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Cited by 23Endometriosis Research and TreatmentEctopic Pregnancy Diagnosis and ManagementEndometrial and Cervical Cancer Treatments

Mortality of midlife women with surgically verified endometriosis—a cohort study including 2.5 million person-years of observation

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Saavalainen, L, But, A, Tiitinen, A, Härkki, P, Gissler, M, Haukka, J, Heikinheimo, O·2019·Human Reproduction
DOI 10.1093/humrep/dez074
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Abstract

STUDY QUESTION: Is all-cause and cause-specific mortality increased among women with surgically verified endometriosis? SUMMARY ANSWER: The all-cause and cause-specific mortality in midlife was lower throughout the follow-up among women with surgically verified endometriosis compared to the reference cohort. WHAT IS KNOWN ALREADY: Endometriosis has been associated with an increased risk of comorbidities such as certain cancers and cardiovascular diseases. These diseases are also common causes of death; however, little is known about the mortality of women with endometriosis. STUDY DESIGN, SIZE, DURATION: A nationwide retrospective cohort study of women with surgically verified diagnosis of endometriosis was compared to the reference cohort in Finland (1987–2012). Follow-up ended at death or 31 December 2014. During the median follow-up of 17 years, 2.5 million person-years accumulated. PARTICIPANTS/MATERIALS, SETTING, METHODS: Forty-nine thousand nine hundred and fifty-six women with at least one record of surgically verified diagnosis of endometriosis in the Finnish Hospital Discharge Register between 1987 and 2012 were compared to a reference cohort of 98 824 age- and municipality-matched women. The age (mean ± standard deviation) of the endometriosis cohort was 36.4 ± 9.0 and 53.6 ± 12.1 years at the beginning and at the end of the follow-up, respectively. By using the Poisson regression models the crude and adjusted all-cause and cause-specific mortality rate ratios (MRR) and 95% confidence intervals (CI) were assessed. Calendar time, age, time since the start of follow-up, educational level, and parity adjusted were considered in the multivariate analyses. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 1656 and 4291 deaths occurred in the endometriosis and reference cohorts, respectively. A lower all-cause mortality was observed for the endometriosis cohort (adjusted MRR, 0.73 [95% CI 0.69 to 0.77])—there were four deaths less per 1000 women over 10 years. A lower cause-specific mortality contributed to this: the adjusted MRR was 0.88 (95% CI 0.81 to 0.96) for any cancer and 0.55 (95% CI 0.47 to 0.65) for cardiovascular diseases, including 0.52 (95% CI 0.42 to 0.64) for ischemic heart disease and 0.60 (95% CI 0.47 to 0.76) for cerebrovascular disease. Mortality due to alcohol, accidents and violence, respiratory, and digestive disease-related causes was also decreased. LIMITATIONS, REASONS FOR CAUSATION: These results are limited to women with endometriosis diagnosed by surgery. In addition, the study does not extend into the oldest age groups. The results might be explained by the characteristics and factors related to women’s lifestyle, and/or increased medical attention and care received, rather than the disease itself. WIDER IMPLICATIONS OF THE FINDINGS: These reassuring data are valuable to women with endometriosis and to their health care providers. Nonetheless, more studies are needed to address the causality. STUDY FUNDING/COMPETING INTEREST: This research was funded by the Hospital District of Helsinki and Uusimaa and The Finnish Medical Foundation. None of the authors report any competing interest in relation to the present work; all the authors have completed the disclosure form.

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Authors
Saavalainen, L., But, A., Tiitinen, A., Härkki, P., Gissler, M., Haukka, J., & Heikinheimo, O.
Affiliations
  • University of Helsinki (FI)
  • Karolinska Institutet (SE)
Corresponding author
Heikinheimo, O
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2019-07-02
Volume
34
Issue
8
Pages
1576-1586
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/dez074
OpenAlex
W2953698566
Cited by
23
References
55
Citations by year
2026: 6 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 1
FWCI
1.68
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Reproduction (publishedVersion)
  • PubMed (publishedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion, other-oa)
  • Tampere University Institutional Repository (Tampere University) (submittedVersion)
  • STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
  • WOS
Funders
  • Finnish Medical Foundation
  • Hospital District of Helsinki and Uusimaa
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
Keywords
endometriosis, mortality, middle-aged women, all-cause mortality, cause-specific mortality, cancer mortality, cardiovascular mortality, surgical verification, comorbidities, parity, educational attainment, Finland
MeSH terms
Adult, Aged, Endometriosis, Female, Finland, Follow-Up Studies, Humans, Middle Aged, Registries, Retrospective Studies, Survival Rate

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