Risk Of Mortality In Women Research Articles

Maternal and Perinatal Mortality and Complications Associated With Caesarean Section in Low-income and Middle-income Countries: A Systematic Review and Meta-Analysis

(Lancet. 2019;393:1973–1982) The vast majority (99%) of maternal deaths occur in low-income and middle-income countries (LMICs). While cesarean section access is an important factor for improving maternal care, cesarean sections sometimes are performed too often. Lack of skilled medical workers and resources in LMICs make complications related to cesarean section even more severe than in high-income countries (HICs). There is a lack of large studies in LMICs on maternal and neonatal deaths after cesarean section. This systematic review and meta-analysis aimed to determine the risk of mortality in women from LMICs after undergoing cesarean section. In addition, risk factors for maternal and perinatal morbidity and mortality following cesarean section were investigated.

Dose-Response Relationships Between Body Composition Indices and All-Cause Mortality in Older Japanese Adults

ObjectivesWe examined the dose-response relationships of body composition indices with mortality and identified the best predictor. Design and settingKusatsu Longitudinal Study and Hatoyama Cohort Study, Japan. ParticipantsIn total, 1977 community-dwelling Japanese adults age ≥65 years (966 men and 1011 women) participated. MeasurementsBody mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and skeletal muscle mass index (SMI) were determined by segmental multifrequency bioelectrical impedance analysis. The main outcome was all-cause mortality. We determined multivariate-adjusted hazard ratios for mortality relative to sex-specific medians of each body composition index and examined the association shapes. ResultsDuring the median follow-up of 5.3 years, 128 (13.3%) men and 75 (7.4%) women died. Compared with median BMIs (23.3 kg/m2 in men and 22.8 kg/m2 in women), a BMI >23.3 and ≤26.1 kg/m2 was associated with significantly lower mortality risk in men, and a BMI <22.8 kg/m2 was associated with significantly higher mortality risk in women. The inverse dose-response relationship with mortality was clearer for FFMI [hazard ratios (95% confidence interval) of 10th and 90th percentiles: 1.58 (1.23–2.03) and 0.58 (0.44–0.79), respectively, in men and 1.56 (1.12–2.16) and 0.68 (0.51–0.91), respectively, in women] and SMI [1.57 (1.22–2.01) and 0.60 (0.45–0.80), respectively, in men and 1.45 (1.05–2.01) and 0.77 (0.61–0.96), respectively, in women] than for BMI [1.30 (0.92–1.83) and 0.65 (0.41–1.03), respectively, in men and 1.87 (1.18–2.95) and 0.88 (0.54–1.42), respectively, in women]. FMI was not associated with mortality in either sex. Conclusions and ImplicationsFFMI and SMI were more definitive predictors of mortality than were BMI and FMI. The lower mortality risk with higher FFMI, regardless of FMI, may explain the age-related weakening of the association between higher BMI and mortality (the “obesity paradox”). FFMI and SMI evaluation should be introduced to clinical assessments of older adults because mortality risk might be reduced by maintaining muscle mass.

Efecto pronóstico diferencial de la diabetes mellitus tipo 2 en mujeres y varones con insuficiencia cardiaca y fracción de eyección conservada

Introduction and objectivesType 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. MethodsWe prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). ResultsThe mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1%, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P<.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). ConclusionsAfter an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.Full English text available from:www.revespcardiol.org/en

Associations of dairy intake with risk of mortality in women and men: three prospective cohort studies

ObjectiveTo examine the association of consumption of dairy foods with risk of total and cause specific mortality in women and men.DesignThree prospective cohort studies with repeated measures of diet and...

Predictor of enhanced mortality in patients with multimorbidity and atrial fibrillation in an acute hospital setting.

