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Risk Factors for Mortality in Middle-aged Women
Jeffrey A. Tice, MD;
Alka Kanaya, MD;
Trisha Hue, MPH;
Susan Rubin, MPH;
Diana S. M. Buist, PhD;
Andrea LaCroix, PhD;
James V. Lacey, Jr, PhD;
Jane A. Cauley, DrPH;
Stephanie Litwack, MPH;
Louise A. Brinton, PhD;
Douglas C. Bauer, MD
Arch Intern Med. 2006;166:2469-2477.
Background Many factors contribute to mortality in older women, but their relative importance and independent contribution have been poorly characterized.
Methods From 1990 to 1992, we assessed demographics, lifestyle measures, prevalent disease, medication use, anthropometrics, vital signs, and physical function in 17 748 postmenopausal women. We used proportional hazards modeling to evaluate their association with mortality.
Results During 9 years of follow-up, 1886 women (10.6%) died. The relative hazard (RH) of death was approximately 1.5 (95% confidence interval [CI], 1.5-1.6) per 5 years of age, 1.4 (95% CI, 1.2-1.6) for a history of heart disease, and 1.9 (95% CI, 1.6-2.3) for a history of breast cancer. Modifiable risk factors associated with mortality included smoking (RH, 3.7 [95% CI, 3.1-4.5] for current smokers with a  50 pack-year history) and systolic blood pressure (RH, 1.3 [95% CI, 1.1-1.5], fifth vs first quintile). Elevated waist-hip ratio was associated with higher mortality (RH, 1.3 [95% CI, 1.1-1.5], fifth vs first quintile), but obesity was associated with lower mortality (RH, 0.7 [95% CI, 0.6-0.9] for body mass index [calculated as weight in kilograms divided by the square of height in meters] of >35.0 vs 18.5-25.0). Poor results on the timed Up and Go Test, a measure of physical function, were also strongly associated with mortality (RH, 1.7 [95% CI, 1.4-2.0], fifth vs first quintile).
Conclusions Simple measures are sufficient to stratify postmenopausal women into groups at high and low risk of dying. Smoking, central obesity, blood pressure, and physical function are potentially modifiable risk factors, although clinical trials are required to demonstrate that change in these factors affects mortality.
Author Affiliations: Division of General Internal Medicine, Department of Medicine (Drs Tice, Kanaya, and Bauer), and Department of Epidemiology and Biostatistics (Mss Hue, Rubin, and Litwack and Dr Bauer), University of California–San Francisco; Group Health Cooperative, Seattle, Wash (Drs Buist and LaCroix); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Drs Lacey and Brinton); and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Cauley).
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