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The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017
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  • Nurunnahar Akter,
  • Elena Kulinskaya,
  • Nicholas Steel,
  • Ilyas Bakbergenuly
Nurunnahar Akter
University of East Anglia
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Elena Kulinskaya
University of East Anglia
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Nicholas Steel
University of East Anglia
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Ilyas Bakbergenuly
University of East Anglia
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Abstract

Objective: To estimate the effect of oestrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46 to 65 at first prescription.
Design: Matched cohort study. 
Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017).
Population: 105,199 HRT users (cases) and 224,643 non-users (controls) matched on age and general practice.
Methods: Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. 
Main outcome measures: All-cause mortality.
Results: A total of 21,751 women died over an average of 13.5 years follow-up per participant, of whom 6,329 were users and 15,422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), compared to non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), for combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) for oestrogen-only users, respectively.
Conclusions: Combined HRT was associated with a 9% lower risk of all-cause mortality and oestrogen-only formulation was not associated with any significant changes.
 Funding: IFoA.
Keywords: Hormone replacement therapy, menopause, mortality, primary care records, THIN.
Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.
19 Jun 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
20 Jun 2021Assigned to Editor
20 Jun 2021Submission Checks Completed
30 Jun 2021Reviewer(s) Assigned
11 Aug 2021Review(s) Completed, Editorial Evaluation Pending
28 Aug 2021Editorial Decision: Revise Major
30 Sep 20211st Revision Received
07 Oct 2021Submission Checks Completed
07 Oct 2021Review(s) Completed, Editorial Evaluation Pending
07 Oct 2021Assigned to Editor
26 Oct 2021Editorial Decision: Revise Minor
31 Oct 20212nd Revision Received
31 Oct 2021Submission Checks Completed
31 Oct 2021Assigned to Editor
31 Oct 2021Review(s) Completed, Editorial Evaluation Pending
09 Nov 2021Editorial Decision: Accept
May 2022Published in BJOG: An International Journal of Obstetrics & Gynaecology volume 129 issue 6 on pages 994-1003. 10.1111/1471-0528.17008