Abstract
To examine the effect of postmenopausal estrogen therapy (ET), including duration and recency of use, on all-cause mortality in older women. As part of a prospective cohort study of residents of a California retirement community begun in the early 1980s, Leisure World Cohort women (median age, 73 y) completed a postal health survey including details on ET use and were followed up for 22 years (1981-2003). Age- and multivariate-adjusted risk ratios (RR) and 95% CIs were calculated using proportional hazard regression. Of the 8,801 women, 6,626 died during follow-up (median age, 88 y). ET users had an age-adjusted mortality rate of 52.9 per 1,000 person-years compared with 56.5 among lifetime nonusers (RR = 0.91; 95% CI, 0.87-0.96). Risk of death decreased with both increasing duration of ET and decreasing years since last use (P for trend < 0.001). The risk was lowest among long-term (≥15 y) users (RR = 0.83; 95% CI, 0.74-0.93 for 15-19 y and RR = 0.87; 95% CI, 0.80-0.94 for 201 y). For long-term users, the age-adjusted mortality rate was 50.4 per 1,000 person-years. Lower-dose users (≤0.625 mg) had a slightly better survival rate than higher-dose users (RR = 0.84; 95% CI, 0.78-0.91 vs RR = 0.91; 95% CI, 0.83-0.97). Risk did not differ by route of administration (P = 0.56). Further adjustment for potential confounders had little effect on the observed RRs for ET. Long-term ET is associated with lower all-cause mortality in older women.
Highlights
MethodsWe mailed a health survey to all residents who owned homes in Leisure World Laguna Hills, a California retirement community, on June 1, 1981
Our study found that estrogen therapy (ET) users, especially long-term users, had increased longevity compared with nonusers
Considering only mortality as the index of therapeutic success or failure, these results suggest that long-term therapy may extend life
Summary
We mailed a health survey to all residents who owned homes in Leisure World Laguna Hills, a California retirement community, on June 1, 1981. Of the 13,978 residents who returned the questionnaire and constitute the Leisure World Cohort, 8,877 are women. The baseline health survey asked about demographic information (birth date, marital status, number of children, height, weight); brief medical history (hypertension, angina, heart attack, stroke, diabetes, rheumatoid arthritis, fractures after age 40 y, cancer, gallbladder surgery, glaucoma, cataract surgery); medication use (hypertensive medication, digitalis, nonprescription pain medication); personal habits (cigarette smoking, alcohol consumption, exercise, coffee and tea intake); use of vitamin supplements and usual frequencies of consumption of 58 foods (or food groups) that are common sources of dietary vitamins A and C; and, for women, menstrual history, including use of ET. Women taking oral conjugated estrogens were asked to supply dose information; the dose reported here is the dose taken for the longest period
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