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Risk factors of pelvic floor disorders in the multiethnic cohort study

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Risk factors of pelvic floor disorders in the multiethnic cohort study

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Content Page | 1

Risk factors of Pelvic Floor Disorders in the Multiethnic Cohort
Study

by

Xiaofang Chu

A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the Requirements for the Degree
MASTER OF SCIENCE
MOLECULAR EPIDEMIOLOGY

August 2018

Page | 2

Table of Contents

Acknowledgements ...................................................................................................... 4
List of Tables ................................................................................................................. 5
Abstract ......................................................................................................................... 6
1. Introduction ...................................................................................................... 9
1.1. Etiology of pelvic floor disorders ................................................................. 10
1.2 The role of race and ethnicity on PFD etiology ........................................... 11
1.3. Treatment of PFDs ......................................................................................... 12
2.0. Study Aims ...................................................................................................... 13
3.0. Methods ........................................................................................................... 14
3.1. Participants ..................................................................................................... 14
3.2. Outcome Data ................................................................................................. 14
3.2. Exposure data and variable definitions ....................................................... 15
3.3. Statistical analysis .......................................................................................... 17
4.0. Results ............................................................................................................. 18
4.1. Risk factors for Urinary Incontinence ......................................................... 19
4.1.1. Univariate analyses for UI ........................................................................ 19
4.1.2. Multivariate models of smoking for UI risk ........................................... 25
4.1.3. Multivariate models of reproductive variables and UI risk .................. 29
4.1.4. Multivariate models of factors related to diet and lifestyle and UI risk31
4.1.5. Multivariate models of all variables for UI risk .................................... 33
4.1.6. Summary of findings for UI .................................................................... 36
4.2. Risk factors for Pelvic Organ Prolapse ....................................................... 38
4.2.1. Univariate analyses for POP .................................................................... 38
4.2.2. Multivariate models of smoking for POP risk ........................................ 43
4.2.3. Multivariate models of reproductive variables and POP risk .............. 45
4.2.4. Multivariate models of factors related to diet and lifestyle and POP risk47
4.2.5. Multivariate models of all variables for POP risk ................................ 49
4.2.6. Summary of findings for POP ................................................................. 52
4.3. Risk factors for Fecal Incontinence ............................................................. 54
4.3.1. Univariate analyses for FI ........................................................................ 54
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4.3.2. Multivariate models of smoking for FI risk............................................ 59
4.3.3. Multivariate models of reproductive variables and FI risk .................. 61
4.3.4. Multivariate models of factors related to diet and lifestyle and FI risk63
4.3.5. Multivariate models of all variables for FI risk ..................................... 65
4.3.6. Summary of findings for FI ..................................................................... 68
5.0 Discussion........................................................................................................ 70
5.1. Role of reproductive variables in PFD risk ................................................. 71
5.2. Role of obesity in PFD risk ............................................................................ 73
5.3. Role of smoking, alcohol, coffee/tea intake in PFD risk ............................. 74
5.4. Role of dietary factors in PFD risk ............................................................... 76
Reference .................................................................................................................... 78

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Acknowledgements

I would like to express my sincere gratitude to my mentor Dr. Mariana C. Stern for her patient
guidance, motivation and enormous help during the whole process of data analyses and writing
of this thesis. I would like to thank my committee members Dr. Larissa V. Rodriguez and Dr.
Anna H Wu for their support and insightful comments. Finally, I would like to thank my family
and friends for supporting me spiritually all the time.

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List of Tables

Table 1. Risk factors for main PFDs………………………….……………………………………11
Table 2. ICD-9 codes for selection…………………………...…………………………………...15
Table 3. Univariate analyses to compare risk factors between women with UI and controls across
ethnic groups……………………………………………………………………………………..23
Table 4. Multivariate models of smoking for UI across ethnic groups………….……………….26
Table 5. Comparisons of population characteristics between smokers and non-smokers among each
PFD subtype control group……………………………………………………………………..…27
Table 6. Multivariate models of estrogen use for UI across ethnic groups……………………...30
Table 7. Multivariate models of factors related to diet and lifestyle for UI across ethnic groups.32
Table 8. Multivariate models of all variables for UI across ethnic groups………………………35
Table 9. Summary for the association between reproductive, lifestyle, dietary factors and risk of
UI………………………..…………………………………………..…………………………….37
Table 10. Univariate analyses to compare risk factors between women with POP and controls
across ethnic groups……………………..………………………………………………………...41
Table 11. Multivariate models of smoking for POP across ethnic groups………………………..44
Table 12. Multivariate models of estrogen use for POP across ethnic groups…………………..…46
Table 13. Multivariate models of factors related to diet and lifestyle for POP across ethnic
groups………………………….……………………………….…………………………………48
Table 14. Multivariate models of all variables for POP across ethnic groups………….…………..51
Table 15. Summary for the association between reproductive, lifestyle, dietary factors and risk of
POP………………………….………….……………………………………..…………………..53
Table 16. Univariate analyses to compare risk factors between women with FI and controls across
ethnic groups………………………………………………………………………………...57
Table 17. Multivariate models of smoking for FI across ethnic groups………..…………………60
Table 18. Multivariate models of estrogen use for FI across ethnic groups……………………..62
Table 19. Multivariate models of factors related to diet and lifestyle for FI across ethnic
groups……………………….…………………………………………………………………….64
Table 20. Multivariate models of all variables for FI across ethnic groups……………………..…67
Table 21. Summary for the association between reproductive, lifestyle, dietary factors and risk of
FI………………………..…………………………………….………………………..…………69
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Abstract
Background: Urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse
(POP) are the three most prevalent pelvic floor disorders (PFD) in the world. In 2010, more than
28 million women in the US were diagnosed with at least one PFD, and the number is expected
to increase to 43.8 million in 2050. [REF]The aims of this thesis are to investigate reproductive,
lifestyle, and dietary risk factors for the three most common PFDs, UI, POP, and FI, across
different racial/ethnic groups including White, Latino, African-American, Native Hawaiians, and
Japanese Americans enrolled in the Multiethnic Cohort (MEC).

Method: Data are available from Medicare and Medicaid Services claims (1999-2014) linked to
individuals by Social Security number, sex and birthdate. We used these claims to identify
women with a PFD, who defined cases for this analysis. All analyses were conducted for three
main subtypes of PFD: UI, POP, and FI. For each subtype of PFD, descriptive analyses were
performed and we presented frequency distributions of variables of interest and corresponding
percentages. These subtype specific results were also presented for each racial/ethnic category.
Univariate analyses were conducted by conditional logistic regression for each subtype and each
race group adjusting for birth year, and number of months of Medicare coverage (+/- 12 months).
Univariate analyses for each subtype were also adjusted for ethnicity. Multivariate conditional
logistic regression models including smoking, reproductive factors, diet and other lifestyle
factors were also conducted.

Results: This analysis included 30,121 women, with 11,493 PFD patients and 18,628 controls,
of these: 9,939 (86.48%) cases were diagnosed with UI, 2928 (25.48%) women had POP
Page | 7

symptoms, and 667 (5.80%) women experienced FI. 16,034 controls were selected for patients
with UI, 4,756 controls without any PFD were matched for cases with POP, and 1,072 controls
were selected to compare with cases with FI. In the univariate analyses, number of children,
progesterone use, estrogen use, total duration of estrogen use, surgical menopause, history of
asthma or allergy, BMI and vitamin D intake were positively associated with risk of UI, but age
at birth of first child, nulliparity, current smoking, coffee and regular coffee had an inverse
association with risk of UI. Number of children, parity, progesterone use, estrogen use, duration
of estrogen use, history of asthma or allergy, BMI, vitamin D intake and total fruits and juice was
positively associated with risk of POP, but nulliparity, current smoking, total number of years
smoked, average number of cigarettes per day, packs of cigarette per year, alcohol, coffee,
regular coffee and calories were negatively associated with risk of POP. There were positive
associations between progesterone use, estrogen use, history of asthma or allergy and risk of FI,
and coffee, total vegetables with risk of FI. In the comprehensive models, estrogen use, previous
progesterone use and BMI were still significantly positively associated with risk of UI, and
nulliparity and coffee consumption were inversely associated with UI. Estrogen use and BMI
were still positively associated with risk of POP, and nulliparity and packs of cigarette per year
were inversely associated with risk of POP. Progesterone use was positively associated with risk
of FI, and estrogen use, red meat (excluding processed red meat), total fruits and juice, coffee,
and vigorous activity were inversely associated with risk of FI.