Patients with atrial fibrillation (AF) admitted to hospital commonly have comorbidities. Few studies have attempted to determine factors prognostic of mortality in hospitalized AF patients with multimorbidity. To identify factors associated with mortality in hospitalized AF patients. Retrospective cohort study. Patients with multimorbidity (≥2 chronic diseases), with or without AF, discharged from Lugo hospital (Spain) between 1 January 2000 and 31 December 2015. Data were extracted from hospital medical records. Of 74220 patients (170978 hospitalizations), 52939 had multimorbidity (14181 had AF; 38758 no AF) and were included in our study. Patients with AF were older (mean ± standard deviation 78.6 ± 10.0 vs. 71.9 ± 14.2 years) and had a higher mortality rate (27.1 vs. 20.5%) than those without AF. Gender (female), age, stroke and congestive heart failure (CHF), but not AF, were independently associated with mortality. AF significantly increased the mortality risk in women [relative risk (RR) 1.091; 95% confidence interval (CI) 1.021-1.165; P = 0.010] and in those aged >80 years (RR 1.153; 95% CI, 1.1-1.2; P < 0.001). CHF independently increased the risk of mortality across all age groups (RR 1.496; 95% CI 1.422-1.574; P < 0.001). Hospitalized patients with AF have a higher mortality rate than those without AF. The prognostic significance of AF changes with age and gender while CHF is associated with the greatest risk of death.

GRANDPARENTHOOD AND RISK OF MORTALITY: FINDINGS FROM THE HEALTH AND RETIREMENT STUDY

Grandparenthood is a significant social role for older adults and may have important health implications. Parenthood itself has been associated with some protective health effects, although findings have been mixed. Whether grandparenthood is associated with important long-term health effects such as mortality is largely unknown. This study examines the grandparenthood-mortality nexus, and whether it is modified by gender and education. Longitudinal data from the Health and Retirement Study (HRS) were used, comprising twelve biennial follow-up waves from 1992 to 2014 with linked data on vital status derived from the National Death Index. Submodules assessed participants’ family structure during follow-up. The sample included 24,325 participants aged > 51 years with at least one child. Cox proportional hazard models were used to test the association between grandparenthood and mortality risk with adjustment for socio-demographic variables, for social variables including characteristics of and contact with children, and for health variables, including measures of overall, functional and mental health. Stratified models assessed these associations separately by gender and education. Grandparenthood was associated with a substantially increased mortality risk in women (fully adjusted HR = 1.65; 95% CI 1.27-21.14), and increased with larger number of grandchildren. No significant association was found for men (fully adjusted HR=1.25; 95% CI 0.97-1.62). Mortality risks associated with grandparenthood were highest among grandparents with low levels of education. The findings are among the first to suggest a potential grandparenthood survival “penalty”, especially for grandmothers. Higher levels of education appear to mitigate this negative survival effect among grandparents.

Impact of osteoporotic fracture type and subsequent fracture on mortality: the Tromsø Study.

Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures. The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables. Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73-2.42 in women and 2.49, 95% CI 2.00-3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21-1.84 and 1.81, 95% CI 1.37-2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52-2.35 and 1.77, 95% CI 1.16-2.71), respectively. Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.

Birth size and cancer prognosis: a systematic review and meta-analysis.

There is an established link between birth parameters and risk of adult-onset cancers. The Developmental Origins of Health and Disease concept provides potential underlying mechanisms for such associations, including intrauterine exposure to endogenous hormones (androgens and estrogens), insulin-like growth factors, etc. However, there is conflicting evidence on the association between birth parameters and the cancer mortality risk. Therefore, we aimed to review and analyse the available data on the association linking birth weight and birth length with cancer mortality. Eleven studies were identified, published until April 2019. A significant association between birth weight and the prognosis of cancer (overall) was found (relative risk, RR 1.06, 95% confidence interval, CI: 1.01, 1.11), with low heterogeneity (I2 = 27.7%). In addition, higher birth weight was associated with poorer prognosis of prostate cancer (RR 1.21, 95% CI: 1.02, 1.44). However, the association of birth weight with breast cancer mortality risk in women was not significant (RR 1.16, 95% CI: 0.93, 1.44), which might be due to high statistical heterogeneity (I2 = 67.9%). Birth length was not associated with cancer mortality risk (RR 1.0, 95% CI: 0.90-1.11). It might be inferred that birth parameters are not associated with cancer mortality as strongly as with the risk of developing cancer. Also, the association between birth parameters and cancer mortality risk is not uniform and varies according to its subtypes, and study characteristics/design. This highlights the need for further prospective studies.

