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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (3): 502-510. doi: 10.19723/j.issn.1671-167X.2023.03.017

• 论著 • 上一篇    下一篇

中国山东某县1951年以来出生女性初潮年龄与绝经年龄长期趋势

王晓伟1,2,穆英超3,*(),郭振宇1,2,周玉博1,2,张勇3,李宏田1,2,4,*(),刘建蒙1,2,4   

  1. 1. 北京大学生育健康研究所，国家卫生健康委员会生育健康重点实验室，北京 100191
    2. 北京大学公共卫生学院流行病与卫生统计学系，北京 100191
    3. 桓台县妇幼保健院，山东淄博 256400
    4. 北京大学人工智能研究院智慧公众健康研究中心，北京 100191
  • 收稿日期:2023-02-14 出版日期:2023-06-18 发布日期:2023-06-12
  • 通讯作者: 穆英超,李宏田 E-mail:1319094858@qq.com;lihongtian@pku.edu.cn
  • 基金资助:
    中央高校基本科研业务费专项资金(BMU2021RCZX029)

Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China

Xiao-wei WANG1,2,Ying-chao MU3,*(),Zhen-yu GUO1,2,Yu-bo ZHOU1,2,Yong ZHANG3,Hong-tian LI1,2,4,*(),Jian-meng LIU1,2,4   

  1. 1. Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
    2. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    3. Women & Children's Health Care Hospital of Huantai, Zibo 256400, Shandong, China
    4. Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100191, China
  • Received:2023-02-14 Online:2023-06-18 Published:2023-06-12
  • Contact: Ying-chao MU,Hong-tian LI E-mail:1319094858@qq.com;lihongtian@pku.edu.cn
  • Supported by:
    the Fundamental Research Funds for the Central Universities(BMU2021RCZX029)

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摘要：

目的: 描述中国山东某县女性初潮年龄与绝经年龄长期趋势。方法: 应用研究地区婚前医学检查及宫颈癌和乳腺癌筛查资料，研究1951—1998年出生女性月经初潮年龄及1951—1975年出生女性绝经年龄长期变化趋势。采用Joinpoint回归确定初潮年龄长期趋势有无拐点以及拐点年份，采用多因素加权Cox回归估计不同年代出生女性较早绝经平均风险比(average hazard ratios，AHR)。结果: 1951年和1998年出生女性平均初潮年龄分别为(16.43±1.89)岁和(13.99±1.22)岁，城镇女性低于农村女性，教育水平越高女性平均初潮年龄越低；Joinpoint回归发现1959年、1973年和1993年三个拐点年份，1951—1959年、1960—1973年和1974—1993年出生者初潮年龄分别年均减小0.03岁(P < 0.001)、0.08岁(P < 0.001)和0.03岁(P < 0.001)，1994—1998年出生者初潮年龄维持平稳(P=0.968)。与1951—1960年出生女性相比，1961—1965年、1966—1970年和1971—1975年出生者较早绝经风险总体上逐渐降低，绝经年龄呈现延迟趋势；分层分析显示，教育水平为初中及以下者较早绝经风险逐渐降低，绝经年龄呈现明显延迟趋势，但教育水平为高中及以上者这一趋势并不明显，其中教育水平为大专及以上者较早绝经风险先降后升，相应的AHR依次为0.90(0.66~1.22)、1.07(0.79~1.44)和1.14(0.79~1.66)。结论: 1951年以来出生女性初潮年龄逐渐下降，至1994年趋于平稳，40余年下降近2.5岁；1951—1975年出生女性绝经年龄总体上随时间推移而延迟，但教育水平相对较高人群呈现先延迟而后提前的趋势。在婚育年龄推迟与人群生育力下降的双重背景下，应加强女性基础生殖健康状况尤其是较早绝经风险的评估与监测。

关键词: 月经初潮, 绝经, 年龄, 妇女卫生, 生殖健康

Abstract:

Objective: To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province. Methods: Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression. Results: The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66). Conclusion: The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

Key words: Menarche, Menopause, Age, Women' s health, Reproductive health

中图分类号: 

  • R173

图1

初潮年龄与绝经年龄趋势分析的研究对象纳入和排除流程"

表1

不同特征人群初潮年龄分布情况(n=58 114)"