Conclusion: Estrogen use, parity and BMI were positively associated with UI/POP both in the
univariate analyses and multivariate models. Trend tests were statistically significant between
these variables and risk of UI/POP in the univariate analyses. The positive association between
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estrogen use and risk of UI/POP was statistically significant among Hawaiians, and Japanese
American. The protective effect of nulliparity on POP was identified for all racial/ethnic groups.
Obesity was found to be a significant risk factor for UI and POP among Whites.
Smoking was inversely associated with risk of POP among Hawaiians and Latinos, but
the association only significantly existed among us-born Latinos. Also, negative association
between alcohol and risk of POP was found among most of the racial/ethnic groups including
Whites, African-American, Japanese American and foreign-born Latinos, but none of the
associations were statistically significant. Coffee was identified to be inversely associated with
all PFDs, especially among Hawaiians and Japanese.
Vitamin D was positively associated with UI and POP, but none of the positive
associations were statistically significant for all women combined. The positive association
between vitamin D and risk of UI/POP was only significant among Latinos.

Page | 9

1. Introduction
Urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) are the three
most prevalent pelvic floor disorders (PFD) in the world [1]. In a national cross-sectional study
based on the 2005-2006 National Health and Nutrition Examination Survey (NHANES), about
24% of US women over age 20 suffered from at least 1 of 3 of the most prevalent PFD, with
16% of US women experiencing UI, 9% having FI and 3% experiencing symptomatic POP [2].
In 2010, more than 28 million women in the US were diagnosed with at least one PFD, and the
number is expected to increase to 43.8 million in 2050. This represents an increase of affected
women with UI, FI or POP of 55%, 59%, and 46%, respectively [3].
Urinary incontinence is a common condition among older women with 17% to 24%
prevalence rate in women over 65 in California, US in 2014 [4]. UI is more common than most
chronic diseases, but it is largely underreported. The typical symptom of UI is the involuntary
leakage of urine.. The most common types of UI include stress incontinence, urgency
incontinence, functional incontinence, and other mixed types [5]. Stress urinary incontinence and
urgency incontinence are the two most prevalent. Stress UI is defined a involuntary loss of urine
with increases in abdominal pressure such as coughing, sneezing or physical activity, and
urgency incontinence is defined as leakage of urine with feeling of need to void [6].
Fecal incontinence is also a common problem with a prevalence rate of 7% to 15% in a
community-dwelling population in US [7]. FI is defined as the involuntary inability to control
defecation through the anus, including passive incontinence, urge incontinence and soiling [8].
Among women FI is mostly due to the damage of the anal sphincter associated with child birth,
and is related to ano-rectal surgery among men [9, 10].
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Pelvic organ prolapse is a problem for older women with a prevalence rate of 6% in
community-dwelling women with average age of 56.5 in US [11]. POP is defined as downward
falling of pelvic organs through the vagina or anal canal. This includes cystocele (prolapse of the
bladder), uterine prolapse, rectocele (prolapse of the rectum), and/or enterocele (apica vaginal
prolapse), dependent on which part of pelvic organs prolapses. The etiology of POP is not fully
understood; congenital factors may play an important role in this disease and vaginal childbirth is
considered to be a contributing factor [12].

1.1. Etiology of pelvic floor disorders
Given the high prevalence of PFDs among women, efforts to prevent the occurrence of PFDs is
needed. Advancing age, high parity, obesity, history of hysterectomy, and vaginal birth have
been associated with a higher risk of one or more pelvic floor disorders [13]. In addition, some
lifestyle factors including fluid intake, smoking, alcohol, vitamin D, caffeine and physical
activities have also been associated with risk PFDs [14]. It has been suggested that diseases like
diabetes, asthma, chronic obstructive pulmonary disease, and constipation correlate with PFDs
[14]. Here, we summarized the risk factors for main PFDs in Table 1.

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Table 1. Risk factors for main PFDs

Risk Factors Reference
UI
Race [15-17]
Age [18-20]
Parity and childbirth [18, 20-25]
BMI [18, 20, 25-27]
Smoking [27]
Hysterectomy [18, 19, 25]
Hormone use [28-30]
Physical activity [27, 31]
POP
Race [17, 32, 33]
Age [20, 34]
Parity and childbirth [17, 20, 33-37]
BMI [20, 33, 34, 36, 37]
Smoking [26]
Hysterectomy [33]
FI
Age [38-41]
Parity and childbirth [40, 42, 43]
BMI [40, 42, 44]
Smoking [40, 43]
Diabetes mellitus [38-41, 44]
Physical activity [40]
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1.2 The role of race and ethnicity on PFD etiology
There is emerging evidence that race is a risk factor for some PFD. Compared to other
racial/ethnic groups, Latinos seem to have a higher risk of PFDs, in particular POP [15, 16, 32].
The prevalence rate of POP is highest in Latino women and lowest among black non-Latino
women [17, 33]. This is of great public health relevance given that currently the Latino
population is the largest minority group in the United States, comprising 16% of the total
population, and it is estimated that one in four women in the US will be Latino in 2050 [45]. The
Reproductive Risks for Incontinence Study of 2,270 women with mean age of 55 years indicated
that compared with African-American women, Latino and white women had 4-5 times higher
risk of POP [32]. In another population-based study that compared the prevalence of UI between
Latino and non-Latino White women, Latino women has 1.7 times and 1.8 times higher risk to
get stress UI and mixed UI than non-Latino White women [15]. However, little evidence
explains the reasons underlying the disparities and there are no comprehensive studies focused
on the etiology of PFDs among multi-racial/ethnic populations.

1.3. Treatment of PFDs
The conservative treatments for PFD include lifestyle changes, pelvic muscle exercise and
antidiarrheal medication. Surgeries may be required based on the severity level of symptoms. A
retrospective cohort study, which included 384 patients who were operated for PFD or UI
indicated that 11.1% of this population with an average age of 79 years old will undergo at least
one surgery, and of these 29% will experience reoperations due to the recurrence of symptoms
[20]. Less than half of community-dwelling US women with UI symptoms were found to initiate
a conversation with their physician about the disease, and women who thought incontinence to
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be a normal status of aging were found to be less likely to seek treatments than women who
considered it as abnormal [46].
Another population-based study found that women with POP were more likely to seek
treatments compared to women with the other two symptoms. For example, 73% of women with
POP were reported to seek care, and among those, women with POP had the greatest possibilities
of no longer reporting the symptom compared to women with UI and FI [47]. However, the rate
of failing to cure the POP using surgery is high despite the applications of different surgical
diagnostic techniques, tools and operations [48], which indicates that pelvic floor dysfunction
dramatically compromises physical and mental quality of patients [49].
Besides, PFD also gives a substantial financial burden for the health care system in US.
In 2004, the estimated annual cost for treating UI alone in US women is $12.4 billion [48]. The
estimated cost increased to $65.9 billion in 2007 and $82.6 billion in 2020 [50]. 10-20% of
women have a risk to require a surgery for POP [12]. A study indicated that the annual direct
costs of POP surgeries were $1012 million in 1997 [51], and another study revealed that the rate
of financial burden increase over the next decades will be two times that of population growth
[52].

