Age at menopause and determinants of hysterectomy and menopause in a multi-ethnic community: the Hilo Women's Health Study.

OBJECTIVES: A lifespan approach was used to evaluate age at menopause, and determinants of surgical and natural menopause, in the multi-ethnic community of Hilo, Hawaii. STUDY DESIGN: Participants aged 40-60 years (n=898) were drawn from a larger, randomly generated sample recruited by postal questionnaires. Median age at natural menopause was computed by probit analysis. Logistic regression analysis was applied to examine determinants of hysterectomy, and Cox regression analysis was used to examine risk factors for an earlier age at menopause. MAIN OUTCOME MEASURES: History of hysterectomy, age at menopause. RESULTS: Frequency of hysterectomy was 19.2% at a mean age of 40.5 years. The likelihood of hysterectomy increased with older ages, lower education, mixed ancestry, having been overweight at age 30, and married 20 years prior to survey. Median age at natural menopause was 53.0 years. Smoking and not being married 10 years before survey were associated with an earlier age at menopause. CONCLUSIONS: Median age at menopause was later than the national average. Ethnicity and education were determinants of hysterectomy, but not associated with age at natural menopause. Events later in the lifespan (e.g., smoking and not being married 10 years prior to the survey) were more important than earlier events (e.g., childhood residence) in relation to age at menopause. The timing of weight gain and marital status appear to be important in relation to surgical menopause, and the timing of marital status appears to be important in relation to the timing of natural menopause.

Ambulatory blood pressure and blood lipids in a multiethnic sample of healthy adults.

OBJECTIVES: Elevated blood pressure (BP), elevated serum cholesterol, and aberrant lipoprotein fractions (low levels of high-density lipoprotein (HDL) and high levels of low-density lipoprotein fractions and triglycerides) have all been used as measures that assess the "metabolic syndrome" and more recently in indexes of allostatic load, which are designed to assess the degree of integrated metabolic pathology. While there are ample data regarding the interrelationships of these measures in various pathophysiological settings, there are limited data regarding the interrelationship of ambulatory BP (ABP) and blood lipids in healthy subjects. The present study evaluates ABP-blood lipid relationships in a multiethnic sample of healthy adults. METHODS: The subjects were 37 men (age = 40.9 ± 10.7 years) and 42 women (age = 35.8 ± 10.4 years) who were employed as hotel workers in Hawaii. Each wore an ABP monitor for one midweek workday and had pressures averaged in three daily microenvironments (work, home, and during sleep). They also had fasting blood samples taken for lipid profiling. RESULTS: Multivariate analysis of covariance shows that there was a strong inverse relationship between HDL and both systolic (P < 0.006) and diastolic (P < 0.006) BP, overall and in each microenvironment, but no statistically significant relationships with other lipid measures. CONCLUSION: These results suggest lipids and BP do not act as a group in healthy adults but that higher HDL is associated with lower BP. This latter finding is consistent with research that shows that HDL promotes vasodilation via its effect on endothelial nitric oxide synthase.

Do Japanese American women really have fewer hot flashes than European Americans? The Hilo Women's Health Study.

OBJECTIVE: Many studies have found a significantly lower frequency of reported hot flashes (HFs) in Japanese and Japanese American (JA) populations, leading to speculation about possible dietary, genetic, or cultural differences. These studies have relied on subjective reports of HFs. Accordingly, the purpose of this study was to compare both reported and objective HFs measured by sternal and nuchal skin conductance among JA and European American (EA) women. METHODS: Two surveys of HF frequencies were carried out among women of either EA or JA ethnicity; aged 45 to 55 years; living in Hilo, Hawaii; and not using exogenous hormones. The first was a postal questionnaire (n = 325); the second was carried out during a clinical study of HFs (n = 134). Women in the second group underwent 24-hour ambulatory and 3-hour laboratory monitoring for objective HFs measured through skin conductance at sternal and nuchal sites. Subjective HFs were recorded on the monitor or in a diary. RESULTS: JAs were significantly less likely to report having had HFs in the previous 2 weeks compared with EAs (postal sample: JAs, 30.9%; EAs, 43.9%; chi(2) = 6.9, P < 0.01; monitored sample: JAs, 26.1%; EAs, 46.6%; chi(2) = 5.3, P < 0.05). JAs were also significantly less likely to report experiencing other symptoms (15 of 30 in the postal sample; 6 of 30 in the monitored sample) than EAs. However, JAs did not significantly differ in likelihood of reporting subjective HFs during the 24-hour ambulatory period (JAs, 51.1%; EAs, 55.8%; chi(2) = 0.3, NS), nor in percentage of individuals displaying one or more objective HFs as measured by the skin conductance monitor (JAs, 77.8%; EAs, 72.1%; chi(2) = 0.5, NS). JAs also did not have a significantly fewer number of objective HFs (t = 0.2, NS) nor of subjective HFs (t = 0.8, NS) during the monitoring period, and these results were unchanged when analyses controlled for menopause status and body mass index. CONCLUSIONS: The common finding of fewer reported HFs in people of Japanese ancestry may be a consequence of reporting bias: JAs report fewer symptoms of many conditions compared with people from other ethnic groups. This is probably due to cultural conceptions of what is appropriate to report.

Age-related differences in health complaints: the Hilo women's health study.

The purpose of this study was to determine the age distribution of health-related complaints and symptom groupings from a random postal survey carried out in the multi-ethnic city of Hilo, Hawaii. Symptom frequencies and factor analyses were compared across three age categories: < 40 (32%), 40-60 (48%), and > 60 years (19%), (n = 1,796). Younger women were most likely to report headaches, menstrual complaints, irritability, and mood swings. Women at midlife were most likely to report fluid retention, trouble sleeping, loss of sexual desire, vasomotor symptoms, and nervous tension. Older women reported the least number of symptoms overall. Using multiple linear regression, menopause status, ethnicity, and alcohol intake were significantly associated with the factor scores for symptoms of menopause, after controlling for age, education, BMI, exercise, smoking habits, and financial comfort.

Vasomotor symptoms among Japanese-American and European-American women living in Hilo, Hawaii.

OBJECTIVE: The Hilo Women's Health Survey was designed and administered to gather baseline data on women's health in Hilo, HI. This randomized, cross-sectional study allowed for a focus on ethnic differences in symptom reporting. The results presented here focus on hot flash and night sweat experience among Japanese-American and European-American women. DESIGN: Survey packets were mailed to street addresses associated with parcel numbers pulled randomly from Hilo tax maps. Of the 6,401 survey packets delivered to households, 1,824 questionnaires were completed and returned. The results reported here are based on 869 women aged 40 to 60, of whom 249 described themselves to be 100% Japanese and 203 described themselves to be 100% European-American. Logistic regression analyses were used to examine whether the relationship between ethnicity and vasomotor symptoms persisted after controlling for other variables. RESULTS: European-American participants were more likely to have ever experienced a hot flash as compared with Japanese-American participants (72% vs 53%, P<0.01). During the 2 weeks before the survey, European-American participants were more likely to have experienced hot flashes (P<0.05) and night sweats (P<0.01). In logistic regression analyses, after controlling for age, body mass index, menopause status, level of education, financial comfort, smoking habits, alcohol intake, exercise, use of hormone therapy, and soy intake, European-American women were still significantly more likely to have experienced hot flashes (odds ratio=1.858) and night sweats (odds ratio=2.672). CONCLUSIONS: The results, based on self-reporting of menopausal symptoms, indicate that Japanese-American women report fewer hot flashes and night sweats than European-American women. Japanese-American women reported a higher intake of soy, but soy intake was not associated with fewer vasomotor symptoms.