Table 3 Cumulative incidence of all obstructive lung disease, all asthma, and all chronic obstructive pulmonary disease overall and in strata by age at oophorectomy, estrogen therapy, surgical indication, cigarette smoking, and body mass index.

From: A population-based cohort study on the risk of obstructive lung disease after bilateral oophorectomy

Strata	Bilateral oophorectomy				Referent women				Unweighted models¹		Weighted models²
Strata	N at risk	Person-years	N of events	Absolute risk³ (95% CI)	N at risk	Person -years	N of events	Absolute risk³ (95% CI)	Hazard ratio (95% CI)	P value	Hazard ratio (95% CI)	P value
All OLD⁴	1336	21,747	214	21.0% (18.2–24.2)	1435	23,782	164	15.3% (13.1–17.8)	1.42 (1.17–1.74)	<0.001	1.31 (1.07–1.61)	0.01
Age ≤45 y	825	13,350	143	22.1% (18.6–26.1)	897	14,719	92	13.9% (11.4–17.0)	1.71 (1.32–2.21)	<0.001	1.53 (1.17–2.01)	0.002
Estrogen >49⁵	399	4876	40	15.0% (10.5–21.0)	378	4795	18	5.9% (3.6–9.7)	2.17 (1.25–3.79)	0.006	2.34 (1.32–4.16)	0.004
No estr. or ≤49	237	2196	18	11.6% (5.3–24.6)	238	2401	9	5.8% (2.7–12.4)	2.16 (0.97–4.81)	0.06	1.65 (0.72–3.76)	0.24
Age 46 to 49 y	511	8397	71	19.4% (14.9–25.0)	538	9063	72	17.4% (13.6–22.1)	1.06 (0.77–1.46)	0.74	1.04 (0.75–1.45)	0.80
Estrogen >49⁵	366	5758	48	20.4% (14.5–28.1)	374	6119	45	15.2% (11.1–20.7)	1.13 (0.76–1.69)	0.55	1.18 (0.78–1.78)	0.43
No estr. or ≤49	127	1625	14	13.0% (5.4–29.6)	125	1690	13	19.9% (9.2–40.1)	1.06 (0.50–2.23)	0.88	0.91 (0.41–2.01)	0.81
Benign indication⁶	541	8746	101	24.2% (19.8–29.4)	579	9608	68	15.4% (12.3–19.3)	1.61 (1.19–2.17)	0.002	1.47 (1.08–2.01)	0.01
No indication⁷	795	13,001	113	18.7% (15.2–22.7)	856	14,174	96	15.4% (12.5–18.9)	1.30 (0.99–1.70)	0.06	1.18 (0.89–1.57)	0.24
Ever smokers	584	9088	121	27.8% (23.0–33.3)	582	9482	101	22.5% (18.6–27.1)	1.23 (0.95–1.58)	0.11	1.22 (0.94–1.58)	0.13
Never smokers	752	12,659	93	16.5% (13.3–20.3)	853	14,300	63	9.5% (7.4–12.2)	1.73 (1.25–2.38)	<0.001	1.52 (1.09–2.13)	0.01
BMI ≥ 30 kg/m²	438	6593	89	28.2% (22.4–35.2)	367	5723	66	22.4% (17.3–28.7)	1.18 (0.86–1.61)	0.31	1.17 (0.85–1.61)	0.35
BMI < 30 kg/m²	898	15,154	125	18.2% (15.1–21.8)	1068	18,059	98	12.5% (10.2–15.2)	1.51 (1.16–1.96)	0.002	1.42 (1.09–1.85)	0.01
All asthma	1336	22,842	133	13.3% (11.1–16.0)	1435	24,276	121	10.8% (9.0–12.9)	1.17 (0.92–1.49)	0.21	1.10 (0.86–1.41)	0.43
Age ≤45 y	825	14,147	89	14.4% (11.5–17.9)	897	14,984	68	9.7% (7.6–12.3)	1.39 (1.02–1.89)	0.04	1.33 (0.96–1.83)	0.09
Estrogen >49⁵	416	5270	26	10.2% (6.5–15.8)	387	4971	9	3.0% (1.4–6.5)	2.73 (1.28–5.82)	0.01	3.26 (1.50–7.10)	0.003
No estr. or ≤49	249	2384	11	8.4% (3.1–21.7)	239	2415	7	2.7% (1.1–6.4)	1.58 (0.61–4.09)	0.34	1.49 (0.53–4.24)	0.45
