Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies.

Zhu, D; Chung, H-F; Pandeya, N; Dobson, AJ; Cade, JE; Greenwood, DC; Crawford, SL; Avis, NE; Gold, EB; Mitchell, ES; Woods, NF; Anderson, D; Brown, DE; Sievert, LL; Brunner, EJ; Kuh, D; Hardy, R; Hayashi, K; Lee, JS; Mizunuma, H; Giles, GG; Bruinsma, F; Tillin, T; Simonsen, MK; Adami, H-O; Weiderpass, E; Canonico, M; Ancelin, M-L; Demakakos, P; Mishra, GD

Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies.

Zhu, D Chung, H-F Pandeya, N Dobson, AJ Cade, JE Greenwood, DC Crawford, SL Avis, NE Gold, EB Mitchell, ES Woods, NF Anderson, D

Brown, DE Sievert, LL Brunner, EJ Kuh, D Hardy, R Hayashi, K Lee, JS Mizunuma, H Giles, GG Bruinsma, F Tillin, T Simonsen, MK Adami, H-O Weiderpass, E Canonico, M Ancelin, M-L Demakakos, P Mishra, GD

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Publisher:: Public Library of Science (PLoS)
Publication Type:: Journal Article
Citation:: PLoS medicine, 2018, 15, (11), pp. e1002704
Issue Date:: 2018-11-27

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Field	Value	Language
dc.contributor.author	Zhu, D
dc.contributor.author	Chung, H-F
dc.contributor.author	Pandeya, N
dc.contributor.author	Dobson, AJ
dc.contributor.author	Cade, JE
dc.contributor.author	Greenwood, DC
dc.contributor.author	Crawford, SL
dc.contributor.author	Avis, NE
dc.contributor.author	Gold, EB
dc.contributor.author	Mitchell, ES
dc.contributor.author	Woods, NF
dc.contributor.author	Anderson, D https://orcid.org/0000-0001-8996-9624
dc.contributor.author	Brown, DE
dc.contributor.author	Sievert, LL
dc.contributor.author	Brunner, EJ
dc.contributor.author	Kuh, D
dc.contributor.author	Hardy, R
dc.contributor.author	Hayashi, K
dc.contributor.author	Lee, JS
dc.contributor.author	Mizunuma, H
dc.contributor.author	Giles, GG
dc.contributor.author	Bruinsma, F
dc.contributor.author	Tillin, T
dc.contributor.author	Simonsen, MK
dc.contributor.author	Adami, H-O
dc.contributor.author	Weiderpass, E
dc.contributor.author	Canonico, M
dc.contributor.author	Ancelin, M-L
dc.contributor.author	Demakakos, P
dc.contributor.author	Mishra, GD
dc.date.accessioned	2021-05-10T01:57:31Z
dc.date.available	2018-10-24
dc.date.available	2021-05-10T01:57:31Z
dc.date.issued	2018-11-27
dc.identifier.citation	PLoS medicine, 2018, 15, (11), pp. e1002704
dc.identifier.issn	1549-1277
dc.identifier.issn	1549-1676
dc.identifier.uri	http://hdl.handle.net/10453/148800
dc.description.abstract	<h4>Background</h4>Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause.<h4>Methods and findings</h4>A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause (<40 (premature), 40-44 (early), 45-49, 50-51 (reference), and ≥52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p < 0.001) and early menopause (1.80; 1.66-1.95) (p < 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p < 0.001) and early (6.55; 5.04-8.52; p < 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p < 0.001) and 3-fold (3.01; 2.15-4.21; p < 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias.<h4>Conclusions</h4>The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	Public Library of Science (PLoS)
dc.relation	http://purl.org/au-research/grants/nhmrc/1027196
dc.relation.ispartof	PLoS medicine
dc.relation.isbasedon	10.1371/journal.pmed.1002704
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	General & Internal Medicine
dc.subject.mesh	Humans
dc.subject.mesh	Ovarian Diseases
dc.subject.mesh	Menopause, Premature
dc.subject.mesh	Risk Assessment
dc.subject.mesh	Risk Factors
dc.subject.mesh	Smoking
dc.subject.mesh	Smoking Cessation
dc.subject.mesh	Age of Onset
dc.subject.mesh	Time Factors
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	United States
dc.subject.mesh	Australia
dc.subject.mesh	Europe
dc.subject.mesh	Female
dc.subject.mesh	Observational Studies as Topic
dc.subject.mesh	Adult
dc.subject.mesh	Age of Onset
dc.subject.mesh	Aged
dc.subject.mesh	Australia
dc.subject.mesh	Europe
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Menopause, Premature
dc.subject.mesh	Middle Aged
dc.subject.mesh	Observational Studies as Topic
dc.subject.mesh	Ovarian Diseases
dc.subject.mesh	Risk Assessment
dc.subject.mesh	Risk Factors
dc.subject.mesh	Smoking
dc.subject.mesh	Smoking Cessation
dc.subject.mesh	Time Factors
dc.subject.mesh	United States
dc.title	Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies.
dc.type	Journal Article
utslib.citation.volume	15
utslib.location.activity	United States
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.date.updated	2021-05-10T01:57:28Z
pubs.issue	11
pubs.publication-status	Published
pubs.volume	15
utslib.citation.issue	11

Abstract:

Background

Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause.

Methods and findings

A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause (<40 (premature), 40-44 (early), 45-49, 50-51 (reference), and ≥52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p < 0.001) and early menopause (1.80; 1.66-1.95) (p < 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p < 0.001) and early (6.55; 5.04-8.52; p < 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p < 0.001) and 3-fold (3.01; 2.15-4.21; p < 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias.

Conclusions

The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/148800