Factors affecting mortality in a large cohort study with special reference to oral contraceptive use



      This analysis updates mortality in the Oxford-Family Planning Association (Oxford-FPA) contraceptive study, with emphasis on oral contraceptive (OC) use.

      Study design

      The Oxford-FPA study includes 17,032 women recruited from 1968���1974 at contraceptive clinics, aged 25���39 years, using OCs a diaphragm or an intrauterine device. Follow-up has been to March 2009; by then, 1715 women had died.


      The rate ratio (RR) for overall mortality was 0.87 (CI 0.79���0.96), comparing ever-users of OCs with never-users. The RR for fatal cervical cancer was increased (7.3), but the CIs were very wide (1.2���305). There was no association between ever-use of OCs and mortality from breast cancer (RR 1.0, CI 0.8���1.2), nor was fatal breast cancer related to duration of OC use. OC use strongly protected against death from other uterine cancer and ovarian cancer; RRs for ever-use of OCs were 0.3 (CI 0.1���0.8) and 0.4 (CI 0.3���0.6), respectively. Protection increased with duration of OC use and persisted more than 20 years after cessation. Circulatory disease mortality was not increased, the RR for ever-use of OCs being 0.9 (CI 0.7���1.1). The overall mortality RR for all women smoking 15+ cigarettes daily was 2.25 (CI 1.99���2.53) and, for all women with a body mass index of 28+ kg/m2, was 1.33 (CI 1.07���1.64).


      Long-term follow-up strongly suggests that OC use slightly reduces all cause mortality.


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        • Vessey M.
        • Painter R.
        • Yeates D.
        Mortality in relation to oral contraceptive use and cigarette smoking.
        Lancet. 2003; 362: 185-191
        • Vessey M.
        • Doll R.
        • Peto R.
        • Johnson B.
        • Wiggins P.
        A long-term follow-up study of women using different methods of contraception.
        J Biosoc Sci. 1976; 8: 373-427
        • Breslow N.E.
        • Day N.E.
        Statistical methods in cancer research: the design and analysis of cohort studies, II. International Agency for Research on Cancer, Lyon1987: 81-118
        • Vessey M.
        30th Anniversary of the Oxford-FPA contraceptive study.
        Trends Urol Gynaecol Sexual Health. 1998; 3: 26-33
        • Burkman R.
        • Schlesselman J.J.
        • Zieman M.
        Safety concerns and health benefits associated with oral contraception.
        Am J Obstet Gynecol. 2004; 190: S5-S22
        • Gruer L.
        • Hart C.L.
        • Gordon D.S.
        • Watt C.M.
        Effect of tobacco smoking on survival of men and women by social position: a 28-year cohort study.
        Br Med J. 2009; b480: 338
        • Centers for Disease Control and Prevention
        Women and smoking: a report of the Surgeon General-2001.
        US Department of Health and Human Services, Washington, DC2001
        • Prospective Studies Collaboration
        Body mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies.
        Lancet. 2009; 373: 1083-1096
        • Collaborative Group on Hormonal Factors in Breast Cancer
        Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies.
        Lancet. 1996; 347: 1713-1727
        • The ESHRE Capri Workshop Group
        Noncontraceptive health benefits of combined oral contraception.
        Hum Rep Update. 2005; 11: 513-525
        • Smith J.S.
        • Green J.
        • Berrington de Gonzalez A.
        • et al.
        Cervical cancer and use of hormonal contraceptives: a systematic review.
        Lancet. 2003; 361: 1159-1167
        • Hannaford P.C.
        • Iversen L.
        • MacFarlane T.V.
        • Elliott A.M.
        • Angus V.
        • Lee A.J.
        Mortality among contraceptive pill users: cohort evidence from the Royal College of General Practitioners Oral Contraception Study.
        Brit Med J. 2010; c927: 340
        • Colditz G.A.
        • for the Nurses Health Study Research Group
        Oral contraceptive use and mortality during 12 years of follow-up: The Nurses' Health Study Group.
        Ann Intern Med. 1994; 120: 821-826