Age 46 to 49 y	511	8695	44	11.4% (8.3–15.6)	538	9292	53	12.2% (9.1–16.2)	0.89 (0.60–1.31)	0.54	0.87 (0.58–1.29)	0.48
Estrogen >49⁵	368	6034	27	10.5% (7.0–15.6)	375	6296	31	10.2% (7.0–14.7)	0.91 (0.55–1.51)	0.72	0.91 (0.54–1.53)	0.72
No estr. or ≤49	127	1646	10	11.5% (4.3–29.0)	125	1741	9	9.8% (4.4–20.9)	1.17 (0.48–2.85)	0.73	1.09 (0.43–2.77)	0.86
Benign indication⁶	541	9309	60	15.0% (11.5–19.5)	579	9832	48	10.3% (7.8–13.7)	1.30 (0.90–1.90)	0.17	1.25 (0.85–1.84)	0.26
No indication⁷	795	13,532	73	11.9% (9.3–15.3)	856	14,444	73	11.2% (8.7–14.2)	1.09 (0.79–1.51)	0.61	1.02 (0.73–1.42)	0.92
Ever smokers	584	9866	59	12.8% (9.8–16.8)	582	9824	68	14.5% (11.4–18.3)	0.84 (0.60–1.18)	0.31	0.85 (0.60–1.19)	0.33
Never smokers	752	12,975	74	13.8% (10.8–17.6)	853	14,452	53	7.8% (5.9–10.3)	1.60 (1.12–2.27)	0.009	1.47 (1.01–2.12)	0.04
BMI ≥ 30 kg/m²	438	6999	61	19.0% (14.4–24.7)	367	5949	50	15.8% (11.8–20.8)	1.04 (0.72–1.50)	0.82	1.03 (0.71–1.51)	0.86
BMI < 30 kg/m²	898	15,843	72	11.0% (8.6–14.1)	1068	18,327	71	8.6% (6.8–11.0)	1.16 (0.84–1.61)	0.36	1.16 (0.83–1.60)	0.39
All COPD⁸	1336	23,909	59	7.2% (5.3–9.6)	1435	25,494	37	4.6% (3.2–6.4)	1.69 (1.13–2.53)	0.01	1.57 (1.04–2.36)	0.03
Age ≤45 y	825	14,860	40	8.1% (5.7–11.5)	897	15,699	20	3.7% (2.3–5.8)	2.10 (1.23–3.59)	0.007	1.88 (1.09–3.25)	0.02
Estrogen >49⁵	438	5544	21	7.3% (4.2–12.5)	403	5191	8	3.2% (1.5–6.6)	2.45 (1.09–5.53)	0.03	2.21 (0.92–5.30)	0.07
No estr. or ≤49	266	2547	13	4.5% (1.7–11.5)	251	2579	5	3.4% (1.1–10.3)	2.63 (0.94–7.37)	0.07	1.52 (0.45–5.19)	0.50
Age 46 to 49 y	511	9050	19	5.2% (3.1–8.8)	538	9795	17	6.0% (3.5–10.1)	1.20 (0.62–2.30)	0.59	1.25 (0.64–2.46)	0.52
Estrogen >49⁵	374	6289	14	5.1% (2.8–9.0)	381	6675	12	6.4% (3.2–12.3)	1.23 (0.57–2.66)	0.60	1.30 (0.56–2.98)	0.54
No estr. or ≤49	127	1737	4	2.1% (0.6–7.7)	127	1842	4	10.7% (3.4–31.0)	1.06 (0.28–3.99)	0.94	0.58 (0.14–2.33)	0.44
Benign indication⁶	541	9710	32	9.4% (6.4–13.6)	579	10,173	19	5.2% (3.3–8.3)	1.77 (1.02–3.08)	0.04	1.65 (0.94–2.89)	0.08
No indication⁷	795	14,199	27	5.7% (3.7–8.9)	856	15,321	18	4.1% (2.5–6.8)	1.60 (0.89–2.87)	0.11	1.52 (0.82–2.79)	0.18
Ever smokers	584	10,151	51	13.9% (10.2–18.8)	582	10,361	36	9.6% (6.7–13.6)	1.48 (0.98–2.24)	0.06	1.45 (0.95–2.21)	0.08
Never smokers	752	13,758	8	2.0% (0.9–4.2)	853	15,134	1	0.1% (0.0–0.9)	8.53 (1.09–66.6)	0.04	10.4 (1.28–84.6)	0.03
BMI ≥ 30 kg/m²	438	7559	17	6.5% (3.6, 11.6)	367	6493	14	6.7% (3.5, 12.5)	1.03 (0.53–2.00)	0.93	1.19 (0.60–2.35)	0.62
BMI < 30 kg/m²	898	16,350	42	7.4% (5.3, 10.4)	1068	19,002	23	3.8% (2.4, 5.8)	2.13 (1.28–3.54)	0.003	1.94 (1.16–3.24)	0.01

