The association between primary ovarian insufficiency and increased multimorbidity in a large prospective cohort (Canadian Longitudinal Study on Aging).

Objective: To describe the prevalence of multimorbidity among individuals with primary ovarian insufficiency (POI) and early menopause compared with those with the average age of menopause.
Design: Prospective cohort.
Setting: Outpatient communities across ten provinces across Canada, available from the Canadian Longitudinal Study on Aging.
Patient(s): This prospective cohort encompassed female postmenopausal individuals from the Canadian Longitudinal Study on Aging. The Canadian Longitudinal Study on Aging collected cross-sectional data from 50,000 community-dwelling Canadians aged 45-85 years between 2010 and 2015.
Intervention(s): The primary exposure was POI (defined by onset of menopause at the age of <40 years). Comparators included average age of menopause (age, 46-55 years), early menopause (40-45 years), and late-onset menopause (56-65 years) and those who underwent hysterectomy.
Main Outcome Measure(s): The primary outcome was multimorbidity, which was defined as two or more chronic conditions. The secondary outcomes were severe multimorbidity (defined as 3 or more chronic conditions) and frequencies of specific chronic conditions among a comprehensive list of 15 individual conditions. We assessed the association between multimorbidity and age at menopause using logistic regression and odds ratios (ORs), with confidence intervals (CIs) set at 95%. The ORs were adjusted for known predictors of multimorbidity, including age, menopausal hormone therapy, education, ethnicity, self-reported loneliness, living alone, body mass index, smoking habits, nutritional risk, social participation, and physical activity.
Result(s): A total of 12,339 postmenopausal participants were included, of whom 374 (3.0%) experienced POI and 1,396 (11.3%) experienced early menopause. The prevalence rates of multimorbidity were 64.8% and 51.1% among those with POI and early menopause, respectively. In contrast, only 43.9% of individuals with average age of menopause (age, 46-55 years) had multimorbidity. The OR for multimorbidity in the POI population was 2.5 (95% CI, 2.0-3.1) compared with that in individuals who had the average age of menopause. This relationship was maintained after adjustment for confounders (adjusted OR [aOR], 2.0; 95% CI, 1.5-2.5). The prevalence of severe multimorbidity was also double in the POI group compared with that in the average age group (39.2% vs. 21.1%). There were significantly increased risks of ischemic heart disease (aOR, 2.8; 95% CI, 1.7-4.7), gastric ulcers (aOR, 1.6; 95% CI, 1.1-2.3), and osteoporosis (aOR, 1.6; 95% CI, 1.2-2.1) in the POI group.
Conclusion(s): Individuals with POI and early menopause experience increased multimorbidity compared with those undergoing menopause at an average age. This trend persists even after adjusting for significant multimorbidity risk factors.
Competing Interests: Declaration of Interests A.K. has nothing to disclose. N.S. has nothing to disclose. A.M. has nothing to disclose. L.E.G. has nothing to disclose. P.R. has nothing to disclose. A.K.S. has nothing to disclose. The opinions expressed in this manuscript are the authors' own and do not reflect the views of the Canadian Longitudinal Study on Aging.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)