Women’s health and development of NCDs

• Gender differences for NCDs- Prevalence and timing of disease development: asthma, depression,

osteoporosis show higher prevalence among women than men- Risk of mortality: heart disease more deadly for women with diabetes

than for men with diabetes- NCDs specific to women: gestational diabetes, breast cancer…- Reproductive health linked with NCD risk: age at menarche, menstrual

problems, pregnancy complications, age at menopause

• Life course approach to NCDs: focus on timing and duration of exposures across life - Gestation- Childhood- Adolescence- Young adulthood- Middle adult life- Later adult life- Across generations

: interlace.org.au

• International research collaboration on women and NCDs- 23 studies of women’s health- 10 countries on five continents- More than 240,000 women- Now aged over 50 years

• Data across life- Early life, age at menarche- Parity, age at menopause, - CVD, diabetes, other NCDs

• Variations in NCD risk- Socioeconomic factors- Race/ethnicity- Health behaviours- Bodyweight- Reproductive factors

Mishra et al. Maturitas 2016; 92:176-85

8.5

6.1

3.3

11.7

6.85.2

0

5

10

15

<10 years 10-11 years ≥12 years

Pre

vale

nce

(%

)

Education level

DiabetesCVD

6.3

4.6

5.7

0

5

10

≤11 years 12-13 14-15 ≥16 years

Dia

be

tes

Pre

vale

nce

(%

)

Age at menarche

19.0

10.7

13.0

0

5

10

15

20

25

<40years

40-44 45-49 50-53 54-55 >55years

Age at menopause

5.0

9.1

0

5

10

None 1 2 3 ≥4

Number of children

11.7

6.47.2

0

5

10

15

≤20 years

21-25 26-30 31-35 >35years

CV

D P

reva

len

ce (

%)

Age at first birth

Integrated approach to NCDs for prevention and research

• Opportunities for action and empowerment to prevent NCDs- Build on existing or developing RMNCAH programs for monitoring and

intervention

- Women, as individuals, community health workers, nurses, etc. engaged with/providing these health services can identify those at risk

- Reproductive health events act as early opportunity for timely intervention and preventive strategies for lifestyle and health behaviour

- An integrated program for detection and prevention also presents an opportunity for data collection for better understanding in LMICs

Early life factors

e.g. birth

weight,

childhood

social position

Reproductive Function: age at menarche, irregular

menses, dysmenorrhea,

age at first birth/last birth,

pregnancy complications,

pre-eclampsia, endometriosis, gestational diabetes, parity

Socioeconomic factors, health behaviours, and body weight

Chronological age

Reproductive Ageing: hysterectomy,

oophorectomy,

duration of peri-menopause

age at menopause,

hot flushes, night sweats

NCDs Mental health

Respiratory

conditions

Cardiovascular

disease Diabetes

Musculoskeletal

conditions

Breast cancer

Use of health services: reproductive health services use and treatments for NCDs

Mishra et al. Maturitas 2013; 74:235-40