, and multiple imputation (right censoring) to estimate racial/ethnic differences in age at menopause (natural and surgical). RESULTS: Unadjusted for selection, no Black/White differences in menopausal timing [hazard ratio (HR)=0.98 (0.86, 1.11)] were observed. After adjustment, Black women had an earlier natural [HR = 1.13 (1.00, 1.26)] and surgical [HR= 3.21 (2.80, 3.62)] menopause than White women with natural menopause-corresponding to a 1.2-year Black/White difference in menopause timing overall. CONCLUSIONS: Failure to account for multiple forms of selection bias masked racial/ethnic disparities in the timing of menopause in SWAN. Results suggest that there may be racial differences in age at menopause and that selection particularly affected the estimated menopausal age for women who experienced earlier menopause. Cohorts should consider incorporating methods to account for all selection biases, including left truncation, as they impact our understanding of health in 'weathered' populations.

Perceived stress across the midlife: longitudinal changes among a diverse sample of women, the Study of Women's health Across the Nation (SWAN).

Background: In women, midlife is a period of social and physiological change. Ostensibly stressful, cross-sectional studies suggest women experience decreasing stress perceptions and increasing positive outlook during this life stage. The aim of this paper was to describe the longitudinal changes in perceived stress as women transitioned through the midlife. Methods: Premenopausal women (n = 3044) ages 42-52 years at baseline, were recruited from seven sites in the Study of Women's Health Across the Nation, and followed approximately annually over 13 visits with assessment of perceived stress and change in menopausal status. Longitudinal regression models were used to assess the effects of age, menopausal status and baseline sociodemographic variables on the trajectory of perceived stress over time. Results: At baseline, mean age was 46.4 ± 2.7 years; participants were white (47%), black (29%), Hispanic (7%), Japanese (9%), or Chinese (8%). Hispanic women, women with lesser educational attainment, and women reporting financial hardship were each more likely to report high perceived stress levels at baseline (all p < 0.0001). After adjustment for baseline sociodemographic factors, perceived stress decreased over time for most women (p < 0.0001), but increased for both Hispanic and white participants at the New Jersey site (p < 0.0001). Changing menopausal status was not a significant predictor of perceived stress. Conclusions: Self-reported stress decreased for most women as they transitioned across the midlife; changing menopausal status did not play a significant role after adjustment for age and sociodemographic factors. Future studies should explore the stress experience for women by racial/ethnic identity and demographics.

Childhood Socioeconomic Circumstances, Inflammation, and Hemostasis Among Midlife Women: Study of Women's Health Across the Nation.

BACKGROUND: Childhood socioeconomic status (SES) is related to risk for cardiovascular disease in adulthood, perhaps, in part, due to associations with inflammatory and hemostasis processes. We tested the hypotheses that childhood SES is related to C-reactive protein (CRP), fibrinogen, factor VIIc, and plasminogen activator inhibitor-1 (PAI-1) in midlife women and that the associations are mediated by adult SES and/or adult body mass index (BMI). METHODS: Using data from the prospective Study of Women's Health Across the Nation, we classified 1067 black and white women into 3 multidimensional childhood SES groups based on latent class analysis. Biological measures were assessed across 7 years along with covariates and mediators and analyzed by mixed regression models, followed by tests for mediation. RESULTS: Compared with women raised in high SES families, those from the lowest SES families had higher levels of CRP (b [standard error] = 0.37 [0.11]), PAI-1 (b = 0.23 [0.07]) factor VIIc (b = 0.05 [0.02]), and fibrinogen (b = 11.06 [4.89]), after adjustment for ethnicity, site, age, ratings of health between ages 11 and 18 years, visit, smoking status, menopausal status, stroke or heart attack, medications, and hormone use. Introduction of adult SES and BMI into the models reduced the childhood SES associations to nonsignificance for all four measures. Indirect mediation was apparent for adult education and BMI for CRP, and BMI for PAI-1. CONCLUSIONS: Women raised in lower SES families had elevated markers of inflammation and hemostasis, in part, due to elevated BMI and education in adulthood.

Longitudinal assessment of the menopausal transition, endogenous sex hormones, and perception of physical functioning: the Study of Women's Health Across the Nation.