2.0. Study Aims
The aims of this thesis are to investigate reproductive, lifestyle, and dietary risk factors for the
three most common PFDs, UI, POP, and FI, across different racial/ethnic groups including
White, Latino, African-American, Native Hawaiians, and Japanese Americans enrolled in the
Multiethnic Cohort (MEC). This study provides new evidence to further investigate the etiology
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of common PFDs and to provide insights to help address disparities in PFD occurrence in
minority populations.

3.0 Methods
3.1. Participants
MEC is a prospective cohort with 215,251 people aged 45-75 years at baseline, which was
established between 1993 and 1996 in Hawaii and in California. The detailed characteristics have
been previously reported [53]. Briefly, the cohort is comprised of non-Latino white (22.9%),
Latino (22.0%), African-American (16.3%), Native Hawaiians (6.5%), Japanese Americans
(26.4%), and other races (5.8%).

3.2. Outcome Data
For participants over 65 years old, data is available from Medicare and Medicaid Services claims
(1999-2014) linked to individuals by Social Security number, sex and birthdate. We used these
claims to identify women with a PFD, who defined our cases. For this, we restricted the
participants to women who were linked to Medicare fee-for-service and excluded women
without valid information. Cases were defined as women who had PFDs who were selected
using as criteria the presence of 1 inpatient claim, or 2 or more outpatient or carrier claims
between 1999 and 2014 using International Classification of Diseases, ninth revision (ICD-9)
codes. These codes were curated by urologists to capture all diagnosis that could identify a PFD
and its various subtypes (Table 2). Controls were selected among MEC participants enrolled in
Medicare Fee-for-Service but women who had any outpatient/carrier PFD claim were excluded
as controls. Up to 2 controls were matched with one case on ethnicity, birth year, and number of
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months of Medicare coverage (+/- 12 months). Our study included 30,121 women, with 11,493
PFD patients and 18,628 controls, of these: 9,939 (86.48%) cases were diagnosed with UI, 2928
(25.48%) women had POP symptoms, and 667 (5.80%) women experienced FI.

Table 2. ICD-9 codes for selection
Diagnosis ICD-9 Code
Stress Incontinence
Stress incontinence 6256
Urethral hypermobility 59981
Intrinsic (urethral) sphincter deficiency 59982
Urethral instability 59983
OAB/Urge Incontinence
Urge incontinence 78831
Hypertonicity of bladder 59651
Detrusor instability 59659
frequency 78841
urgency 78863
Mixed Incontinence
Mixed incontinence, male, female 78833
Other Incontinence
Urinary incontinence, unspecified 7883
Incontinence without sensation 78834
Continuous leakage 78837
Other urinary incontinence 78839
functional urinary incontinence 78891
Prolapse
Prolapse of vaginal walls 61800
Cystocele, midline 61801
Cystocele, lateral 61802
urethrocele 61803
Rectocele 61804
Page | 16

Perineocele 61805
other prolapse of vaginal walls without mention
of uterine prolapse 61809
Uterine prolapse 6181
Uterine prolapse, incomplete 6182
Uterine prolapse, complete 6183
Uterine prolapse, unspecified 6184
prolapse of vaginal vault after hysterectomy 6185
Enterocele 6186
Other specified genital prolapse 6188
Unspecified genital prolapse 6189
Fecal Incontinence
Fecal incontinence 7876
Full incontinence of feces 78760
Incomplete defecation 78761
Fecal smearing 78762
Fecal urgency 78763

3.2. Exposure data and variable definitions
For these analyses, we used data collected from a questionnaire administered at baseline, which
included dietary habits from a food frequency questionnaire, demographic information,
behaviors including smoking and physical activity, medical condition history, use of
medications, and family history of cancer. Reproductive history and hormone use were also
asked for women. We included the following variables: study area (Hawaii or California), place
of birth, year of birth, year of cohort entry, total months of Medicare coverage, years in the
United States (if not US born), ethnicity, history of asthma or allergy, age at birth of first child,
number of children, parity, nulliparity, age that period stopped due to hysterectomy but no
oophorectomy, progesterone use, estrogen use, menopausal status. We also studied other risk
factors including BMI, vigorous activity, smoking, alcohol, and dietary factors including coffee
Page | 17

(regular coffee and decaffeinated), black tea, calories, total red meat, red meat, processed meat,
total vegetables, total fruits and juice, density for vitamin D. For smoking, we took into account
smoking status (never, former, current), total number of years smoked, average number of
cigarettes per day and packs of cigarette per year.
Place of birth was divided into USA, and outside of USA. Ethnicity was composed of
White, African American, Hawaiian, Japanese American, Latinos – foreign born, Latinos born in
US, and other racial/ethnic group. Years in the United States was included for non-US born
participants and was categorized as ≤15 years, 16 – 25 years, ≥ 26 years. Year of cohort entry
included 1993, 1994, 1995, and 1996. Age at birth of first child was divided into 4 groups: < 19
years old, 19 – 25 years old, 26 – 32 years old, and > 33 years old. Age that period stopped was
cut off by 50 years old. Number of children was divided into 0 – 6, and 7 or more. Progesterone
use, estrogen use, and smoking status was categorized into never, yes and previously, and yes
and currently. Total number of years smoked, average number of cigarettes per day and packs of
cigarette per year were categorized into never, below median and above median of ever user.
Menopausal status included pre-menopausal, natural menopause and surgical menopause.
Definitions of normal weight, overweight, and obesity were based on established cut-off points
of 25 and 30 kg/m
2
in terms of BMI. Physical activity was measured by the intensity per day, and
population were divided into 4 groups: none,  0.11 hours per day, > 0.11 hours to  0.36 hours
per day, and > 0.36 hours per day. People who drink alcohol were categorized by a cut-off point
of 14g/day. Coffee intake was divided into 4 groups based on never drinking coffee, drinking 1
cup per day, 2 to 4 cups per day and > 4 cups per day. Regular coffee was cut off by 240 g/day,
and decaffeinated coffee was cut off by 33.95 g/day, and 600 g/day. Black tea was also divided
into 3 groups based on the cut-off point 33.94 g/day and 240 g/day. Calories, total red meat
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intake, rea meat excluding processed red meat intake, processed red meat intake, vitamin D
intake, total vegetables, and total fruits and juice were categorized based on quartiles among
controls.

3.3. Statistical analysis
All analyses were conducted separately for the three main subtypes of PFD: UI, POP, and FI. We
conducted descriptive analyses for variables of interest and showed results as frequencies and
corresponding percentages for each subtype of PFD, for all subjects combined and separately for
each racial/ethnic group. Univariate analyses were conducted by conditional logistic regression
for each subtype adjusting for birth year, ethnicity, and number of months of Medicare coverage
(+/- 12 months), and univariate analyses for racial groups were also adjusted for birth year and
number of months of Medicare coverage. Several multivariate conditional logistic regression
models were included in the analyses as follows:
Smoking models. To check the associations between smoking and risks of PFD, we considered
total number of years smoked, average number of cigarettes per day and packs of cigarettes per
year worked as independent variable. Models were adjusted for alcohol use, coffee intake,
vigorous activity, and BMI.
Reproductive models. We examined the role of estrogen use, menopausal status, progesterone
use, and parity using multivariate models to investigate the main driving reproductive factors
associated with PFD risks.
Diet and lifestyle models. We considered the possible associations of dietary factors and PFD
risks such as red meat excluding processed red meat, processed red meat, total vegetables, total
fruits and juice, vitamin D, adjusting for potential confounders such as total calories, regular
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coffee, decaffeinated coffee, black tea, BMI, packs of cigarette per year, alcohol, and vigorous
activity.
Comprehensive model. Finally, we considered a model including all key risk determinants to
explore mutual adjusting for each other, including estrogen use, menopausal status, progesterone
use, nulliparity, red meat excluding processed res meat, processed red meat, total vegetables,
total fruits and juice, calories, BMI, packs of cigarette per year, alcohol, coffee, density for
vitamin D and vigorous activity.
In all models, odds ratios and 95% confidence interval were reported, heterogeneity tests
were conducted to measure if the associations between risk factors and disease differed by
race/ethnicity by adding the interaction term in the test, and comparing the difference between
the models with and without the interaction term. Likelihood ratio tests were performed to see if
there were linear trends between levels of exposure and disease. All statistical analyses were
completed with STATA 15.0. All tests were two-sided and p values < 0.05 were considered as
statistically significant.

