Age at menopause and mortality in Taiwan: A cohort analysis

Objective: Previous research suggested age at menopause may predict risk of all-cause, cardiovascular disease (CVD), cancer and diabetes mortality; however, findings were inconsistent across populations. We aimed to investigate this association in Taiwanese postmenopausal women. Study design: We used data from the MJ Health Database in Taiwan and included 36,931 postmenopausal women who entered health check-up programs during 1999–2016. Information on age at menopause and covariates were collected from health surveys and medical examinations at baseline. Age at menopause was categorized into <40−44, 45−49, 50−54 (reference) and 55−60 years. We used Cox proportional hazards regression for analysis. Main outcome measures: Causes of death (obtained from the National Register of Death as of July 2018). Results: Mean age (SD) at menopause was 50.2 (4.0) years and there were 5316 deaths over an average follow-up time of 14.6 years. After adjustment for birth cohort, education, smoking, BMI and comorbidities, results showed women aged <40−44 years at menopause compared with the reference category had higher diabetes mortality (hazard ratio [HR] = 1.44; 95 % CI: 1.03, 2.02). Women aged 45−49 years at menopause had higher all-cause mortality (HR = 1.07, 1.01, 1.14), and these women were also associated with increased CVD mortality (HR = 1.22; 1.07, 1.40). Conclusions: In Taiwanese women, early age (<40−44) at menopause is associated with higher diabetes mortality, and earlier age (45−49) at menopause is associated with higher all-cause and CVD mortality. Age at menopause could be deemed an important cardio-metabolic disease marker for women at midlife that indicates future longevity.