Differential prognostic impact of type 2 diabetes mellitus in women and men with heart failure with preserved ejection fraction.

Type 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. We prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). The mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P <.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). After an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.

Cardiorespiratory Fitness, Different Measures of Adiposity, and Cardiovascular Disease Mortality Risk in Women.

Background: Associations among cardiorespiratory fitness (CRF), different adiposity exposures, and cardiovascular disease (CVD) mortality in women are not well defined. Materials and Methods: A total of 19,838 women completed a baseline examination between 1971 and 2013. Measures included body mass index (BMI), waist circumference (WC), waist-to-height (W:HT) ratio, skinfold-derived percent body fat (% Fat), and CRF estimated from a maximal treadmill test. CRF categories were low (quintile 1), moderate (quintiles 2-3), and high (quintiles 4-5); standard cut points were used for adiposity exposures. Hazard ratios (HRs) were estimated using Cox regression. Results: During a mean follow-up period of 19.2 ± 10.3 years, 391 cardiovascular deaths occurred. HRs (95% confidence interval) for CVD in moderate and low CRF groups, using high CRF as the referent, were 1.87 (1.46-2.38) and 2.54 (1.93-3.35), respectively (p trend <0.001). HRs of obese women within each adiposity exposure were higher when compared with normal-weight women (p ≤ 0.03). Joint associations of CRF × adiposity showed a positive trend in CVD mortality across decreasing categories of CRF within each category of W:HT and % Fat, as well as within the normal and overweight BMI categories and the normal WC category (p ≤ 0.03 for each). Conclusion: Higher levels of CRF are associated with lower CVD mortality risk in women, and predict lower risk of CVD mortality in normal-weight women and in obese women. Using different measures of adiposity to predict CVD mortality risk in women may be misleading unless CRF is taken into account. These results support the American Heart Association (AHA) recommendation for including CRF as a clinical vital sign.

Handgrip strength, inflammatory markers, and mortality.

To investigate the extent to which inflammatory markers explain the association between handgrip strength and mortality. Analyses of data from The English Longitudinal Study of Ageing. Handgrip strength and inflammatory marker data (C-reactive protein and fibrinogen) were collected at baseline (2004/5) and inflammatory marker data at follow-up (2012/13). Participant data were linked with death records. General linear models were used to explore associations between handgrip strength and inflammatory markers at follow-up. Cox proportional hazards regression models were used to examine associations between grip strength and risk of death. Models were estimated with the covariates age, sex, wealth, physical activity, smoking, depressive symptoms, long-standing illness, and adiposity. The sample comprised of 5,240 participants (mean age 65.9 (SD 9.4)years; 53.8% female). Over an average 9.7±1.4years follow-up, there were 650 deaths. Inverse associations were evident between handgrip strength and change in inflammatory markers in women only. There was an association between grip strength and lower risk of mortality in women (hazard ratio=0.85; 95% CI, 0.74, 0.98) after adjusting for age and wealth. The association was attenuated after adjustment for clinical and behavioral risk factors (0.92; 0.79, 1.07), and further attenuated after adjusting for inflammatory markers (0.95; 0.82, 1.11). Higher grip strength is associated with lower levels of inflammation at 8-year follow-up, and inflammatory markers partly explained the association between handgrip strength and mortality.

Abstract P2-08-03: Multiple foci of microinvasion is associated with an increased risk of invasive local recurrence and an increased risk of breast cancer mortality in women with ductal carcinoma in situ treated with breast-conserving therapy

