Objective To prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years). Design Prospective cohort study Setting The Nurses’ Health Study II, United States (1989-2019). Participants 110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer. Main outcome measures Hazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires. Results 4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids. Conclusion Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health. The data used in the present study will not be made publicly available, but they are accessible by contacting the research staff from NHSII at . The analytic SAS codes are available from the corresponding author and can also be found in supporting materials.

中文翻译：

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子宫内膜异位症和子宫肌瘤以及过早死亡的风险：前瞻性队列研究


目的 前瞻性评估子宫内膜异位症和子宫肌瘤对早产 （70 岁以下） 长期风险的影响。设计 前瞻性队列研究 设置护士健康研究 II，美国（1989-2019 年）。参与者 110 091 年，25 091 名年龄在 42-1989 岁之间的女性在子宫内膜异位症或肌瘤诊断、心血管疾病或癌症之前没有子宫切除术史。主要结局指标 根据两年一次的问卷中报告的腹腔镜确诊的子宫内膜异位症或超声或子宫切除术确诊的子宫肌瘤，总死亡率和原因特异性过早死亡率的风险比（由 Cox 比例风险模型估计）。结果 在 2 994 354 人年 （每人 27.2 年） 的随访中记录了 4356 例过早死亡，其中癌症 1459 例，心血管疾病 304 例，呼吸系统疾病 90 例。经腹腔镜证实的子宫内膜异位症和不经腹腔镜证实的子宫内膜异位症女性的全因过早死亡率粗略发生率分别为 2.01 例/1000 人和 1.40 例/1000 人年。在年龄调整的模型中，腹腔镜证实的子宫内膜异位症与过早死亡的风险比为 1.19 （95% 置信区间 1.09 至 1.30） 相关;在还调整了包括行为因素 （1.31， 1.20 至 1.44） 在内的潜在混杂因素后，这些模型得到了加强。原因特异性死亡率分析显示，该关联主要由衰老和定义不明确的疾病死亡率 （1.80， 1.19 至 2.73）、非恶性呼吸系统疾病 （1.95， 1.11 至 3.41）、神经系统和感觉器官疾病 （2.50， 1.40 至 4.44） 和妇科器官恶性肿瘤 （2.76， 1.79 至 4.26） 驱动。 超声或子宫切除术证实子宫肌瘤与全因过早死亡率 （1.03， 0.95 至 1.11） 无关，但在特定原因死亡率分析中，子宫肌瘤与妇科器官恶性肿瘤的死亡风险增加 （2.32， 1.59 至 3.40） 相关。心血管和呼吸系统疾病引起的死亡风险因子宫内膜异位症和子宫肌瘤的关节类别而异，在报告子宫内膜异位症和子宫肌瘤的女性中，全因过早死亡的风险增加。结论 有子宫内膜异位症和子宫肌瘤病史的女性在超过生育寿命后，长期过早死亡的风险可能会增加。这些情况也与妇科癌症导致的死亡风险增加有关。子宫内膜异位症与非癌症死亡风险增加相关。这些发现强调了初级保健提供者在评估女性健康时考虑这些妇科疾病的重要性。本研究中使用的数据不会公开提供，但可以通过联系 NHSII 的研究人员来获取这些数据。分析型 SAS 代码可从通讯作者处获得，也可以在支持材料中找到。