Age at menopause and mortality in Taiwan: A cohort analysis.

OBJECTIVE: Previous research suggested age at menopause may predict risk of all-cause, cardiovascular disease (CVD), cancer and diabetes mortality; however, findings were inconsistent across populations. We aimed to investigate this association in Taiwanese postmenopausal women. STUDY DESIGN: We used data from the MJ Health Database in Taiwan and included 36,931 postmenopausal women who entered health check-up programs during 1999-2016. Information on age at menopause and covariates were collected from health surveys and medical examinations at baseline. Age at menopause was categorized into <40-44, 45-49, 50-54 (reference) and 55-60 years. We used Cox proportional hazards regression for analysis. MAIN OUTCOME MEASURES: Causes of death (obtained from the National Register of Death as of July 2018). RESULTS: Mean age (SD) at menopause was 50.2 (4.0) years and there were 5316 deaths over an average follow-up time of 14.6 years. After adjustment for birth cohort, education, smoking, BMI and comorbidities, results showed women aged <40-44 years at menopause compared with the reference category had higher diabetes mortality (hazard ratio [HR] = 1.44; 95 % CI: 1.03, 2.02). Women aged 45-49 years at menopause had higher all-cause mortality (HR = 1.07, 1.01, 1.14), and these women were also associated with increased CVD mortality (HR = 1.22; 1.07, 1.40). CONCLUSIONS: In Taiwanese women, early age (<40-44) at menopause is associated with higher diabetes mortality, and earlier age (45-49) at menopause is associated with higher all-cause and CVD mortality. Age at menopause could be deemed an important cardio-metabolic disease marker for women at midlife that indicates future longevity.

Secular trends and associated factors of age at natural menopause in Taiwanese women.

OBJECTIVE: Age at natural menopause (ANM) is considered an indicator for chronic disease and mortality risk in later life. Research suggests that ANM appears to vary across geographic regions and ethnicities. The aim of this study was to explore the secular trends and factors associated with ANM in Taiwanese women. METHODS: We used data from three cross-sectional phases of the Nutrition and Health Survey in Taiwan. In all, 4,111 women aged 35 years and over were included. Information on ANM and sociodemographics, lifestyle, and health factors were collected using household questionnaires. A Cox proportional-hazards model was used to determine the association of ANM with relevant factors, and a life table method was used to estimate median ANM. RESULTS: Life table method estimated the median ANM to be 50 years. ANM was getting later for women born in younger cohorts (hazard ratio [HR] 0.87 per 10-year difference, 95% confidence interval [CI] 0.81-0.95). ANM was also later among women who achieved higher educational levels (HR 0.91 per one-category difference, 95% CI 0.86-0.96) and who had been married (HR 0.64, 95% CI 0.42-0.96). ANM occurred later for parous than for nulliparous women. Multivariable analysis found no significant associations of ANM with age at menarche, smoking, or alcohol drinking. CONCLUSIONS: The results suggest that women in the younger cohorts, with higher educational levels, and who are parous and married may have later ANM. The trend effect of secular time and educational levels on ANM may reflect the influences of socioeconomic/nutritional status in their childhood or throughout their lifetime.