4.0. Results
Our study included 30,121 women, with 11,493 PFD cases and 18,628 controls, of these: 9,939
(86.48%) cases were diagnosed with UI, 2928 (25.48%) women had POP symptoms, and 667
(5.80%) women experienced FI. These cases were matched to 16,034 controls for patients with
UI, 4,756 controls without any PFD were matched for cases with POP, and 1,072 controls were
selected to compare with cases with FI.

4.1. Risk factors for Urinary Incontinence
Page | 20

UI is the most common subtype for patients with PFD, and many women have more than one or
more pelvic floor disorder symptom. Among the 9,939 UI cases, 2,487 (25.02%) were White,
1,249 (12.57%) were African-American, 491 (4.94%) were Hawaiian, 3,408 (34.29%) were
Japanese Americans, 749 (7.54%) were Latinos – US born, 997 (10.03%) were Latinos – foreign
born, and 558 (5.61%) were from other racial/ethnic groups (Latinos born in the Caribbean,
Filipinos, Samoans, etc).

4.1.1. Univariate analyses for UI
Table 1 shows the distribution of cases and controls, and univariate analyses for all considered
variables. Women with age at birth of first child more than 19 years old were less likely to get UI
compared to women who had their first baby at ages less than 19 years old. The risk of UI
statistically significantly decreased with increasing age at birth of first child (trend p< 0.001).
This association was mainly driven by African-American and Latinos – foreign born, where
significant trends were observed. The test of heterogeneity across racial/ethnic groups was
marginally significant (p = 0.0518). Number of children was a risk factor for UI, and women
with more than 7 children was 1.64 times to get the disease compared to women without children
(95%CI: 1.44-1.86). The risk of UI increased with increasing number of children (trend
p<0.0001), and the trend was significant among Whites, Japanese Americans and Latinos, with a
test of heterogeneity that did not reach statistical significance (p = 0.067).
Estrogen users were more likely to develop UI, and longer duration of estrogen use was
associated with increasing risk of UI (trend p<0.0001). Current estrogen users had almost a two-
fold higher risk of diagnosis of UI compared to non-users (OR=1.94, 95%CI: 1.81-2.07), similar
risk estimates were observed for all racial/ethnic groups, except for weaker estimates of
Page | 21

association among foreign born Latinos (heterogeneity p <0.001). Dose-response trends for
duration of estrogen use were not statistically significant for either group of Latinos.
Progesterone use was also a risk factor for UI, including foreign born Latinos, but there was no
duration dose-response significant trend for all women combined, or any racial/ethnic (trend
p=0.0690). Compared to premenopausal women, women who reported a history of surgical
menopause at baseline had a higher risk of UI (OR = 1.52; 95% CI: 1.31-1.76), but no increased
risk was observed for those who had a natural menopause. Similar findings were seen among
Whites, who also showed an association with natural menopause, African-Americans,
Hawaiians, Japanese, but not Latinos (heterogeneity p = 0.0614).
Women with a history of asthma or allergy had a higher risk of UI than women without a
history of asthma or allergy (OR=1.29, 95% CI: 1.22-1.36). The association was statistically
significant for all racial/ethnic group, and there was no significant heterogeneity across groups (p
= 0.4812). Current smoking was statistically significantly inversely associated with risk of UI
(OR = 0.89; 95%CI: 0.81-0.97) but this finding was only significant among whites. The
association between smoking and risk of UI differed for women of “other” race/ethnicity as the
risk of UI was higher for smokers, and significantly higher for former smokers. Analyses of total
number of years smoked, average number of cigarettes per year, and packs of cigarette per year
showed no associations with risk of UI, except for women of other race/ethnicity among whom
positive associations were observed between the highest levels of smoking compared to never
smokers.
Coffee intake (regular and decaffeinated combined) was inversely associated with risk of
UI. Women who drank more than 4 cups of coffee per day had a lower risk of UI (OR=0.78,
95%CI: 0.68-0.91); risk decreased with increasing intake of coffee (trend p <0.001). This
Page | 22

association seemed mostly driven by regular coffee, rather than decaffeinated coffee. This trend
was only significant among white and Japanese women, although inverse associations with
coffee intake were observed across most racial/ethnic groups. No association was observed
between vigorous physical activity and risk of UI, except among white women were an inverse
association was observed between >0.36 hours/day versus no vigorous activity (OR = 0.83; 95%
CI: 0.72-0.97) (heterogeneity p = 0.0262).
Women with BMI between 25 kg/m
2
and 30 kg/m
2
were 1.22 times more likely to develop UI
(95%CI: 1.15-1.3), and women over 30 kg/m
2
were 1.34 times to develop UI compared to those
with BMI less than 25 kg/m
2
(95%CI: 1.24-1.45). Increasing BMI was statistically significantly
associated with risk of UI among Whites, Japanese Americans, Latinos, and women of other
race/ethnicity, but not among African-Americans and Hawaiians (heterogeneity p = 0.0608).
Among the dietary variables investigated, we observed that women eating more than
42.98 g/day red meat (excluding processed red meat) were more likely to get UI than people
eating less than 12.91 g/day (OR=1.12, 95%CI: 1.04-1.21). This association was only
statistically significant among Japanese women. Positive associations with processed meat were
observed only among African-American and Japanese women. High intake of Vitamin D was
positively associated with UI risk, with women taking over 91.87 IU/1000 kcal/day Vitamin D
having 1.25 times the risk of having UI compared to women taking less than 38.02 IU/1000
kcal/day (95%CI: 1.16-1.34). There was a positive statistically significant with increasing doses
associated with higher risk of UI (trend p<0.0001). This association was observed among whites,
Japanese, foreign born Latinos and women of other racial/ethnic groups, although the test of
heterogeneity was not statistically significant (p = 0.1847). No associations were observed with
total vegetables or total fruits and juice.
Page | 23

Table 3. Univariate analyses to compare risk factors between women with UI and controls across ethnic groups