Abstract Purpose: Ductal Carcinoma in Situ (DCIS) with microinvasion (MI) (&amp;lt; 1mm) includes a spectrum of cases with a single focus of MI and those with multiple foci (2 or more) of MI. The impact of multiple foci of MI on the risks of local recurrence (LR), invasive LR and breast cancer-specific survival (BCSS) is unknown, leading to uncertainty if DCIS with multiple foci of MI requires more aggressive treatment than those with a single focus of MI or pure DCIS. We examined the impact of multiple foci of MI, confirmed by expert pathology review, on the 15-yr risks of LR, invasive LR and breast-cancer specific survival (BCSS) in a population cohort of DCIS (+/-MI) treated with breast-conserving surgery (BCS) +/- radiotherapy (RT). Methods: The cohort includes all women diagnosed with DCIS +/- MI in Ontario from 1994-2003 treated with BCS+/-RT. Cases with prior malignancy were excluded. Treatment and outcomes were ascertained by deterministic linkage with chart validation. Cause of death was determined from the provincial cancer registry or terminal hospital admission records. Cox proportional hazards model was used to evaluate the impact of multiple foci of MI on the risks of ipsilateral invasive LR and ipsilateral DCIS LR, adjusting for significant co-variates. The 15-yr invasive local recurrence-free survival (LRFS), DCIS LRFS and 15-yr BCSS risks were calculated using the Kaplan-Meier method with differences compared using the log-rank test. Results: The cohort includes 3529 women; 2988 (85%) with pathology review are included in this analysis. 2,721 had pure DCIS (51% received RT), 267 had DCIS with MI (1 focus, N=156; multiple foci, N=111 (58% had RT)). Median follow-up was 13 years. Median age at diagnosis was 58 years. LR developed in 571 cases (21%) of pure DCIS, 33 cases (21%) with 1 focus of MI and 23 cases (27%) with multiple foci of MI. On multivariable analyses, the presence of multiple foci of MI was associated with an increased risk of invasive LR (HR=1.59, 95%CI: 1.01-2.49, p=0.04) but not DCIS LR (HR=0.89, 95%CI: 0.46, 1.76, p=0.7). Women with multiple foci of MI had higher risks of invasive LR and lower BCSS at 15 years compared to those with pure DCIS. The 15-year invasive LRFS risks for cases with pure DCIS, with 1 focus or multiple foci of MI were 85.7%, 85.6%, 74.7% for cases treated by BCS alone and 87.2%, 89.9% and 77% following BCS+RT without boost; however, women treated with boost RT had substantially higher 15-yr invasive LRFS risks than those who did not receive boost RT. The 15-yr invasive LRFS risks for those with pure DCIS, 1 or multiple foci of MI, were 89.2%, 91.3% and 95% (all p values&amp;gt;.05, limited by low event rate). The 15-yr BCSS risks for cases with 1 focus, multiple foci of MI or pure DCIS were 92.1%, 93.1%, 96.4% (p=.006). Conclusions: The presence of multiple foci of MI in DCIS is associated with higher 15-year risks of invasive LR and lower breast-cancer specific survival after breast-conserving therapy compared to women with pure DCIS but treatment with whole breast and boost RT can mitigate this risk. Citation Format: Rakovitch E, Sutradhar R, Lalani N, Gu S, Nofech-Mozes S, Hanna W, Fong C, Paszat L. Multiple foci of microinvasion is associated with an increased risk of invasive local recurrence and an increased risk of breast cancer mortality in women with ductal carcinoma in situ treated with breast-conserving therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-03.

Lower baseline value and greater decline in BMD as independent risk factors for mortality in community dwelling elderly

Skeleton plays diverse roles via crosstalk between others, thus it is conceivable that lower BMD per se may reflect negative influences on health status and threats to life independent of fracture events. We investigated investigate the association between BMD and mortality, and to examine whether the rate of bone loss can predict future mortality in an elderly population. This study was conducted as a part of the Korean Longitudinal Study on Health and Aging, a community-based prospective study of Korean people aged 65 years and older that began in 2005. A total of 648 people (318 men and 330 women) were included. Dual energy X-ray absorptiometry were conducted at baseline and at 5 years. Mortality data were collected until the date of death or the last follow-up in December 2014. Osteoporosis in all skeletal sites significantly related to increased risk of mortality in men and women, but the associations were stronger for BMD in the femur neck and total hip than in the lumbar spine. A multivariable Cox proportional-hazards model showed that baseline BMD level was a significant independent predictor of increased all-cause mortality for all three skeletal sites in men, and for lumbar spine and total hip in women. Furthermore, faster bone loss of BMDs, as shown by the decline in BMD in the lumbar spine, femur neck, and total hip, was significantly related to increased risk of mortality after adjusting for all covariates in men. Faster BMD loss at femur neck was also related to the increased risks of mortality in women. Conclusively, both a lower baseline values and greater decline in BMD were associated with excess morality in community-dwelling elderly population; there associations were stronger in men than in women. This study emphasizes the importance of skeletal health for healthy aging, revealing lower bone mass and faster bone loss may be markers of poorer health that are driving excess mortality.

