Table 3. Hazard Ratio (HR) and 95% confidence interval (CI) for Global index events (GIE) and components by Vaginal estrogen (VE) use.
| Intact uterus | Hysterectomy | Overall | |||||||
|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||
| N (rate/1000 person- years)a |
Adjusted Model 1b HR (95% CI) |
Adjusted Model 2c HR (95% CI) |
N (rate/1000 person- years) |
Adjusted Model 1 HR (95% CI) |
Adjusted Model 2 HR (95% CI) |
N (rate/1000 person- years) |
Adjusted Model 1 HR (95% CI) |
Adjusted Model 2 HR (95% CI) |
|
| N | 32,433 | 32,156 | 26,069 | 14,133 | 13,988 | 11,303 | 45,663 | 45,251 | 36,629 |
|
| |||||||||
| GIEd | |||||||||
| No VE | 4,110 (19.9) | 1 (ref) | 1 (ref) | 1796 (24.1) | 1 (ref) | 1 (ref) | 5,906 (21.0) | 1 (ref) | 1 (ref) |
| VE | 96 (12.0) | 0.63 (0.51-0.77) | 0.68 (0.55-0.86) | 57 (19.7) | 0.83 (0.63-1.08) | 0.94 (0.70-1.26) | 153 (14.0) | 0.69 (0.59-0.81) | 0.76 (0.64-0.91) |
|
| |||||||||
| Invasive Breast cancer | |||||||||
| No VE | 858 (4.0) | 1 (ref) | 1 (ref) | 327 (4.2) | 1 (ref) | 1 (ref) | 1,185 (4.1) | 1 (ref) | 1 (ref) |
| VE | 26 (3.2) | 0.78 (0.53-1.15) | 0.79 (0.51-1.22) | 14 (4.7) | 1.06 (0.61-1.85) | 1.23 (0.68-2.21) | 40 (3.6) | 0.86 (0.62-1.18) | 0.91 (0.64-1.29) |
|
| |||||||||
| Death | |||||||||
| No VE | 1683 (7.7) | 1 (ref) | 1 (ref) | 909 (11.3) | 1 (ref) | 1 (ref) | 2,592 (8.7) | 1 (ref) | 1 (ref) |
| VE | 32 (3.9) | 0.58 (0.41-0.82) | 0.62 (0.41-0.93) | 27 (9.0) | 0.85 (0.58-1.25) | 1.04 (0.68-1.58) | 59 (5.3) | 0.67 (0.52-0.87) | 0.78 (0.58-1.04) |
|
| |||||||||
| CHDe | |||||||||
| No VE | 865 (4.0) | 1 (ref) | 1 (ref) | 446 (5.6) | 1 (ref) | 1 (ref) | 1,311 (4.5) | 1 (ref) | 1 (ref) |
| VE | 10 (1.2) | 0.35 (0.19-0.65) | 0.39 (0.19-0.78) | 10 (3.4) | 0.61 (0.33-1.15) | 0.74 (0.37-1.50) | 20 (1.8) | 0.44 (0.29-0.69) | 0.52 (0.31-0.85) |
|
| |||||||||
| Stroke | |||||||||
| No VE | 619 (2.9) | 1 (ref) | 1 (ref) | 283 (3.6) | 1 (ref) | 1 (ref) | 902 (3.1) | 1 (ref) | 1 (ref) |
| VE | 9 (1.1) | 0.41 (0.21-0.80) | 0.54 (0.28-1.04) | 11 (3.7) | 1.08 (0.59-1.99) | 1.27 (0.67-2.40) | 20 (1.8) | 0.63 (0.40-0.98) | 0.78 (0.49-1.24) |
|
| |||||||||
| Colorectal cancer | |||||||||
| No VE | 342 (1.6) | 1 (ref) | 1 (ref) | 144 (1.8) | 1 (ref) | 1 (ref) | 486 (1.6) | 1 (ref) | 1 (ref) |
| VE | 9 (1.1) | 0.70 (0.36-1.36) | 0.63 (0.28-1.41) | 4 (1.3) | 0.76 (0.28-2.07) | 0.82 (0.26-2.62) | 13 (1.2) | 0.72 (0.41-1.25) | 0.67 (0.35-1.31) |
|
| |||||||||
| Hip Fracture | |||||||||
| No VE | 409 (1.9) | 1 (ref) | 1 (ref) | 173 (2.2) | 1 (ref) | 1 (ref) | 582 (2.0) | 1 (ref) | 1 (ref) |
| VE | 6 (0.7) | 0.42 (0.19-0.94) | 0.40 (0.16-0.96) | 4 (1.3) | 0.67 (0.25-1.81) | 0.42 (0.10-1.69) | 10 (0.9) | 0.49 (0.26-0.92) | 0.40 (0.19-0.85) |
|
| |||||||||
| Endometrial cancer | |||||||||
| No VE | 222 (1.0) | 1 (ref) | 1 (ref) | NAa | NA | NA | NA | NA | NA |
| VE | 11 (1.3) | 1.27 (0.69-2.33) | 1.47 (0.75-2.90) | NA | NA | NA | NA | NA | NA |
|
| |||||||||
| PE/DVTb | |||||||||
| No VE | 385 (1.8) | 1 (ref) | 1 (ref) | 215 (2.7) | 1 (ref) | 1 (ref) | 600 (2.0) | 1 (ref) | 1 (ref) |
| VE | 9 (1.1) | 0.68 (0.35-1.31) | 0.72 (0.34-1.53) | 3 (1.0) | 0.43 (0.14-1.33) | 0.57 (0.18-1.81) | 12 (1.1) | 0.59 (0.33-1.05) | 0.68 (0.36-1.28) |
Rates are crude rates per 1000 person-years (N= 45,663)
Model 1 is adjusted for age, education, past estrogen use, history of cancer before study baseline, history of cardiovascular disease before study baseline, history of deep vein thrombosis or pulmonary embolism before study baseline. Model 1 in the overall sample also includes hysterectomy status
Model 2 is adjusted for variables in Model 1 and race/ethnicity, baseline body mass index, baseline diagnosis of diabetes, baseline physical activity (total MET-hours/week), hypertension, Gail breast cancer risk score, fracture after age 55 prior to study enrollment, smoking, income, and alcohol use (servings/week)
GIE denotes Global Index Event, defined as time to first coronary heart disease, breast cancer, stroke, pulmonary embolism, hip fractures, colorectal cancer, endometrial cancer, or death.
CHD denotes coronary heart disease
Endometrial cancer analysis was not conducted in participants with hysterectomy or in the overall sample
PE denotes pulmonary embolism; DVT denotes deep vein thrombosis