Total White Black Hawaiian Japanese L-us born L-foreign born Other Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 16034 9939 3929 2487 2249 1249 888 491 5154 3408 1206 749 1630 997 978 558
Area <0.0001
Hawaiian 8231 (51.3%) 5497 (55.3%) 2631 (67.0%) 1668 (67.1%) 39 (1.7%) 22 (1.8%) 881 (99.2%) 490 (99.8%) 3958 (76.8%) 2900 (85.1%) 116 (9.6%) 79 (10.5%) 8 (0.5%) 3 (0.3%) 598 (61.1%) 335 (60.0%)
Los Angeles 7803 (48.7%) 4442 (44.7%) 0.78*** 0.72-0.83 1298 (33.0%) 819 (32.9%) 0.95 0.85-1.06 2210 (98.3%) 1227 (98.2%) 1 0.59-1.69 7 (0.8%) 1 (0.2%) 0.29 0.04-2.32 1196 (23.2%) 508 (14.9%) 0.57*** 0.51-0.64 1090 (90.4%) 670 (89.5%) 0.82 0.6-1.11 1622 (99.5%) 994 (99.7%) 1.64 0.43-6.29 380 (38.9%) 223 (40.0%) 1.03 0.82-1.29
Place of Birth 0.0868
USA 12516 (78.3%) 7967 (80.5%) 3427(87.4%) 2213(89.3%) 2146 (96.6%) 1184 (96.2%) 884 (99.9%) 488 (99.6%) 4495 (87.4%) 3098 (91.1%) 1180(41.6%) 730(41.8%) 384 (39.5%) 254(46.1%)
Outside of USA 3463 (21.67%) 1928 (19.48%) 0.78*** 0.71-0.86 494(12.6%) 264(10.7%) 0.81** 0.69-0.95 76(3.4%) 47(3.8%) 1.1 0.75-1.6 1(0.11%) 2(0.4%) 4 0.36-44.11 650(12.6%) 303 (8.9%) 0.7*** 0.61-0.82 1654(58.4%) 1015(58.2%) 1.31 0.71-2.39 / / 588(60.5%) 297(53.9%) 0.78** 0.63-0.97
Years in the United States 0.0003
<=15 years 569 (3.6%) 312 (3.2%) 35 (0.9%) 24 (1.0%) 16 (0.8%) 7 (0.6%) 1 (0.1%) 1 (0.2%) 43 (0.8%) 12 (0.4%) 10 (0.9%) 3 (0.4%) 283 (17.5%) 180 (18.4%) 181 (18.7%) 85 (15.5%)
16-25 years 932 (6.0%) 536 (5.5%) 1.04 0.87-1.24 81 (2.1%) 47 (1.9%) 0.82 0.43-1.55 41 (2.0%) 22 (1.9%) 1.19 0.42-3.43 / / / / 150 (2.9%) 55 (1.6%) 1.36 0.66-2.78 15 (1.3%) 6 (0.9%) 1.84 0.36-9.42 474 (29.4%) 333 (34.0%) 1.08 0.85-1.37 171 (17.7%) 73 (13.3%) 0.91 0.62-1.33
>=26 years 14169 (90.4%) 8889 (91.3%) 1.1 0.94-1.29 3760 (97.0%) 2389 (97.1%) 0.86 0.51-1.46 2008 (97.2%) 1141 (97.5%) 1.27 0.51-3.15 884 (99.9%) 485 (99.8%) 1.00 0.06-15.99 4940 (96.2%) 3330 (98.0%) 2.19 1.14-4.19 1106 (97.8%) 685 (98.7%) 2.00 0.54-7.35 857 (53.1%) 467 (47.7%) 0.83 0.66-1.04 614 (63.6%) 392 (71.3%) 1.42 1.05-1.91
Trend test p-value 0.1674 0.7969 0.5822 / 0.0001 0.3051 0.0247 0.0063
Year of Cohort Entry 0.0195
1993 5894 (36.8%) 3409 (34.3%) 1357 (34.5%) 758 (30.5%) 1580 (70.3%) 929 (74.4%) 271 (30.5%) 137 (27.9%) 1394 (27.0%) 888 (26.1%) 469 (38.9%) 274 (36.6%) 527 (32.3%) 253 (25.4%) 296 (30.3%) 170 (30.5%)
1994 8014 (50.0%) 5326 (53.6%) 1.10*** 1.03-1.16 2210 (56.2%) 1494 (60.1%) 1.17*** 1.05-1.31 274 (12.2%) 145 (11.6%) 0.83 0.66-1.06 495 (55.7%) 297 (60.5%) 1.18 0.92-1.53 3070 (59.6%) 2117 (62.1%) 1.06 0.96-1.18 647 (53.6%) 405 (54.1%) 0.99 0.81-1.21 790 (48.5%) 557 (55.9%) 1.45*** 1.18-1.77 528 (54.0%) 311 (55.7%) 1 0.79-1.27
1995 1431 (8.9%) 776 (7.8%) 0.90** 0.81-0.99 193 (4.9%) 122 (4.9%) 1.12 0.87-1.43 364 (16.2%) 161 (12.9%) 0.70*** 0.56-0.87 83 (9.3%) 41 (8.4%) 0.94 0.62-1.44 682 (13.2%) 399 (11.7%) 0.89 0.76-1.03 8 (0.7%) 8 (1.1%) 1.75 0.64-4.76 12 (0.7%) 3 (0.3%) 0.46 0.13-1.66 89 (9.1%) 42 (7.5%) 0.81 0.53-1.24
>=1996 695 (4.3%) 428 (4.3%) 1.14* 0.99-1.32 169 (4.3%) 113 (4.5%) 1.33** 1.01-1.75 31 (1.4%) 14 (1.1%) 0.66 0.34-1.28 39 (4.4%) 16 (3.3%) 0.79 0.43-1.45 8 (0.2%) 4 (0.1%) 0.79 0.23-2.67 82 (6.8%) 62 (8.3%) 1.49* 0.99-2.24 301 (18.5%) 184 (18.5%) 1.31** 1.01-1.71 65 (6.7%) 35 (6.3%) 0.95 0.59-1.55
Trend test p-value 0.4644 0.0066 0.0007 0.703 0.3385 0.0994 0.0448 0.5621
Age at Birth of First Child 0.0518
<19 years old 801 (7.0%) 605 (8.1%) 133(4.6%) 95(4.9%) 275(16.9%) 213(22.7%) 77(10.5%) 32(7.9%) 27 (0.7%) 21(0.8%) 121(12.4%) 80(12.7%) 168(13.0%) 164(20.1%)
19 - 25 years old 7340 (64.3%) 4692 (62.9%) 0.77*** 0.68-0.87 2047(70.4%) 1354(69.9%) 0.81 0.6-1.09 1097(67.3%) 580(61.9%) 0.66*** 0.52-0.83 561(76.7%) 322(79.9%) 1.27 0.8-2.03 2128(54.7%) 1477(53.9%) 0.9 0.5-1.64 714(73.4%) 447(71.0%) 0.96 0.69-1.34 793(61.6%) 512(62.6%) 0.66*** 0.5-0.86
26 - 32 years old 2388 (20.9%) 1602 (21.5%) 0.74*** 0.64-0.85 528(18.2%) 354(18.3%) 0.79 0.57-1.09 174(10.7%) 104(11.1%) 0.8 0.57-1.13 71(9.7%) 37(9.2%) 1.03 0.58-1.85 1316(33.9%) 935(34.1%) 0.86 0.47-1.57 100(10.3%) 77(12.2%) 1.18 0.75-1.83 199(15.5%) 95(11.6%) 0.50*** 0.35-0.71
>33 years old 890 (7.8%) 566 (7.6%) 0.74*** 0.62-0.87 201(6.9%) 134(6.9%) 0.82 0.56-1.2 84(5.2%) 40(4.3%) 0.59** 0.36-0.96 22(3.0%) 12(3.0%) 1.06 0.45-2.5 417(10.7%) 307(11.2%) 0.93 0.5-1.72 38(3.9%) 26(4.1%) 1.13 0.6-2.11 128(9.9%) 47(5.8%) 0.41*** 0.27-0.63
Trend test p-value 0.0009 0.4063 0.0097 0.9485 0.8388 0.4973 <0.0001
Age that period stopped due to (surgery) hysterectomy but no oophorectomy 0.4802
< 50 years old 1831 (93.0%) 1417 (92.2%) 501 (94.2%) 425 (92.4%) 431 (95.4%) 272 (96.1%) 110 (93.2%) 65 (94.2%) 400 (89.9%) 360 (88.7%) 194 (92.4%) 162 (93.6%) 195 (92.0%) 133 (91.1%)
>=50 years old 138 (7.0%) 120 (7.8%) 0.69 0.36-1.3 31 (5.8%) 35 (7.6%) 0.63 0.2-1.91 21 (4.7%) 11 (3.9%) 0.91 0.2-4.12 8 (6.8%) 4 (5.8%) / / 45 (10.1%0 46 (11.3%) 0.29 0.06-1.38 16 (7.6%) 11 (6.4%) 0.75 0.17-3.35 17 (8.0%) 13 (8.9%) 3 0.31-28.84
Nulliparity 0.0589
no (have 1 or more kids) 11748 (85.7%) 7661 (89.8%) 2956 (82.4%) 1980 (87.0%) 1704 (85.9%) 975 (87.5%) 758 (92.7%) 417 (93.7%) 3998 (85.0%) 2796 (89.9%) 995 (88.7%) 646 (93.1%) 1337 (89.1%) 847 (94.7%)
yes 1967 (14.3%) 871 (10.2%) 0.69*** 0.63-0.75 631 (17.6%) 296 (13.0%) 0.74*** 0.63-0.86 280 (14.1%) 139 (12.5%) 0.82 0.65-1.04 60 (7.3%) 28 (6.3%) 0.81 0.49-1.35 705 (15.0%) 313 (10.1%) 0.67*** 0.58-0.77 127 (11.3%) 48 (6.9%) 0.56***0.39-0.8 164 (10.9%) 47 (5.3%) 0.46*** 0.32-0.65
