Causes of death and associated risk factors among climacteric women from Southern Brazil: a population based-study

Abstract

BackgroundAging and menopause are particular cardiovascular risk factors for women, due to estrogen deprivation at the time of menopause. Studies show that diabetes mellitus (DM), smoking, hypertension, high body mass index (BMI), and serum lipids are associated with increased risk of cardiovascular disease (CVD), the main cause of female mortality in Brazil. The aim of this study was to assess the mortality rate, causes of death and associated risk factors in a cohort of women from Brazil.MethodsA longitudinal population-based study of menopausal status is currently underway in a city in South Brazil. In 2010, a third follow-up of this population was performed to assess cardiovascular risk and mortality rate between 1995 and 2011. For this analysis, 358 participants were studied. At baseline, participants had completed a standardized questionnaire including demographic, lifestyle, medical and reproductive characteristics. In addition to the contacts with relatives, mortality data were obtained through review of medical records in all city hospitals and the Center for Health Information (NIS/RS-SES). Multivariate-adjusted hazard risk (HR) and 95% confidence intervals (CI95%) were estimated using Cox proportional hazards regression. Survival curves were estimated using the Kaplan-Meier curve.ResultsThere were 17 (4.7%) deaths from all causes during the study period. Seven (41.2%) deaths were caused by CVD, including four cases of stroke and three cases of myocardial infarction. Six (35.3%) deaths were due to cancer, and four (23.5%) were due to other reasons. In the age and smoking-adjusted multivariate models, diabetes (HR 6.645, 95% CI: 1.938–22.79, p = 0.003), alcohol intake (HR 1.228, 95% CI: 1.014-1.487, p = 0.035) and postmenopausal status (HR = 6.216, 95% CI: 0.963–40.143, p = 0.055) were associated with all-cause mortality. A significant association was found between abdominal obesity (WHR ≥ 0.85) and mortality even after the adjustment for BMI (HR = 9.229, 95% IC: 2.083–41.504, p = 0.003).ConclusionCVD was an important cause of mortality in this cohort and DM and/or central adiposity were associated with all-cause mortality. Lifestyle and dietary factors seem to be related to risk of mortality in middle-aged women.

The risk of mortality among people with type 2 diabetes in Latin America: A systematic review and meta‐analysis of population‐based cohort studies

“…Across the outcomes of interest, sex, and age groups, all studies revealed a positive association between T2DM and mortality …”

“…After duplicates were excluded, 828 titles and abstracts were reviewed, 801 of these were excluded, and hence, 27 scientific papers were studied in detail (Supporting Material p 03). Seventeen papers were included for the qualitative synthesis (including one unpublished work) . Of these 17 studies, three were excluded from the meta‐analyses: Two publications reported on the same study, ie, only included once in the quantitative synthesis; and two studies were excluded because the risk estimates were computed differently (see Section ); Therefore, 14 reports were included for the final quantitative synthesis ( N = 416 821) …”

“…Table presents the characteristics of the selected 17 reports. The oldest studies started in 1976 to 1978, three in the 1980s, five in the 1990s, and six in the 2000s . It was not possible to retrieve this information from two publications .…”

“…It was not possible to retrieve this information from two publications . Eleven studies based their estimates on self‐reported T2DM diagnosis, while six used a composite definition (eg, self‐reported and fasting glucose) …”

“…For all‐cause mortality, nine studies were analysed using self‐reported diabetes as the exposure . These studies showed an increased mortality risk in patients with T2DM compared with people without T2DM.…”