BMI body mass index, CI confidence interval, COPD chronic obstructive pulmonary disease, OLD obstructive lung disease.
¹Hazard ratios were calculated using Cox proportional hazards models with age as the time scale.
²Hazard ratios were calculated using Cox proportional hazards models with age as the time scale and including inverse probability weights derived from a logistic regression model including 16 chronic conditions present at baseline, years of education (≤12, 13–16, >16), quartiles of household income (<$42,000, $42,000–56,999, $57,000–71,999, ≥$72,000), race (white vs. nonwhite), BMI (≥30 kg/m² vs. <30), cigarette smoking (current or former vs. never), age at index date (continuous), and calendar year at index date (continuous). These weights were calculated separately in each stratum to maximize the balance at index date. A significant interaction was found by smoking for all asthma (P = 0.03). No significant interactions were found by age, estrogen therapy, indication, or by BMI for any of the three outcomes.
³Absolute cumulative risk at 25 years after bilateral oophorectomy (or index date) calculated using the Kaplan-Meier method and including inverse probability weights derived from a logistic regression model. These weights were calculated in each stratum to maximize the balance at index date.
⁴Includes all asthma (confirmed, probable, and possible), all COPD (confirmed, probable, and emphysema), undifferentiated OLD, other OLD, and chronic bronchitis.
⁵Women who were taking systemic estrogen therapy (only oral or transdermal) on their 50th birth date, after bilateral oophorectomy. Women who died or were lost to follow-up prior to their 50th birth date, or had not reached age 50 years as of 31 December 2018 were not included in this analysis. Follow-up for these analyses was started at age 50 years.
⁶The benign condition (e.g., cysts, endometrioma) was listed by the gynecologist in the medical record at the time of oophorectomy, but may not have been the sole indication for the surgery.
⁷Women without a benign ovarian condition. Historically, the terms “prophylactic”, “elective”, or “incidental” oophorectomy were used; however, we prefer to avoid these terms.
⁸Includes confirmed COPD, probable COPD, and emphysema (without airflow limitation and without pulmonary function testing).

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Table 3 Cumulative incidence of all obstructive lung disease, all asthma, and all chronic obstructive pulmonary disease overall and in strata by age at oophorectomy, estrogen therapy, surgical indication, cigarette smoking, and body mass index.

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