Impact of Life Course Socioeconomic Status on the Ovarian Reserve

生命历程社会经济地位对卵巢储备的影响

• 批准号: 8747818
• 负责人: Maria E. Bleil
• 金额: $ 7.73万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-20 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8747818
• 关键词: Accounting; Address; Adult; Age; Age at Menarche; Aging; Antral; Atherosclerosis; Biological Markers; Biological Process; Body mass index; California; Cardiac; Censuses; Childhood; Cigarette; Communities; Data Set; Development; Disadvantaged; Endocrine Disruptors; Environment; Environmental Exposure; Ethnic Origin; Exposure to; Funding; Goals; Health; Intervention; Investigation; Life Cycle Stages; Link; Literature; Measures; Menopause; Morbidity - disease rate; Myocardial Ischemia; Neighborhoods; Online Systems; Outcome; Ovarian; Participant; Patient Self-Report; Postmenopause; Premenopause; Puberty; Public Health; Race; Recording of previous events; Research; Residencies; Review Literature; Risk; Risk Factors; Services; Socioeconomic Status; Stroke; Testing; Time; Toxic Environmental Substances; Toxicant exposure; United States National Institutes of Health; Woman; base; cardiovascular risk factor; cigarette smoking; cohort; early onset; hormonal contraception; indexing; insight; low socioeconomic status; mortality; mullerian-inhibiting hormone; parity; public health relevance; reproductive; screening; socioeconomics; tool; toxicant

DESCRIPTION (provided by applicant): The number of post-menopausal US women will rise by 30% between years 2007 and 2020, an increase of more than 1 million women per year over a period of just 13 years. The timing of menopause is a key determinant of post-menopausal health and mortality. In particular, earlier age at menopause is associated with an increase in cardiovascular risk for outcomes including ischemic heart disease, stroke, atherosclerosis, and cardiac-specific mortality which together account for a significant proportion of morbidity and mortality among women in the post-menopausal period. In this regard, elucidating factors that explain variability in the timing of menopause is of critical importance as it raises the possibiliy that such factors may be modified through intervention efforts specifically targeting the delay of menopause and/or the amelioration of its sequelae. Review of the literature examining predictors of menopausal onset shows a growing number of studies have found lower socioeconomic status (SES) is prospectively related to earlier menopausal onset, even independently of other well-established risk factors for accelerated reproductive aging such as cigarette smoking. The examination of menopausal timing as an outcome is significantly limited; however, as menopause by definition is determined retrospectively after which time intervention is not possible. To address this limitation and extend the current literature, the proposed study will instead examine variability in "ovarian aging", the biological process underlying the loss of ovarian function leading to the permanent cessation of menses (i.e., menopause). Specifically, the goals of the proposed study are to examine aspects of women's environments, including 1) neighborhood-level SES, measured over the life course and in particular developmental periods (childhood, puberty, and adulthood) as well as 2) selected environmental toxicants (that commonly cluster in low SES environments) in relation to ovarian aging. These associations will be examined in an existing, community-based cohort of 978 pre-menopausal women ages 25-45 who were participants in the OVA Study (2006-2011), a cross-sectional investigation that assessed ovarian aging as indexed by well- established biomarkers of total ovarian reserve, including antral follicle count (AFC) and anti-Mullerian hormone (AMH). NIH funding will support the extraction of SES-related and environmental exposure variables from publically available datasets to be merged with the existing OVA Study dataset in order to evaluate whether histories of greater neighborhood-level socioeconomic disadvantage and increased exposure to selected toxicants may accelerate the depletion of the ovarian reserve as indexed by lower AFC and AMH levels. Results from the current study will provide new insights into the identification of predictors of accelerated ovarian aging and its sequelae and in pointing to new avenues for screening and intervention among at-risk women.

描述（由申请人提供）：2007 年至 2020 年间，美国绝经后妇女人数将增加 30%，在短短 13 年时间内每年增加超过 100 万妇女。绝经时间是绝经后健康和死亡率的关键决定因素。特别是，更年期较早与心血管疾病风险增加相关，包括缺血性心脏病、中风、动脉粥样硬化和心脏特异性死亡率，这些疾病在绝经后妇女的发病率和死亡率中占很大比例。在这方面，阐明解释绝经时间变异性的因素至关重要，因为它提高了通过专门针对绝经延迟和/或改善其后遗症的干预措施来改变这些因素的可能性。对更年期开始预测因素的文献回顾显示，越来越多的研究发现，较低的社会经济地位（SES）可能与更年期提前相关，甚至与吸烟等加速生殖衰老的其他既定危险因素无关。 将绝经时间作为结果的检查非常有限；然而，根据定义，更年期是回顾性确定的，在此之后就不可能进行干预。为了解决这一局限性并扩展现有文献，拟议的研究将改为检查“卵巢衰老”的变异性，即卵巢功能丧失导致月经永久停止（即更年期）的生物过程。具体来说，拟议研究的目标是检查女性环境的各个方面，包括 1) 社区层面的社会经济地位（SES），在生命历程中特别是发育时期（儿童期、青春期和成年期）进行测量，以及 2) 与卵巢衰老相关的选定环境毒物（通常聚集在低社会经济地位环境中）。这些关联性将在现有的、以社区为基础的队列中进行检查，该队列由 978 名年龄 25-45 岁的绝经前女性组成，她们是 OVA 研究 (2006-2011) 的参与者，这是一项横断面调查，以成熟的总卵巢储备生物标志物为索引，评估卵巢衰老，包括窦卵泡计数 (AFC) 和抗苗勒氏管激素 (AMH)。 NIH 的资金将支持从公开数据集中提取与 SES 相关的变量和环境暴露变量，并将其与现有的 OVA 研究数据集合并，以评估社区层面社会经济劣势较大和选定有毒物质暴露增加的历史是否可能加速卵巢储备功能的消耗（以较低的 AFC 和 AMH 水平为指标）。当前研究的结果将为识别卵巢加速老化及其后遗症的预测因素提供新的见解，并指出 对高危妇女进行筛查和干预的新途径。