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Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study
Prince MJ, Acosta D, Guerra M, Huang Y, Jimenez-Velazquez IZ, Llibre Rodriguez JJ, Salas A, Sosa AL et al.. PloS one, 2018-02-28
Topic: Risk, prevention and care in population studies
Background Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversely associated with dementia incidence. Methods Population-based cohort studies of women aged 65 years and over in urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and China. Sociodemographic and risk factor questionnaires were administered to all participants, including ages at menarche, birth of first child, and menopause, and parity, with ascertainment of incident 10/66 dementia, and mortality, three to five years later. Results 9,428 women participated at baseline, with 72-98% responding by site. The 'at risk' cohort comprised 8,466 dementia-free women. Mean age varied from 72.0 to 75.4 years, lower in rural than urban sites and in China than in Latin America. Mean parity was 4.1 (2.4-7.2 by site), generally higher in rural than urban sites. 6,854 women with baseline reproductive period data were followed up for 26,463 person years. There were 692 cases of incident dementia, and 895 dementia free deaths. Pooled meta-analysed fixed effects, per year, for reproductive period (Adjusted Sub-Hazard Ratio [ASHR] 1.001, 95% CI 0.988-1.015) did not support any association with dementia incidence, with no evidence for effect modification by APOE genotype. No association was observed between incident dementia and; ages at menarche, birth of first child, and menopause: nulliparity; or index of cumulative endogenous estrogen exposure. Greater parity was positively associated with incident dementia (ASHR 1.030, 95% CI 1.002-1.059, I2 = 0.0%). Conclusions We found no evidence to support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period influences dementia incidence in late life.
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APA 7th
Prince, M. J., Acosta, D., Guerra, M., Huang, Y., Jimenez-Velazquez, I. Z., Llibre Rodriguez, J. J., et al. (2018). Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study. PloS one. https://doi.org/10.1371/journal.pone.0192889
Vancouver
Prince MJ, Acosta D, Guerra M, Huang Y, Jimenez-Velazquez IZ, Llibre Rodriguez JJ, et al. Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study. PloS one. 2018. doi:10.1371/journal.pone.0192889. PMID: 29489847.
BibTeX
@article{prince2018-29489847,
author = {Prince, M. J. and Acosta, D. and Guerra, M. and Huang, Y. and Jimenez-Velazquez, I. Z. and Llibre Rodriguez, J. J. and Salas, A. and Sosa, A. L. and others},
title = {{Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study}},
journal = {PloS one},
year = {2018},
doi = {10.1371/journal.pone.0192889},
pmid = {29489847},
url = {https://doi.org/10.1371/journal.pone.0192889}
}
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Key findings
- We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversely associated with dementia incidence.
- Results 9,428 women participated at baseline, with 72-98% responding by site.
- Greater parity was positively associated with incident dementia (ASHR 1.030, 95% CI 1.002-1.059, I2 = 0.0%).
- Conclusions We found no evidence to support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period influences dementia incidence in late life.
Why it matters
This large population-based cohort study in Latin America and China found no evidence that natural variation in reproductive period or other indicators of endogenous estrogen exposure protects against dementia. It also found greater parity was positively associated with incident dementia, but this does not establish a treatment or prevention.
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Study details
- Study designmeta-analysis
- Effect sizeHR 1.030; 0.0%
- Evidence strengthHigh
How this study scored 65/100
Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies. Scored zero for sample size and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (PloS one) |
| Journal's citation record | 4 / 4 | PLoS ONE: journal h-index 594 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A meta-analysis pooling many studies |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2018 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 4 / 7 | Cited 79 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 7.9 citations a year over 10 year(s) since 2018 |
| Impact for its field and year | 3 / 6 | Cited 5.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 2 / 4 | Cited 25 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Adolfo Valhuerdi: h-index 8 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | King's College London: institution h-index 1,348 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 12 institution(s) in 7 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29489847) |
| Free to read | 2 / 2 | Free to read |
| Total | 65 / 100 | — |
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