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Mortality in 43,598 men with infertility - a Swedish nationwide population-based cohort study
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.ORCID iD: 0000-0001-7061-7178
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.ORCID iD: 0000-0002-1191-7231
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.ORCID iD: 0000-0003-1024-5602
2019 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, p. 645-657Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies indicate a higher risk of comorbidity in men with infertility; however, research on mortality is scarce and the few studies that do exist have rarely differentiated between infertility and infertility-related diagnoses.

Objective: To examine mortality in men with an infertility or infertility-related diagnosis.

Design, setting, and participants: Population-based cohort study of men born in 1944-1992 in Sweden. We used Cox regression estimated hazard ratios (HRs) for infertility while adjusting for number of children, education, year of birth, country of birth, diabetes, hypertension, liver disease and end-stage renal disease. In all, 43,598 men with a diagnosis of infertility and 57,733 men with an infertility-related diagnosis were compared with 2,762,254 men (reference group) without such diagnoses.

Outcome measures: All-cause and cause-specific mortality at age 20 to 69 years.

Results and limitations: The 2,863,585 men in the study were followed for a median time of 22.0 years. During follow-up, 439 men with a diagnosis of infertility died, corresponding to a crude incidence rate of 1.56 deaths per 1,000 person-years. These figures can be compared with 1,400 deaths in men with an infertility-related diagnosis (1.96 deaths/1,000 person-years) and 99,463 deaths in reference individuals (2.17 deaths/1,000 person-years). Overall, men with a diagnosis of infertility did not have a higher risk of death (adjusted [a] HR=0.98; 95% confidence interval [95% CI]=0.89-1.08), but had a higher risk of death before age 30 (20-29 years) (aHR=3.26; 95% CI=2.42-4.41). This early excess mortality was largely explained by cancer diagnosed before infertility. Having an infertility-related diagnosis was associated with death (aHR=1.23; 95% CI=1.17-1.30). Limitations include the lack of general screening for infertility in Sweden and the lack of information on semen parameters.

Conclusion: Men with a diagnosis of infertility are not at a higher risk of death than the general population, although having a diagnosis related to infertility may be linked to a higher risk of death.

Patient summary: Men with a diagnosis of infertility do not seem to have a higher risk of death though an infertility-related diagnosis in men is associated with the risk of death.

Place, publisher, year, edition, pages
DOVE Medical Press Ltd. , 2019. Vol. 11, p. 645-657
Keywords [en]
cancer, death, infertility
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-75748DOI: 10.2147/CLEP.S210180ISI: 000477645400001OAI: oai:DiVA.org:oru-75748DiVA, id: diva2:1342054
Funder
Swedish Research Council, K2011-69X-21871-01-6 SIMSAM 340-2013-5867
Note

Funding Agencies:

EU-FP7 Health Program  259679

Strategic Research Program in Epidemiology Young Scholar Awards, Karolinska Institutet

Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved

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Ludvigsson, Jonas F.

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