American Journal of Epidemiology Advance Access published online on December 21, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwj048
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1 Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
* To whom correspondence should be addressed. Knowledge is limited on mortality of grand multiparous women (
Received March 15, 2005
Accepted October 4, 2005
ORIGINAL CONTRIBUTIONS
Cause-specific Mortality of Grand Multiparous Women in Finland
Marianne Hinkula 1 *,
Antti Kauppila 1,
Simo Näyhä 2,
and
Eero Pukkala 3
2 Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland; Regional Institute of Occupational Health in Oulu, University of Oulu, Oulu, Finland
3 Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
Marianne Hinkula, E-mail: marianne.hinkula{at}oulu.fi
Abstract 
5 deliveries), whose hormonal, metabolic, and social conditions differ from the average. The authors studied overall and cause-specific mortality in 1974-2001 among 87,922 grand multiparous women including 3,678 grand grand multiparous women (10 deliveries) in Finland. Standardized mortality ratios were defined as ratios of observed to expected numbers of deaths, both derived from national cause-of-death files. During follow-up, 18,870 grand multiparous women and 625 grand grand multiparous women died (standardized mortality ratios (SMRs) = 0.95 and 1.01, respectively). Decreased mortality among grand multiparous women was found for cancers of the breast (SMR = 0.64, 95% confidence interval (CI): 0.59, 0.69), corpus uteri (SMR = 0.68, 95% CI: 0.56, 0.80), ovary (SMR = 0.68, 95% CI: 0.60, 0.75), bladder (SMR = 0.59, 95% CI: 0.41, 0.82), and respiratory tract (SMR = 0.80, 95% CI: 0.72, 0.88). The only malignant tumor associated with elevated mortality was kidney cancer (SMR = 1.38, 95% CI: 1.21, 1.56). The standardized mortality ratio was also low for dementia (SMR = 0.78, 95% CI: 0.72, 0.84), respiratory diseases (SMR = 0.80, 95% CI: 0.75, 0.85), and accidents and violent causes (SMR = 0.79, 95% CI: 0.73, 0.84). Mortality from diabetes mellitus (SMR = 1.42, 95% CI: 1.29, 1.55) and ischemic heart disease (SMR = 1.10, 95% CI: 1.08, 1.13) was increased. According to this study, overall mortality among grand multiparous women is not elevated. Low mortality from cancers is offset by higher mortality from cardiovascular conditions and diabetes mellitus.
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