Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46,000 women from Royal College of General Practitioners' oral contraception study
Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46,000 women from Royal College of General Practitioners' oral contraception study
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DOI：
10.1136/bmj.318.7176.96
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发表时间：
1999-01-09
影响因子：
--
通讯作者：
Reeves, G
中科院分区：
文献类型：
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作者：
Beral, V;Hermon, C;Reeves, G
目的探讨口服避孕药对死亡率的长期影响。全科医生每六个月报告一次口服避孕药使用情况以及发病率和死亡率的详细情况。最初的队列中有75%在NHS中央登记处被标记，在英国各地设置了1400个普通诊所，受试者为46000名妇女，其中一半在1968- 1969年招募时使用口服避孕药。随访结束时的中位年龄为49 years.Main outcome measures经年龄、产次、社会阶层和吸烟调整后的死亡相对风险。在整个随访期间，所有原因导致的死亡风险在曾经使用和从未使用口服避孕药的人群中相似（相对危险度= 1.0，95%置信区间0.9 ~ 1.1; P = 0.7），两组中大多数特定原因的死亡风险没有显著差异，但是，在当前和最近的（10年内）使用者死于卵巢癌的相对风险为0.2（0.1 ~ 0.8; P = 0.01），宫颈癌2.5（1.1 ~ 6.1; P = 0.04），脑血管病1.9（1.2 ~ 3.1，P = 0.009）。相比之下，对于停止使用超过或等于10年的女性，无论是总体还是任何特定死亡原因，都没有显着的过度或不足。结论口服避孕药似乎对死亡率有主要影响在使用期间和停止使用后的10年内。停止使用10年或更长时间后，过去使用者的死亡率与从未使用者的死亡率相似。
Objective To describe the long term effects of the use of oral contraceptives on mortalityDesign Cohort study with 25 year follow up. Details of oral contraceptive use and of morbidity and mortality were reported six monthly by general practitioners. 75% of the original cohort was "flagged" on the NHS central registers.Setting 1400 general practices throughout Britain.Subjects 46 000 women, half of whom were using oral contraceptives at recruitment in 1968-9. Median age at end of follow up was 49 years.Main outcome measures Relative risks of death adjusted for age, parity, social class, and smoking.Results Over the 25 year follow up 1599 deaths were Research reported. Over the entire period of follow up the risk of death from all causes was similar in ever users and never users of oral contraceptives (relative risk = 1.0, 95% confidence interval 0.9 to 1.1; P = 0.7) and the risk of death for most specific causes did not differ significantly in the two groups, However, among current and recent (within 10 years) users the relative risk of death from ovarian cancer was 0.2 (0.1 to 0.8; P = 0.01), from cervical cancer 2.5 (1.1 to 6.1; P = 0.04), and from cerebrovascular disease 1.9 (1.2 to 3.1, P = 0.009). By contrast, for women who had stopped use greater than or equal to 10 years previously there were no significant excesses or deficits either overall or for any specific cause of death.Conclusion Oral contraceptives seem to have their main effect on mortality while they are being used and in the 10 years after use ceases. Ten or more years after use ceases mortality in past users is similar to that in never users.