Female Reproductive Factors and the Risk of Bronchiectasis: A Nationwide Population-Based Longitudinal Study

Abstract

Although the oestrogen level is thought to be involved in the occurrence of bronchiectasis, limited data are available on the relationship between female reproductive factors and the risk of bronchiectasis. We performed a population-based retrospective cohort study of 959,523 premenopausal women and 1,362,401 postmenopausal women without a previous history of bronchiectasis who participated in a health screening exam in 2009 in South Korea. In premenopausal women, compared with a later age at menarche (>= 16 years), an earlier menarche (<12 years) was associated with a reduced risk of bronchiectasis with an adjusted hazard ratio (aHR) (95% confidence interval (CI)) of 0.74 (0.67-0.81). However, there were no significant associations between other reproductive factors (breastfeeding, parity, or oral contraceptive use) and the risk of bronchiectasis. In postmenopausal women, the risk of bronchiectasis (aHR (95% CI)) was lower in those with an earlier menarche (0.79 (0.72-0.87) for <12 years vs. >= 16 years), a later menopause (0.90 (0.84-0.96) >= 55 years vs. <40 years), and a longer reproductive period (0.90 (0.86-0.94) for >= 40 years vs. <30 years). There was no significant relationship between parity and the risk of bronchiectasis. Although breastfeeding <1 year (aHR (95% CI) = 0.92 (0.87-0.97) for <0.5 years and 0.93 (0.88-0.97) for 0.5-1 years) and oral contraceptive use <1 year (0.97 (0.94-0.99)) reduced the risk of bronchiectasis, hormone replacement therapy >= 5 years increased the risk of bronchiectasis (1.24 (1.18-1.30)). Female reproductive factors are risk factors for developing bronchiectasis, showing a higher risk associated with shorter endogenous oestrogen exposure regardless of the menopausal status.