Factors Associated With 10-Year Declines in Physical Health and Function Among Women During Midlife

Abstract

IMPORTANCEWomen in midlife often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines in physical health and function among these women may allow for targeted interventions. OBJECTIVE To examine the factors associated with clinically important 10-year declines in the physical component summary score (PCS) of the Short Form 36 (SF-36), a widely used patientreported outcome measure, in women in midlife. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study collected data from geographically dispersed sites in the US. Participants were part of the Study of Women's Health Across the Nation (SWAN), a racially and ethnically diverse cohort of women enrolled at or immediately before the menopause transition. Women have been followed for up to 21 years, between 1996 and 2016, with annual visits. Data were analyzed from October 2020 to March 2021. EXPOSURES Demographic indicators, health status measures, and laboratory and imaging assessments. MAIN OUTCOMES AND MEASURESThe main outcome was a clinically important decline (Ն8 points) on the PCS, based on the 10-year difference in scores between ages 55 and 65 years. RESULTSFrom the SWAN cohort of 3302 women, 1091 women (median [IQR] age, years; 264 [24.2%] Black women; 126 [11.6%] Chinese women; 135 [12.4%] Japanese women; 566 [51.9%] White women) were eligible for analyses based on duration of follow-up and availability of SF-36 data. At age 55, women had a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27.0 (23.2-32.6), a median (IQR) baseline PCS of 53.1 (46.8-56.7), 108 women (9.9%) were current smokers, and 938 women (86.3%) had at least 1 comorbidity. Between ages 55 and 65 years, the median (IQR) change in PCS was −1.02 (−6.11 to 2.53) points with 206 women (18.9%) experiencing declines of 8 points or more. In multivariable models, factors associated with clinically important decline included higher baseline PCS (odds ratio [OR],

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“…In fact, PCS was significantly negatively associated with smoking (beta = −2.286; p = 0.006), full-term pregnancy (beta = −2.513; p = 0.003), and comorbidities (beta = −5.035; p < 0.001). These results are similar to the findings from a recent cohort study among 1091 women that reported that currently smoking and comorbidities were factors associated with the decline in the PCS score of the Short Form 36 [66]. Another important finding of the study was the negative relation between PCS and alcohol consumption.…”

Associations of age at first birth and lifetime parity with weight and adiposity across midlife in women from Project Viva

“…Second, reproductive information was self-reported 18 years after enrollment, which might lead to misclassification of exposure status; however, ample evidence suggests that maternal recall of pregnancy-related events is reliable [34,35]. women's long-term health [12,13]. Fourth, we did not have information on BMI before the first pregnancy for all women.…”

“…Third, our sample size was modest, and we did not have enough women with births at age ≤18 years ( n = 27) to analyze them in a separate category and conduct the appropriate sensitivity analyses. Despite this, considering age at first birth before age 23 years as the lowest category is informative because this period represents the average age at college graduation in the United States and an important milestone associated with women's long‐term health [12, 13]. Fourth, we did not have information on BMI before the first pregnancy for all women.…”

“…We categorized age at first birth as <23, 23 to 29, 30 to 34, 35 to 39, and ≥40 years and parity as one, two, three, and four or more births. We selected the lowest category of age at first birth as <23 years based on the age distribution of our population and because this threshold coincides with the typical age at college graduation in the United States [11], which is associated with better health outcomes in women [12,13]. We defined the highest age categories using cutoffs that align with those used to report pregnancy rates and outcomes by public health agencies [14].…”

Physical and Behavioral Factors Associated With Improvement in Physical Health and Function Among US Women During Midlife

“… 1 Several studies have found that physical health and functional limitations commence during midlife for women and that these limitations persist throughout midlife and into late adulthood. 2 , 3 , 4 Furthermore, evidence suggests that these limitations or decreases in physical health and function are associated with chronic conditions that develop before or during midlife. 5 However, other work has shown the highly dynamic nature of functional status during midlife, 6 demonstrating that some women may improve their physical health and functioning during this time.…”