Merritt, Melissa ARiboli, ElioMurphy, NeilKadi, MaiTjønneland, AnneOlsen, AnjaOvervad, KimDossus, LaureDartois, LaureenClavel-Chapelon, FrançoiseFortner, Renée TKatzke, Verena ABoeing, HeinerTrichopoulou, AntoniaLagiou, PagonaTrichopoulos, DimitriosPalli, DomenicoSieri, SabinaTumino, RosarioSacerdote, CarlottaPanico, SalvatoreBueno-de-Mesquita, H BasPeeters, Petra HLund, EilivNakamura, AurelieWeiderpass, ElisabeteQuirós, J RamónAgudo, AntonioMolina-Montes, EstherLarrañaga, NereaDorronsoro, MirenCirera, LluísBarricarte, AurelioOlsson, ÅsaButt, SalmaIdahl, AnnikaLundin, EvaWareham, Nicholas JKey, Timothy JBrennan, PaulFerrari, PietroWark, Petra ANorat, TeresaCross, Amanda JGunter, Marc J2016-07-132016-07-132015-10-30Merritt MA, Riboli E, Murphy N, Kadi M, Tjønneland A, Olsen A, et al. Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study. BMC Med 2015; 13:252http://hdl.handle.net/10668/2278Journal Article;BACKGROUND Reproductive events are associated with important physiologic changes, yet little is known about how reproductive factors influence long-term health in women. Our objective was to assess the relation of reproductive characteristics with all-cause and cause-specific mortality risk. METHODS The analysis was performed within the European Investigation into Cancer and Nutrition prospective cohort study, which enrolled >500,000 women and men from 1992 to 2000, who were residing in a given town/geographic area in 10 European countries. The current analysis included 322,972 eligible women aged 25-70 years with 99 % complete follow-up for vital status. We assessed reproductive characteristics reported at the study baseline including parity, age at the first birth, breastfeeding, infertility, oral contraceptive use, age at menarche and menopause, total ovulatory years, and history of oophorectomy/hysterectomy. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality were determined using Cox proportional hazards regression models adjusted for menopausal status, body mass index, physical activity, education level, and smoking status/intensity and duration. RESULTS During a mean follow-up of 12.9 years, 14,383 deaths occurred. The HR (95 % CI) for risk of all-cause mortality was lower in parous versus nulliparous women (0.80; 0.76-0.84), in women who had ever versus never breastfed (0.92; 0.87-0.97), in ever versus never users of oral contraceptives (among non-smokers; 0.90; 0.86-0.95), and in women reporting a later age at menarche (≥15 years versus <12; 0.90; 0.85-0.96; P for trend = 0.038). CONCLUSIONS Childbirth, breastfeeding, oral contraceptive use, and a later age at menarche were associated with better health outcomes. These findings may contribute to the development of improved strategies to promote better long-term health in women.enAge at menarcheAge at menopauseBreastfeedingMortalityOral contraceptivesParityLactancia MaternaEstudios de CohortesAnticonceptivos OralesParto ObstétricoMenarquiaNeoplasiasPartoEmbarazoEstudios ProspectivosReproducciónMedical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Feeding Behavior::Breast FeedingMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort StudiesMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Reproductive Control Agents::Contraceptive Agents::Contraceptive Agents, Female::Contraceptives, OralMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Obstetric Surgical Procedures::Delivery, ObstetricMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Puberty::MenarcheMedical Subject Headings::Diseases::NeoplasmsMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproductive Physiological Processes::Reproduction::Pregnancy::ParturitionMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproductive Physiological Processes::Reproduction::PregnancyMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective StudiesMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproductive Physiological Processes::Reproductionresearch article26515238open access10.1186/s12916-015-0484-31741-7015PMC4627614