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994\u20132013)

PurposeWe aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994–2013) and to estimate the all-cause mortality excess risk of diagnosed women.MethodsAge-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC).ResultsOf the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10).ConclusionsAmong women aged 50–69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

208. Risk of cardiovascular mortality in women with a history of hypertensive pregnancy disorders: A nationwide cohort study

Introduction Hypertensive pregnancy disorders (HPD) are associated with cardiovascular disease (CVD) later in life. Since hypertension in pregnancy occurs at a relatively young age this may signal an opportunity for preventive measure for CVD at a relative early age. This study investigated the relationship between HPD and cardiovascular mortality in a large national cohort. Methods Women who gave birth during 1995–2015 (registered in the Dutch National Birth Registry) were linked with the National Death Registry. The risk of cardiovascular mortality (CVM) after HPD was analyzed prospectively in two different cohorts: Women with a history of HDP in one or more pregnancies and HDP in the first pregnancy of the women. Cox-regression models with survival curves were executed. Results Of 1,625,246 parous women 21.9% had a history of HDP. Both gestational hypertension (GH; 18.1%) and preeclampsia (PE; 3.8%) were associated with a 2–3 times higher CVM risk compared to women without a history of HPD. Similar results were found in the cohort of 1,243,890 women whose first nulliparous pregnancy was analyzed. Women with HDP, delivery 110 mmHg had a 4.5-fold higher CVM-risk. Women were followed for a mean time of 10.4 years and died at a mean age of 40 years old. Conclusion Women with a history of HDP have a 2–3-fold times higher CVM risk. Cardiovascular mortality risk is present at a relatively young age (

Abstract A55: Premenopausal gynecologic surgery and breast cancer mortality in the Carolina Breast Cancer Study

