Association between infertility and all-cause mortality: analysis of US claims data.
Association between infertility and all-cause mortality: analysis of US claims data.
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DOI：
10.1016/j.ajog.2021.02.010
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发表时间：
2021-07
影响因子：
9.8
通讯作者：
Eisenberg ML
中科院分区：
文献类型：
--
作者：
Murugappan G;Li S;Alvero RJ;Luke B;Eisenberg ML
不孕症诊断的后果超出了对家庭建设的追求，因为不孕妇女还面临着严重孕产妇发病、癌症和慢性病的风险增加。研究女性不孕症与全因死亡率之间的关联。对 2003 年至 2019 年 Optum Clinformatics 数据集市中通过不孕症诊断、测试和治疗代码确定的 72,786 名不孕女性进行回顾性分析，与寻求常规妇科护理的 3,845,790 名非不孕女性进行比较。使用≥1 种代谢综合征 (MetS) 诊断和查尔森合并症指数 (CCI) 来评估基线合并症。全因死亡率的主要结果是通过与社会保障管理局死亡主档案结果和医疗索赔的联系来确定的。使用Cox比例风险回归检查不孕症与死亡率的关联，同时调整年龄、高血压、高脂血症、II型糖尿病、评估年份、吸烟、每年就诊次数、未生育、肥胖、国家地区和种族。在 16,473,458 人年的随访中，有 13,934 名女性死亡。与非不孕女性相比，不孕女性全因死亡的相对风险高出 32%（0.42% vs 0.35%，aHR 1.32，95% CI 1.18-1.48）。每位患者的平均随访时间为 4.0±3.7 年，而不孕女性和非不孕女性的平均随访时间分别为 4.2±3.8 年。当按年龄 < 35 岁或 ≥ 35 岁或基线医学合并症进行分层时，不孕症与死亡率之间的关联仍然存在。与整体不孕组相比，在随访期间分娩的不孕妇女面临类似的死亡风险增加。最后，与仅接受不孕不育诊断或检测相比，接受生育治疗与较高的死亡风险无关。虽然两组的绝对死亡风险均较低，但与非不孕女性相比，不孕女性面临更高的相对死亡风险。这种关联在所有年龄、种族/民族、发病率和分娩阶层中都存在。重要的是，不孕症治疗与死亡风险增加无关。这些发现加重了与不孕不育相关的疾病负担及其造成长期后遗症的可能性。
The consequences of an infertility diagnosis extend beyond the pursuit of family building, as infertile women also face increased risks of severe maternal morbidity, cancer, and chronic disease. To examine the association between female infertility and all-cause mortality. Retrospective analysis of 72,786 infertile women identified in the Optum Clinformatics Datamart from 2003-2019 by infertility diagnosis, testing and treatment codes compared with 3,845,790 non-infertile women seeking routine gynecologic care. Baseline comorbidities were assessed using the presence of ≥1 metabolic syndrome (MetS) diagnoses and the Charlson Comorbidity Index (CCI). The primary outcome of all-cause mortality was identified by linkage to Social Security Administration Death Master File outcomes and medical claims. The association of infertility with mortality was examined using Cox proportional hazard regression while adjusting for age, hypertension, hyperlipidemia, type II diabetes, year of evaluation, smoking, number of visits per year, nulliparity, obesity, region of country, and race. Among 16,473,458 person-years of follow up, 13,934 women died. Infertile women had a 32% higher relative risk of death from any cause (0.42% versus 0.35%, aHR 1.32, 95% CI 1.18-1.48) compared to non-infertile women. Mean follow up time per patient was 4.0±3.7 years versus 4.2±3.8 years for infertile and non-infertile women, respectively. When stratified by age < 35 or ≥35 years or baseline medical comorbidity, the association between infertility and mortality remained. Infertile women who delivered a child during the follow up period faced similar increased risk of mortality compared to the overall infertile group. Finally, receipt of fertility treatment was not associated with a higher risk of death compared to receiving an infertility diagnosis or testing alone. While absolute risk of death was low in both groups, infertile women faced a higher relative risk of mortality compared to non-infertile women. The association remained across all age, race/ethnicity, morbidity, and delivery strata. Importantly, infertility treatment was not associated with an increased risk of death. These findings reinforce the disease burden associated with infertility and its potential for longer-term sequelae.
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影响因子：
6.7
作者：
Eisenberg, Michael L.;Li, Shufeng;Baker, Laurence C.
通讯作者：
Baker, Laurence C.
影响因子：
5.7
作者：
Bennett, Wendy L.;Chang, Hsien-Yen;Clark, Jeanne M.
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Clark, Jeanne M.
影响因子：
9.8
作者：
Murugappan G;Li S;Lathi RB;Baker VL;Luke B;Eisenberg ML
通讯作者：
Eisenberg ML
影响因子：
6.1
作者：
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通讯作者：
Ingelsson, Erik
影响因子：
23.4
作者：
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通讯作者：
Montorsi, Francesco