Number of children 0.0674
0 2291 (14.5%) 1005 (10.2%) 705 (18.1%) 320 (13.0%) 316 (14.4%) 154 (12.6%) 65 (7.4%) 28 (5.7%) 771 (15.1%) 348 (10.3%) 132 (11.1%) 55 (7.5%) 164 (10.4%) 53 (5.5%) 138 (14.3%) 47 (8.5%)
1 1785 (11.3%) 1008 (10.3%) 1.29*** 1.16-1.44 482 (12.4%) 267 (10.8%) 1.19* 0.97-1.46 325 (14.8%) 190 (15.6%) 1.25 0.95-1.64 60 (6.8%) 30 (6.2%) 1.15 0.6-2.19 590 (11.6%) 352 (10.4%) 1.30*** 1.08-1.57 80 (6.7%) 41 (5.6%) 1.24 0.75-2.04 157 (9.9%) 73 (7.6%) 1.42 0.93-2.17 91 (9.4%) 55 (10.0%) 1.95*** 1.19-3.21
2 3716 (23.5%) 2447 (24.9%) 1.48*** 1.35-1.62 983 (25.2%) 643 (26.1%) 1.44*** 1.22-1.7 407 (18.5%) 224 (18.3%) 1.17 0.91-1.52 116 (13.2%) 83 (17.0%) 1.66* 0.96-2.87 1605 (31.4%) 1119 (33.1%) 1.50*** 1.29-1.74 213 (17.9%) 119 (16.1%) 1.28 0.87-1.9 209 (13.2%) 118 (12.2%) 1.72*** 1.16-2.54 183 (18.9%) 141 (25.5%) 2.33*** 1.53-3.55
3 3192 (20.2%) 2139 (21.8%) 1.49*** 1.36-1.64 836 (21.5%) 573 (23.3%) 1.47*** 1.23-1.74 329 (14.9%) 188 (15.4%) 1.2 0.91-1.57 183 (20.8%) 95 (19.5%) 1.23 0.72-2.11 1214 (23.8%) 886 (26.2%) 1.54*** 1.32-1.8 232 (19.5%) 159 (21.5%) 1.59** 1.08-2.34 211 (13.3%) 129 (13.4%) 1.95*** 1.31-2.89 187 (19.4%) 109 (19.7%) 1.83*** 1.19-2.8
4 2063 (13.0%) 1389 (14.2%) 1.49*** 1.34-1.65 467 (12.0%) 369 (15.0%) 1.65*** 1.36-2.01 260 (11.8%) 143 (11.7%) 1.17 0.88-1.56 143 (16.3%) 91 (18.7%) 1.38 0.81-2.36 630 (12.3%) 443 (13.1%) 1.44*** 1.2-1.72 218 (18.4%) 124 (16.8%) 1.3 0.88-1.93 220 (13.9%) 146 (15.1%) 2.07*** 1.41-3.05 125 (12.9%) 73 (13.2%) 1.74** 1.1-2.74
5 1101 (7.0%) 770 (7.8%) 1.60*** 1.42-1.81 215 (5.5%) 151 (6.1%) 1.49*** 1.16-1.91 196 (8.9%) 114 (9.3%) 1.25 0.92-1.71 119 (13.6%) 63 (12.9%) 1.2 0.69-2.11 216 (4.2%) 182 (5.4%) 1.72*** 1.36-2.19 128 (10.8%) 88 (11.9%) 1.62** 1.05-2.48 157 (9.9%) 113 (11.7%) 2.11*** 1.43-3.12 70 (7.2%) 59 (10.7%) 2.53*** 1.55-4.12
6 663 (4.2%) 367 (3.7%) 1.33*** 1.15-1.55 115 (3.0%) 75 (3.0%) 1.37* 0.99-1.9 130 (5.9%) 68 (5.6%) 1.12 0.78-1.59 86 (9.8%) 35 (7.2%) 0.97 0.53-1.79 56 (1.1%) 34 (1.0%) 1.32 0.84-2.08 77 (6.5%) 60 (8.1%) 1.92***1.2-3.07 143 (9.0%) 74 (7.7%) 1.67** 1.09-2.56 56 (5.8%) 21 (3.8%) 1.06 0.57-1.96
7 or more 1004 (6.3%) 685 (7.0%) 1.64*** 1.44-1.86 91 (2.3%) 63 (2.6%) 1.58** 1.1-2.26 238 (10.8%) 140 (11.5%) 1.26 0.94-1.7 106 (12.1%) 62 (12.7%) 1.39 0.79-2.44 25 (0.5%) 21 (0.6%) 1.57 0.86-2.87 108 (9.1%) 92 (12.5%) 2.10***1.37-3.22 320 (20.2%) 260 (26.9%) 2.41*** 1.68-3.45 116 (12.0%) 47 (8.5%) 1.15 0.71-1.87
Trend test p-value <0.0001 <0.0001 0.3158 0.9684 <0.0001 0.0001 <0.0001 0.6989
Progesterone Use 0.6653
No 5565 (63.9%) 3683 (58.7%) 1402 (56.5%) 941 (52.5%) 948 (80.3%) 598 (78.0%) 317 (68.9%) 184 (58.0%) 1686 (57.4%) 1203 (52.4%) 498 (70.3%) 327 (65.4%) 714 (75.2%) 430 (71.2%)
Yes, previously 1225 (14.1%) 1071 (17.1%) 1.47*** 1.31-1.65 439 (17.7%) 380 (21.2%) 1.36*** 1.13-1.65 139 (11.8%) 114 (14.9%) 1.62*** 1.15-2.29 65 (14.1%) 62 (19.6%) 1.70** 1.06-2.75 343 (11.7%) 329 (14.3%) 1.54*** 1.24-1.9 95 (13.4%) 87 (17.4%) 1.60** 1.07-2.39 144 (15.2%) 99 (16.4%) 1.24 0.87-1.78
Yes, currently 1925 (22.1%) 1522 (24.3%) 1.25*** 1.13-1.38 642 (25.9%) 470 (26.2%) 1.1 0.93-1.31 93 (7.9%) 55 (7.2%) 1.04 0.69-1.57 78 (17.0%) 71 (22.4%) 1.59* 1-2.52 906 (30.9%) 765 (33.3%) 1.34*** 1.15-1.55 115 (16.2%) 86 (17.2%) 1.26 0.87-1.81 91 (9.6%) 75 (12.4%) 1.52** 1.01-2.29
Trend test p-value <0.0001 0.1142 0.1854 0.0186 <0.0001 0.099 0.0292
Estrogen Use 0.0008
No 6787 (50.9%) 3101 (37.1%) 1481 (41.8%) 630 (27.9%) 1107 (58.1%) 519 (47.9%) 466 (58.7%) 168 (38.4%) 2308 (50.1%) 1031 (33.8%) 576 (52.5%) 275 (40.2%) 849 (60.9%) 478 (57.5%)
Yes, previously 2375 (17.8%) 1538 (18.4%) 1.38*** 1.27-1.5 661 (18.6%) 414 (18.3%) 1.42*** 1.2-1.68 450 (23.6%) 291 (26.8%) 1.33*** 1.1-1.61 125 (15.7%) 92 (21.0%) 2.18*** 1.54-3.11 636 (13.8%) 415 (13.6%) 1.38*** 1.18-1.61 208 (19.0%) 139 (20.3%) 1.36** 1.04-1.78 295 (21.1%) 187 (22.5%) 1.14 0.91-1.43
Yes, currently 4178 (31.3%) 3713 (44.5%) 1.94*** 1.81-2.07 1405 (39.6%) 1216 (53.8%) 2.03*** 1.78-2.31 347 (18.2%) 274 (25.3%) 1.67*** 1.36-2.03 203 (25.6%) 178 (40.6%) 2.58*** 1.92-3.46 1659 (36.0%) 1608 (52.7%) 2.15*** 1.92-2.4 313 (28.5%) 270 (39.5%) 1.69***1.34-2.12 251 (18.0%) 167 (20.1%) 1.22 0.96-1.55
Trend test p-value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 0.076
Total Duration of Estrogen Use 0.4948
0.5 years 1607 (22.1%) 956 (16.4%) 392 (17.6%) 211 (12.1%) 261 (30.5%) 160 (26.4%) 97 (27.6%) 58 (20.4%) 448 (18.5%) 258 (11.9%) 123 (22.8%) 85 (20.0%) 200 (37.1%) 123 (35.1%) 86 (25.2%) 61 (22.3%)
1.5 years 1226 (16.8%) 854 (14.6%) 1.15* 0.98-1.34 325 (14.6%) 203 (11.6%) 1.16 0.86-1.56 178 (20.8%) 115 (18.9%) 0.94 0.61-1.47 58 (16.5%) 47 (16.5%) 0.75 0.37-1.52 361 (14.9%) 288 (13.3%) 1.39** 1.04-1.84 93 (17.2%) 69 (16.3%) 1.43 0.79-2.62 139 (25.8%) 78 (22.3%) 0.9 0.51-1.56 72 (21.1%) 54 (19.7%) 0.88 0.44-1.77
4 years 1399 (19.2%) 1045 (17.9%) 1.27*** 1.09-1.48 401 (18.0%) 302 (17.3%) 1.37** 1.04-1.8 138 (16.1%) 115 (18.9%) 1.12 0.72-1.75 77 (21.9%) 56 (19.6%) 1.51 0.8-2.85 507 (20.9%) 405 (18.7%) 1.49*** 1.15-1.94 107 (19.8%) 64 (15.1%) 0.93 0.53-1.64 94 (17.4%) 56 (16.0%) 0.72 0.37-1.4 75 (22.0%) 47 (17.2%) 0.97 0.48-1.97
7.5 years 1051 (14.4%) 874 (14.9%) 1.33*** 1.13-1.56 345 (15.5%) 264 (15.1%) 1.37** 1.04-1.81 76 (8.9%) 49 (8.1%) 1.03 0.58-1.81 42 (11.9%) 40 (14.0%) 1.63 0.81-3.26 423 (17.5%) 383 (17.7%) 1.52*** 1.15-2 71 (13.1%) 65 (15.3%) 1.34 0.75-2.4 49 (9.1%) 35 (10.0%) 0.96 0.42-2.21 45 (13.2%) 38 (13.9%) 1.05 0.45-2.41
