Key result
Seven reproductive risk factors accounted for a population attributable fraction for stroke of 20.5% (95% CI 20.4-20.5%) in low-SES and 3.1% (95% CI 1.7-4.9%) in high-SES postmenopausal women.
Why the study?
The individual and combined population attributable fractions of stroke associated with reproductive factors in postmenopausal women, and how they vary across socioeconomic strata, were not well understood.
What is the population attributable fraction of stroke associated with reproductive factors among postmenopausal women across different socioeconomic strata?
Cohort (n=138,873)
What is the population attributable fraction of stroke associated with reproductive factors among postmenopausal women across different socioeconomic strata?
Effect estimate: PAF 20.5% (low-SES women) (95% CI 20.4-20.5)
Reproductive factors account for a significant proportion of stroke risk in Chinese postmenopausal women, with the specific risk factors and overall attributable fraction varying substantially by socioeconomic status.
SES modifies reproductive factor contributions to stroke; hypothesis-generating for targeted prevention research in low-SES women.
BACKGROUND: This prospective study aimed to examine the individual and combined population attributable fractions (PAFs) of stroke and its subtypes associated with reproductive factors among Chinese postmenopausal women, highlighting variations across socioeconomic status (SES) stratas. METHODS: Data were from 138,873 Chinese postmenopausal women enrolled in the China Kadoorie Biobank. Reproductive factors evaluated in this study included early age at menarche, early age at menopause, advanced age at first live birth, high parity, history of stillbirth, history of miscarriage or termination, and non-lactation. PAFs were calculated using hazard ratios, estimated using Cox proportional hazard regression, and prevalence of the seven reproductive factors. PAF for each reproductive risk factor and combined PAFs for all factors were estimated in total population and across SES classes. RESULTS: Of the 138,873 included participants, 17,042 developed strokes during a median follow-up period of 8.9 years. Across SES classes, the greatest attributable fractions of total stroke cases were observed for high parity among low-SES women (PAF 17.2%, 95% confidence interval [CI] 13.7%, 20.6%), history of miscarriage or termination among medium-SES women (PAF 11.4%, 95% CI 8.2%, 14.5%), and no history of lactation among high-SES women (PAF 3.1%, 95% CI 1.7%, 4.9%). A multiplicatively estimated 20.5% (95% CI 20.4%, 20.5%) and 3.1% (95% CI 1.7%, 4.9%) of stroke cases were attributable to the seven reproductive risk factors in low-SES and high-SES women, respectively. CONCLUSIONS: A large fraction of stroke cases among Chinese postmenopausal women were associated with reproductive factors. Targeted cardiovascular prevention strategies are warranted among women with different SES to mitigate risks associated with different reproductive profiles.
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Sun et al. (2025) conducted a cohort in Stroke (n=138,873). Reproductive factors (e.g., early menarche/menopause, high parity, non-lactation) vs. Reference reproductive profiles was evaluated on Stroke (PAF 20.5% (low-SES women), 95% CI 20.4-20.5). Seven reproductive risk factors accounted for a population attributable fraction for stroke of 20.5% (95% CI 20.4-20.5%) in low-SES and 3.1% (95% CI 1.7-4.9%) in high-SES postmenopausal women.
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