Ethnic Differences in the Association Between Age at Natural Menopause and Risk of Type 2 Diabetes Among Postmenopausal Women: A Pooled Analysis of Individual Data From 13 Cohort Studies

Author:

Chung Hsin-Fang1ORCID,Dobson Annette J.1ORCID,Hayashi Kunihiko2,Hardy Rebecca3,Kuh Diana4,Anderson Debra J.5,van der Schouw Yvonne T.6,Greenwood Darren C.7,Cade Janet E.7,Demakakos Panayotes8,Brunner Eric J.8,Eastwood Sophie V.4,Sandin Sven910,Weiderpass Elisabete11,Mishra Gita D.1

Affiliation:

1. 1School of Public Health, University of Queensland, Brisbane, Queensland, Australia

2. 2School of Health Sciences, Gunma University, Maebashi City, Gunma, Japan

3. 3School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, U.K

4. 4Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, U.K

5. 5Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia

6. 6Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

7. 7Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, U.K

8. 8Department of Epidemiology and Public Health, University College London, London, U.K

9. 9Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

10. 10Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY

11. 11International Agency for Research on Cancer, World Health Organization, Lyon, France

Abstract

OBJECTIVE To investigate associations between age at natural menopause, particularly premature ovarian insufficiency (POI) (natural menopause before age 40 years), and incident type 2 diabetes (T2D) and identify any variations by ethnicity. RESEARCH DESIGN AND METHODS We pooled individual-level data of 338,059 women from 13 cohort studies without T2D before menopause from six ethnic groups: White (n = 177,674), Chinese (n = 146,008), Japanese (n = 9,061), South/Southeast Asian (n = 2,228), Black (n = 1,838), and mixed/other (n = 1,250). Hazard ratios (HRs) of T2D associated with age at menopause were estimated in the overall sample and by ethnicity, with study as a random effect. For each ethnic group, we further stratified the association by birth year, education level, and BMI. RESULTS Over 9 years of follow-up, 20,064 (5.9%) women developed T2D. Overall, POI (vs. menopause at age 50–51 years) was associated with an increased risk of T2D (HR 1.31; 95% CI 1.20–1.44), and there was an interaction between age at menopause and ethnicity (P < 0.0001). T2D risk associated with POI was higher in White (1.53; 1.36–1.73), Japanese (4.04; 1.97–8.27), and Chinese women born in 1950 or later (2.79; 2.11–3.70); although less precise, the risk estimates were consistent in women of South/Southeast Asian (1.46; 0.89–2.40), Black (1.72; 0.95–3.12), and mixed/other (2.16; 0.83–5.57) ethnic groups. A similar pattern, but with a smaller increased risk of T2D, was observed with early menopause overall (1.16; 1.10–1.23) and for White, Japanese, and Chinese women born in 1950 or later. CONCLUSIONS POI and early menopause are risk factors for T2D in postmenopausal women, with considerable variation across ethnic groups, and may need to be considered in risk assessments of T2D among women.

Funder

National Health and Medical Research Council

Japan Society for the Promotion of Science

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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