BACKGROUND: To evaluate the longitudinal associations between menopausal status, related hormonal changes, and level of self-reported physical functioning. METHODS: Study included 2,495 women (age: 45-57 between 2000 and 2001) from the Study of Women's Health Across the Nation. Physical functioning scale of the Medical Outcomes Study Short-Form (SF-36; score 0-100) was categorized as: no limitation (86-100), moderate limitation (51-85), and substantial limitation (0-50). Study variables were collected between 2000 (visit-04) and 2011 (visit-12) at five timepoints. Statistical models were adjusted for age at visit-04, time since visit-04, ethnicity, site, economic status, level and change in body mass index, level and change in physical activity, and presence of comorbid conditions. RESULTS: In final models, natural and surgical postmenopausal women had significantly higher odds of functional limitation, compared with premenopausal women. Less reduction in estradiol and testosterone since visit-04 were significantly associated with lower odds of functional limitation, while greater increase in sex hormone-binding globulin was associated with higher odds of functional limitation. CONCLUSIONS: Our findings suggest the menopause-related changes in endogenous sex hormones as a possible mechanism of action to explain the greater limitation in physical functioning reported in women at midlife.

Relationship of race-ethnicity, body mass index, and economic strain with longitudinal self-report of physical functioning: the Study of Women's Health Across the Nation.

PURPOSE: This study examined progression and improvement of physical functioning limitations during the mid-life and whether race-ethnicity, economic strain, or body mass index were associated with these changes. METHODS: Women from the Study of Women's Health Across the Nation with one or more measure of self-reported physical functioning, categorized as no, some, or substantial limitations, between study visits 4 and 12 were included (n = 2497). RESULTS: When women were aged 56-66 years, almost 50% reported limitations in functioning. African American women were more likely to report substantial (odds ratio, 1.63; 95% confidence interval, 1.06-2.52) and Chinese women were more likely to report some limitations (odds ratio, 2.03; 95% CI, 1.22-3.36) compared with Caucasian women. Economic strain and obesity predicted limitations. The probability of worsening ranged from 6% to 22% and of improving ranged from 11% to 30%. Caucasian and Japanese women had the highest probability of remaining fully functional (80% and 84%, respectively) compared with 71% of African American women. CONCLUSIONS: Race-ethnicity, obesity, and economic strain were associated with prevalence and onset of physical functioning limitations. Functional improvement is common, even among vulnerable subgroups of women. Future studies should characterize predictors of decline and improvement so that interventions can sustain functioning even in the context of many known immutable risk factors.

Prevalence and correlates of disability in a late middle-aged population of women.

OBJECTIVE: This study estimates the prevalence of disability among late middle-aged women and identifies important correlates of disability among this population. METHOD: Disability was assessed among 376 participants of the Michigan Study of Women's Health Across the Nation cohort at the 2011 follow-up using the World Health Organization Disability Assessment Schedule. Demographic and health measures were related to disability status using logistic regression models (none or mild vs. moderate, severe, or extreme disability). RESULTS: Nearly 25% of women reported moderate to extreme global disability. African American race/ethnicity, economic strain, peripheral neuropathy, and depressive symptomatology were associated with global disability. Obesity, knee osteoarthritis, and hypertension were only associated with disability for the mobility domain (getting around). DISCUSSION: The prevalence of disability is relatively high among this population of late middle-aged women. Efforts to prevent or forestall disability should be extended to include middle-aged populations as they may be most amenable to intervention.

The relation of tobacco use during hospitalization to post-discharge smoking cessation among US veterans.

OBJECTIVE: The objective of this study was to determine if tobacco use while in the hospital was associated with post-discharge cessation rates. METHODS: During 2006-2008, smokers from three Veterans Affairs hospitals (n=354) were surveyed during their hospitalization and again 6 months later. Data analysis was conducted in 2009. RESULTS: While veterans smoked an average of 19 cigarettes per day, prior to admission, the average was 6-7 cigarettes per day during hospitalization. About 40% (n=140) were able to quit smoking for more than 24 h and the median days quit was 29. The 6-month self-reported quit rate was 15% (n=53). Multivariate analyses showed that veterans who quit tobacco use during their hospitalization had nearly 4 times increased odds of quitting smoking for more than 24 h and 2.7 times increased odds of quitting at 6 months post-hospitalization as compared to veterans that did not quit using tobacco during hospitalization. CONCLUSION: Many veterans quit tobacco use during hospital admissions and those who do not quit, tended to decrease their use. Veterans who quit tobacco use were more likely to be abstinent at 6-month follow-up. State-of-the-art cessation interventions need to be provided to smokers hospitalized in Veterans Affairs hospitals.