Abstract Introduction: In the United States, gynecologic surgery, including hysterectomy and oophorectomy, is frequently performed before menopause for benign conditions such as endometriosis, uterine fibroids, and ovarian cysts. Evidence has suggested that the prevalence of these procedures in the United States is far greater in Black women than in White women. Previous studies conducted in primarily White populations have shown that hysterectomy with bilateral oophorectomy reduces the risk of breast cancer mortality for women with breast cancer. The present study sought to evaluate the effect of premenopausal gynecologic surgery on breast cancer-specific and all-cause mortality in a population-based sample of Black and White women diagnosed with breast cancer. Methods: This study analyzed data from Phase 1 and Phase 2 of the Carolina Breast Cancer Study (CBCS). The CBCS is a population-based study that recruited Black and White women from 24 counties in central and eastern North Carolina between 1993 and 2001. Women with an incident invasive breast cancer diagnosis were identified using the North Carolina Central Rapid Case Ascertainment system. Information on gynecologic surgery was collected during nurse-administered in-person interviews, and women diagnosed with breast cancer with known surgical status were included in this analysis (n=1,723). Gynecologic surgery was operationalized in three categories: no surgery; hysterectomy with bilateral oophorectomy; hysterectomy with conservation of ≥ 1 ovary. Cause-specific mortality was ascertained using the National Death Index, last updated in 2011. Hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer-specific and all-cause mortality were estimated with Cox Proportional Hazard Models. Multivariable HRs were adjusted for age at diagnosis, family history of breast cancer, smoking, alcohol use, hormone replacement therapy, and reproductive history factors. All participants still living at the end of follow-up were right censored. Models were weighted using the CBCS sampling fractions. Results: Among 1,723 women, there were 686 deaths of which 411 were from breast cancer. In this sample, 74.1% (n=1,276) of women reported having no gynecologic surgery, 8.8% (n=152) reported having had a hysterectomy with bilateral oophorectomy, and 17.1% (n=295) reported hysterectomy conservation of ≥ 1 ovary. Compared to women who had not had gynecologic surgery, the adjusted HR for breast cancer-specific mortality associated with hysterectomy and bilateral oophorectomy was 0.68 (95% CI: 0.48,0.94). In stratified models, HRs for breast cancer specific mortality were similar between White (HR=0.67, 95% CI: 0.43,1.0) and Black (HR=0.71, 95% CI: 0.38,1.22) women. No relationship was observed between hysterectomy with ovarian conservation and breast cancer survival. Estimated HRs for the association between hysterectomy with bilateral oophorectomy and all-cause mortality were in the opposite direction for Black (HR=0.73, 95% CI: 0.48,1.08) and White (HR=1.16, 95% CI: 0.93,1.44) women; however, these confidence intervals were wide and overlapping. Conclusions: This study supports prior evidence that hysterectomy with bilateral oophorectomy reduces the risk of breast cancer-specific mortality and this effect is consistent across White and Black women. The relationship between premenopausal gynecologic surgery and all-cause mortality in women diagnosed with breast cancer may potentially differ by racial group. Impact: Premenopausal gynecologic surgeries are very common in Black women diagnosed with breast cancer, but the effect of these surgeries on mortality was, to our knowledge, previously unknown in this population. Our findings add to the evidence base in understanding racial disparities in mortality after breast cancer more broadly. Citation Format: Mya Roberson, Whitney Ragan Robinson, Hazel Nichols, Andrew Olshan, Melissa Troester. Premenopausal gynecologic surgery and breast cancer mortality in the Carolina Breast Cancer Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A55.

Abstract P070: Risk of All-cause Mortality in Women versus Men With Type 2 Diabetes: A Systematic Review and Meta-analysis

Introduction: Previous studies have shown sex differences in the all cause mortality rate associated with type 2 diabetes. Hypothesis: We did a meta-analysis to provide reliable and comprehensive estimates of type 2 diabetes on risk of all-cause mortality in women versus men. Methods: We systematically searched PubMed, Embase, and Web of science for studies published from their starting dates to October 10, 2017. Studies were selected only if they reported sex-specific estimates of the standardized mortality ratio (SMR) or hazard ratios associated with type 2 diabetes for all-cause mortality. We used random effects meta-analyses with inverse-variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality. Study quality was assessed using the Newcastle–Ottawa scale. Results: Data from 30 studies including 2,307,694 individuals and 252,491 deaths occurred were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1·14 (95% CI 1.09-1.19, p&lt;0.001; I 2 =81.6%). Compared with healthy counterparts, the pooled SMR for all-cause mortality in patients with T2D was 2.30(95%CI 1.97-2.68) in women, and 1.94(95%CI 1.73-2.18) in men, respectively. Sensitivity analysis with omission of one study at a time did not change the results of this meta-analysis. Conclusions: Women with type 2 diabetes have a roughly 14% greater excess risk of all-cause mortality compared with men counterparts. This meta-analysis was registered at the International Prospective Register of Systematic Reviews (Prospero) ( http://www.crd.york.ac.uk/PROSPERO ; registration number: CRD42017074187). Figure 1 .Pooled women-to-men ratios of SMRs for all-cause mortality, comparing people with type 2 diabetes versus healthy counterparts.

Characteristics and Prognosis in Women and Men With Type 1 Diabetes Undergoing Coronary Angiography: A Nationwide Registry Report.