12 years 838 (11.5%) 840 (14.4%) 1.49*** 1.26-1.76 288 (12.9%) 285 (16.3%) 1.74*** 1.31-2.33 79 (9.2%) 54 (8.9%) 0.82 0.48-1.41 34 (9.7%) 35 (12.3%) 1.45 0.7-2.99 307 (12.7%) 349 (16.1%) 1.77*** 1.32-2.38 63 (11.7%) 56 (13.2%) 0.98 0.52-1.83 31 (5.8%) 34 (9.7%) 1.35 0.61-3 36 (10.6%) 27 (9.9%) 0.95 0.42-2.12
17 years 492 (6.8%) 517 (8.8%) 1.77*** 1.46-2.16 185 (8.3%) 184 (10.5%) 1.75*** 1.26-2.42 48 (5.6%) 36 (5.9%) 1.91* 0.92-4 18 (5.1%) 23 (8.1%) 1.79 0.7-4.55 178 (7.3%) 213 (9.9%) 2.00*** 1.44-2.77 39 (7.2%) 34 (8.0%) 1.23 0.58-2.61 13 (2.4%) 9 (2.6%) 1.45 0.43-4.93 11 (3.2%) 18 (6.6%) 7.64** 1.59-36.72
20 years 665 (9.1%) 761 (13.0%) 1.81*** 1.51-2.16 291 (13.1%) 297 (17.0%) 1.77*** 1.32-2.37 77 (9.0%) 78 (12.9%) 2.53*** 1.47-4.37 26 (7.4%) 26 (9.1%) 2.38* 0.93-6.11 198 (8.2%) 265 (12.3%) 1.82*** 1.31-2.52 44 (8.1%) 51 (12.0%) 1.98* 1-3.93 13 (2.4%) 15 (4.3%) 1.49 0.53-4.2 16 (4.7%) 29 (10.6%) 1.95 0.78-4.89
Trend test p-value <0.0001 <0.0001 0.0015 0.0217 <0.0001 0.1716 0.1779 0.0153
Total Duration of Progesterone Use 0.7636
0.5 years 849 (24.7%) 644 (23.0%) 272 (24.1%) 186 (21.3%) 85 (35.1%) 61 (34.9%) 39 (26.2%) 46 (33.8%) 256 (20.0%) 192 (16.8%) 55 (25.3%) 55 (32.4%) 92 (38.8%) 66 (37.5%) 50 (27.3%) 38 (28.6%)
1.5 years 714 (20.8%) 539 (19.2%) 1.06 0.8-1.38 220 (19.5%) 167 (19.1%) 1.35 0.87-2.1 48 (19.8%) 41 (23.4%) 2.18 0.5-9.51 32 (21.5%) 31 (22.8%) 1.64 0.47-5.78 253 (19.7%) 197 (17.3%) 0.88 0.55-1.38 58 (26.7%) 31 (18.2%) 0.34 0.08-1.44 65 (27.4%) 35 (19.9%) 1.19 0.42-3.4 38 (20.8%) 37 (27.8%) 0.43 0.12-1.6
4 years 861 (25.0%) 672 (24.0%) 1.11 0.86-1.42 267 (23.7%) 207 (23.7%) 1.37 0.9-2.06 59 (24.4%) 37 (21.1%) 1.09 0.3-3.92 52 (34.9%) 27 (19.9%) 0.34 0.08-1.41 332 (25.9%) 299 (26.2%) 1.09 0.72-1.66 47 (21.7%) 37 (21.8%) 0.63 0.24-1.69 49 (20.7%) 38 (21.6%) 1.26 0.42-3.72 55 (30.1%) 27 (20.3%) 0.72 0.2-2.56
7.5 years 605 (17.6%) 477 (17.0%) 1.05 0.8-1.38 203 (18.0%) 149 (17.1%) 1.23 0.8-1.91 29 (12.0%) 18 (10.3%) 1.65 0.44-6.21 14 (9.4%) 13 (9.6%) 1.09 0.17-7.21 284 (22.2%) 243 (21.3%) 1.04 0.67-1.62 31 (14.3%) 20 (11.8%) 0.59 0.15-2.37 17 (7.2%) 16 (9.1%) 0.2 0.02-1.82 27 (14.8%) 18 (13.5%) 0.43 0.07-2.56
12 years 296 (8.6%) 348 (12.4%) 1.43** 1-2.04 119 (10.5%) 120 (13.7%) 1.7** 1-2.9 13 (5.4%) 12 (6.9%) 0.92 0.18-4.6 10 (6.7%) 16 (11.8%) 0.66 0.05-8.34 112 (8.7%) 159 (13.9%) 1.47 0.8-2.67 19 (8.8%) 13 (7.6%) 0.5 0.07-3.31 12 (5.1%) 18 (10.2%) 1.83 0.29-11.49 11 (6.0%) 10 (7.5%) 0.88 0.1-7.52
>= 17 years 113 (3.3%) 123 (4.4%) 1.42 0.82-2.45 47 (4.2%) 44 (5.0%) 1.27 0.57-2.86 8 (3.3%) 6 (3.4%) / / 2 (1.3%) 3 (2.2%) / / 45 (3.5%) 50 (4.4%) 1.5 0.6-3.79 7 (3.2%) 14 (8.2%) 0.91 1.13-6.33 2 (0.8%) 3 (1.7%) 2.16 0.19-24.64 2 (1.1%) 3 (2.3%) / /
Trend test p-value 0.0690 0.2269 0.6746 0.2913 0.1276 0.9508 0.7766 0.4909
Menopausal status 0.0614
Pre-Menopausal 1111 (8.9%) 508 (6.5%) 305 (9.1%) 117 (5.5%) 131 (7.5%) 54 (5.3%) 90 (12.2%) 31 (7.7%) 432 (10.1%) 215 (7.5%) 76 (7.5%) 41 (6.6%) 77 (5.7%) 50 (6.2%)
Natural Menopause 7509 (60.1%) 4311 (55.1%) 1.11 0.96 - 1.29 1975 (59.0%) 1126 (52.9%) 1.40** 1.05 - 1.88 834 (47.6%) 437 (43.2%) 1.36 0.90 - 2.06 412 (56.0%) 214 (53.0%) 1.71* 0.98 - 3.00 2802 (65.2%) 1723 (60.5%) 0.98 0.77 - 1.25570 (56.3%) 292 (46.9%) 0.76 0.46 - 1.25 916 (68.0%) 519 (64.4%) 0.74 0.47 - 1.18
Surgical Menopause 3872 (31.0%) 3002 (38.4%) 1.52*** 1.31 - 1.76 1070 (31.9%) 885 (41.6%) 2.07*** 1.54 - 2.77 786 (44.9%) 521 (51.5%) 1.68** 1.11 - 2.52 234 (31.8%) 159 (39.4%) 2.13*** 1.22 - 3.72 1062 (24.7%) 911 (32.0%) 1.34** 1.05 - 1.72366 (36.2%) 289 (46.5%) 1.13 0.69 - 1.86 354 (26.3%) 237 (29.4%) 0.89 0.55 - 1.44
Trend test p-value <0.0001 <0.0001 0.0016 0.0064 <0.0001 0.0074 0.3428
History of Asthma or Allergy 0.4812
no 11244 (70.1%) 6439 (64.8%) 2525 (64.3%) 1434 (57.7%) 1573 (69.9%) 796 (63.7%) 619 (69.7%) 312 (63.5%) 3628 (70.4%) 2296 (67.4%) 862 (71.5%) 477 (63.7%) 1309 (80.3%) 752 (75.4%) 728 (74.4%) 372 (66.7%)
yes 4790 (29.9%) 3500 (35.2%) 1.29*** 1.22-1.36 1404 (35.7%) 1053 (42.3%) 1.33*** 1.2-1.48 676 (30.1%) 453 (36.3%) 1.32*** 1.14-1.53 269 (30.3%) 179 (36.5%) 1.30** 1.04-1.63 1526 (29.6%) 1112 (32.6%) 1.18*** 1.07-1.3 344 (28.5%) 272 (36.3%) 1.39***1.14-1.69 321 (19.7%) 245 (24.6%) 1.35*** 1.11-1.64 250 (25.6%) 186 (33.3%) 1.45*** 1.15-1.83
Smoking status 0.4626
No 9244 (58.8%) 5806 (59.5%) 1777 (45.7%) 1125 (45.8%) 1019 (46.2%) 578 (47.1%) 416 (47.4%) 240 (49.4%) 3591 (70.6%) 2431 (72.2%) 672 (56.7%) 427 (57.7%) 1057 (69.6%) 624 (67.4%) 712 (74.1%) 381 (69.5%)
Yes and quit smoking 4528 (28.8%) 2937 (30.1%) 1.06* 1-1.13 1510 (38.8%) 1043 (42.4%) 1.10* 0.98-1.23 795 (36.0%) 435 (35.5%) 0.98 0.84-1.14 281 (32.0%) 167 (34.4%) 1.03 0.8-1.32 1093 (21.5%) 716 (21.3%) 1 0.9-1.12 367 (31.0%) 235 (31.8%) 1.05 0.85-1.29 321 (21.1%) 223 (24.1%) 1.15 0.93-1.41 161 (16.8%) 118 (21.5%) 1.38** 1.05-1.81
Yes and currently smoking 1957 (12.4%) 1008 (10.3%) 0.89*** 0.81-0.97 605 (15.5%) 290 (11.8%) 0.81** 0.69-0.96 393 (17.8%) 213 (17.4%) 0.97 0.79-1.19 181 (20.6%) 79 (16.3%) 0.77 0.57-1.06 404 (7.9%) 220 (6.5%) 0.87 0.73-1.04 146 (12.3%) 78 (10.5%) 0.9 0.67-1.22 140 (9.2%) 79 (8.5%) 1.01 0.75-1.37 88 (9.2%) 49 (8.9%) 1.08 0.74-1.56
Trend test p-value 0.1970 0.1953 0.729 0.1846 0.2557 0.7584 0.4585 0.1614
Page | 24