Characteristic Total, n(%)Age at menarcheP value
Mean±SD M (P25, P75)
Birth cohort < 0.001
   1951-1959 7 247 (12.47) 16.23±1.93 16.00 (15.00, 18.00)
   1960-1969 20 766 (35.73) 15.56±1.55 15.00 (15.00, 16.00)
   1970-1979 17 365 (29.88) 14.89±1.34 15.00 (14.00, 16.00)
   1980-1989 8 245 (14.19) 14.43±1.28 15.00 (14.00, 15.00)
   1990-1998 4 491 (7.73) 14.05±1.25 14.00 (13.00, 15.00)
Region < 0.001
   Urban 40 598 (69.86) 15.10±1.57 15.00 (14.00, 16.00)
   Rural 17 516 (30.14) 15.34±1.70 15.00 (14.00, 16.00)
Educational level < 0.001
   Primary school or below 17 559 (30.21) 15.75±1.72 15.00 (15.00, 17.00)
   Junior high school 24 094 (41.46) 15.18±1.49 15.00 (14.00, 16.00)
   Senior high school 8 432 (14.51) 14.80±1.47 15.00 (14.00, 16.00)
   College or above 7 973 (13.72) 14.24±1.31 14.00 (13.00, 15.00)
   Unknown 56 (0.10) 14.68±1.16 15.00 (14.00, 15.00)

图2

月经初潮年龄的长期变化趋势"

表2

月经初潮年龄分段一般线性模型回归分析结果"

Birth cohort β SE t P value
1951-1959 -0.03 0.008 -4.38 < 0.001
1960-1973 -0.08 0.002 -47.55 < 0.001
1974-1993 -0.03 0.002 -17.55 < 0.001
1994-1998 0.00 0.014 0.04 0.97

表3

不同特征人群绝经年龄分布情况(n=38 483)"

Characteristic Total, n(%) Postmenopausal, n(%)Age at menopauseχ2 P value
Mean±SEa M (P25, P75)b
Birth cohort 42.969 < 0.001
   1951-1960 7 853 (20.41) 7 845 (99.90) 50.24±0.05 50.00 (48.00, 53.00)
   1961-1965 10 275 (26.70) 10 015 (97.47) 50.71±0.04 51.00 (49.00, 53.00)
   1966-1970 11 815 (30.70) 8 046 (68.10) 50.95±0.04 51.00 (49.00, 53.00)
   1971-1975 8 540 (22.19) 1 670 (19.56) 50.10±0.19 51.00 (49.00, 52.00)
Region 7.605 0.006
   Urban 26 083 (67.78) 18 302 (70.17) 50.81±0.03 51.00 (49.00, 53.00)
   Rural 12 400 (32.22) 9 274 (74.79) 50.60±0.04 51.00 (49.00, 53.00)
Educational level 29.068 < 0.001
   Primary school or below 16 092 (41.82) 13 280 (82.53) 50.49±0.03 51.00 (48.00, 53.00)
   Junior high school 17 335 (45.05) 11 281 (65.08) 50.89±0.03 51.00 (49.00, 53.00)
   Senior high school 3 613 (9.39) 2 335 (64.63) 50.96±0.07 51.00 (49.00, 53.00)
   College or above 1 443 (3.75) 680 (47.12) 51.13±0.11 51.00 (50.00, 53.00)

图3

不同出生年代女性绝经年龄的Kaplan-Meier曲线"

图4

不同出生年代女性绝经年龄的Kaplan-Meier曲线(按城乡分层)"

图5

不同出生年代女性绝经年龄的Kaplan-Meier曲线(按教育水平分层)"

表4

出生年代与较早绝经的关联分析"

Birth cohortAdjusted AHR (95%CI)
1951-1960 1961-1965 1966-1970 1971-1975
Total Reference 0.91 (0.88-0.94) 0.89 (0.86-0.91) 0.80 (0.75-0.84)
Region
   Rural Reference 0.90 (0.86-0.95) 0.84 (0.80-0.89) 0.71 (0.64-0.78)
   Urban Reference 0.92 (0.89-0.96) 0.91 (0.88-0.95) 0.85 (0.79-0.91)
Educational level
   Primary school or below Reference 0.96 (0.92-1.00) 0.87 (0.83-0.91) 0.81 (0.73-0.89)
   Junior high school Reference 0.92 (0.86-0.98) 0.94 (0.88-1.00) 0.86 (0.79-0.94)
   Senior high school Reference 0.81 (0.72-0.90) 0.86 (0.77-0.97) 0.87 (0.72-1.06)
   College or above Reference 0.90 (0.66-1.22) 1.07 (0.79-1.44) 1.14 (0.79-1.66)
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ISSN 1671-167X
CN 11-4691/R
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