To describe sex aspects on extent of coronary artery disease (CAD) and prognosis in a contemporary population with type 1 diabetes. All patients undergoing coronary angiography, 2001-2013, included in the Swedish Coronary Angiography and Angioplasty Registry and the Swedish National Diabetes Register as type 1 diabetes were followed for mortality until 31 December 2013. The coronary angiogram was classified into normal, one-vessel disease, two-vessel disease, three-vessel disease, and left main stem disease. In all, 2,776 patients (42% women) with mean age 58 years (SD 11) were followed for 7.2 years (SD 2.2). Diabetes duration was longer in women (37 ± 14 vs. 34 ± 14 years in men; P < 0.001), who also had more retinopathy (68% vs. 65%; P = 0.050), whereas microalbuminuria was less common (41% vs. 51%; P < 0.001). Indications for coronary angiography did not substantially differ in women and men. The extent of CAD was somewhat less severe in women (normal angiogram 23.5% vs. 19.1%, three-vessel and left main stem disease 34.5% vs. 40.4%; P = 0.002), whereas mortality did not differ (adjusted hazard ratio 1.03 [95% CI 0.88-1.20]; P = 0.754). The standard mortality ratio for women the first year was 7.49 (5.73-9.62) and for men was 4.58 (3.60-5.74). In patients with type 1 diabetes admitted for coronary angiography, the extent of CAD was almost similar in women and men, and total long-term mortality did not differ. Type 1 diabetes was associated with higher mortality risk in women than in men when compared with the general population. These data support that type 1 diabetes attenuates the cardiovascular risk difference seen in men and women in the general population.

P18-3 - Gender Difference in Acute Myocardial Infarction

Background: It remains unexplained that high risk of mortality in women compared to men after acute myocardial infarction (AMI). Methods: The study subjects were 477 patients after AMI between 2006 and 2015. All patients underwent revascularization. We compared retrospectively clinical characteristics, hemodynamic parameters, laboratory data and prognosis between men and women. Results: Female patients were significantly older and lower BMI compared with male patients. Female patients were more prevalence of CKD and anemia compared with male patients. There was no difference in-hospital mortality between men and women. During the follow up, female patients had high rate of cardiac event especially re-admission on heart failure (Logrank P = .004), although all-cause mortality was no difference between men and women after AMI. On stepwise multivariate Cox regression analysis, female gender remained an independent predictor of cardiac event. Higher age (P < .0001) and peak CPK (P < .0001), lower albumin (P = .008), prior MI (P < .0001) and TIMI flow grade less than 2 (P = .002) were independent predictors of cardiac event in male patients, although lower hemoglobin (P = .0009) was only independent predictor of cardiac event in female patients. Conclusions: These findings indicated that female gender was associated with higher incidence of cardiac event especially heart failure, but not in-hospital mortality and all-cause death.

Comparison of Mortality and Nonfatal Cardiovascular Events in Adults With Atrial Fibrillation With Versus Without Levothyroxine Treatment

Levothyroxine has been suggested to be cardiotoxic, but previous studies on the risk of cardiovascular events associated with levothyroxine treatment have been inconclusive. We aimed to study the association between levothyroxine treatment and all-cause mortality as well as cardiovascular events. Study population included all adults (n = 12,283) ≥ 45 years diagnosed with atrial fibrillation (AF) at 75 primary care centers in Sweden in 2001 to 2007, with (n = 1,189; 283 men and 906 women) or without (n = 11,094) levothyroxine treatment. Outcome was defined as all-cause mortality and cardiovascular events, that is, myocardial infarction, ischemic stroke, and congestive heart failure until December 31, 2010. During a mean 5.8 years (standard deviation 2.4 years) of follow-up, a total of 3,954 patients died (32.2%), among whom 92 men (32.5%) and 266 women (29.4%) were treated with levothyroxine. In fully adjusted Cox regression models (age, co-morbidity, socioeconomic factors, and warfarin treatment), a significant association between levothyroxine treatment and lower mortality was found among women (hazard ratio 0.78, 95% confidence interval 0.68 to 0.91), but not among men (hazard ratio 0.87, 95% confidence interval 0.69 to 1.10). In the secondary analysis, levothyroxine treatment was not associated with the risk of myocardial infarction, ischemic stroke, or congestive heart failure (p > 0.05). In conclusion, in a large representative cohort, we found that levothyroxine treatment decreased the mortality risk in women with AF, which suggests that such treatment could be of benefit in this setting.