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- Title
Mortality Risk Among Women With Premenstrual Disorders in Sweden.
- Authors
Opatowski, Marion; Valdimarsdóttir, Unnur Anna; Oberg, Anna Sara; Bertone-Johnson, Elizabeth R.; Lu, Donghao
- Abstract
Key Points: Question: Do women with premenstrual disorders (PMDs) have higher risks of all-cause and cause-specific mortality compared with women without PMDs? Findings: This nationwide matched cohort study of 406 488 women in Sweden during a mean (SD) follow-up of 6.2 (4.6) years (range, 1-18 years) revealed that overall, women with diagnosed PMDs did not have an increased risk of all-cause premature death. However, there was an increased mortality risk among women with PMDs diagnosed before age 25 years, as well as increased risk of death due to suicide, irrespective of age at diagnosis. Meaning: These findings suggest that women with PMDs are not at increased risk of all-cause mortality, but active surveillance might be needed among young patients and for suicide prevention for all ages. This cohort study examines the association of premenstrual disorders with overall and cause-specific mortality among women in Sweden. Importance: Premenstrual disorders (PMDs) adversely affect the quality of life of millions of women worldwide, yet research on the long-term consequences of PMDs is limited, and the risk of mortality has not been explored. Objective: To estimate the associations of PMDs with overall and cause-specific mortality. Design, Setting, and Participants: This nationwide, population-based, matched cohort study used data from population and health registers in Sweden. Participants included women of reproductive age with a first diagnosis of PMDs between January 1, 2001, and December 31, 2018. Data analysis was performed from September 2022 to April 2023. Exposures: PMDs were identified through inpatient and outpatient diagnoses and drug dispensing. Main Outcomes and Measures: Dates of death and underlying causes were ascertained from the National Cause of Death Register. Conditional Cox regression was used to estimate the hazard ratios (HRs) of overall and cause-specific death (eg, death due to natural or nonnatural cause, suicide, or cardiovascular events), adjusting for age, socioeconomic status, and somatic and psychiatric comorbidities; in a separate sibling comparison, models were also adjusted for all factors that sisters share. Results: A total of 67 748 women with clinically diagnosed PMDs and 338 740 matched unaffected women were included, for a total of 406 488 women. Women with PMDs received a diagnosis at a mean (SD) age of 35.8 (8.2) years. During a mean (SD) follow-up of 6.2 (4.6) years (range, 1-18 years), 367 deaths were observed among women with PMDs (rate, 8.4 deaths per 10 000 person-years; 95% CI, 7.6-9.3 deaths per 10 000 person-years), and 1958 deaths were observed among women without PMDs (rate, 9.1 deaths per 10 000 person-years; 95% CI, 8.7-9.6 deaths per 10 000 person-years). Compared with unaffected women, women with PMDs had increased risk of death due to nonnatural causes (HR, 1.59; 95% CI, 1.25-2.04), particularly suicide (HR, 1.92; 95% CI, 1.43-2.60), but they did not have increased risk of overall mortality (adjusted HR, 0.91; 95% CI, 0.82-1.02). Notably, women who received a diagnosis before the age of 25 years experienced higher all-cause mortality (HR, 2.51; 95% CI, 1.42-4.42) and death from both suicide (HR, 3.84; 95% CI, 1.18-12.45) and natural causes (HR, 2.59; 95% CI, 1.21-5.54). Conclusions and Relevance: The findings of this matched cohort study suggest that women with PMDs are not at increased risk of early death overall. However, the risk was elevated among young women and for death by suicide. This supports the importance of careful follow-up for young patients and highlights the need to develop suicide prevention strategies for all women with PMDs.
- Subjects
SWEDEN; MORTALITY risk factors; RISK assessment; RESEARCH funding; PREMENSTRUAL syndrome; QUESTIONNAIRES; CAUSES of death; REPORTING of diseases; AGE distribution; DESCRIPTIVE statistics; LONGITUDINAL method; SURVEYS; CONFIDENCE intervals; DATA analysis software; PROPORTIONAL hazards models; REGRESSION analysis; COMORBIDITY
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2413394
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.13394