Total number of years smoked 0.3317
Never 9244 (59.5%) 5806 (60.4%) 1777 (45.9%) 1125 (46.2%) 1019 (47.2%) 578 (48.2%) 416 (48.2%) 240 (50.5%) 3591 (71.0%) 2431 (72.9%) 672 (57.8%) 427 (58.7%) 1057 (72.0%) 624 (69.4%) 712 (74.9%) 381 (70.3%)
<25 years 2985 (19.2%) 1856 (19.3%) 1.02 0.95 - 1.09 915 (23.6%) 607 (24.9%) 1.05 0.93 - 1.20 515 (23.9%) 265 (22.1%) 0.89 0.74 - 1.08 175 (20.3%) 97 (20.4%) 0.97 0.73 - 1.31 737 (14.6%) 455 (13.6%) 0.96 0.84 - 1.10272 (23.4%) 176 (24.2%) 1.05 0.84 - 1.32 252 (17.2%) 185 (20.6%) 1.25* 1.00 - 1.58 119 (12.5%) 71 (13.1%) 1.14 0.82 - 1.58
>=25 years 3300 (21.3%) 1951 (20.3%) 0.98 0.92 - 1.05 1178 (30.4%) 704 (28.9%) 0.98 0.87 - 1.11 623 (28.9%) 356 (29.7%) 1.02 0.86 - 1.20 272 (31.5%) 138 (29.1%) 0.91 0.70 - 1.19 728 (14.4%) 448 (13.4%) 0.95 0.83 - 1.08219 (18.8%) 125 (17.2%) 0.91 0.70 - 1.18 160 (10.9%) 90 (10.0%) 0.92 0.70 - 1.23 120 (12.6%) 90 (16.6%) 1.39** 1.03 - 1.89
Trend test p-value 0.7868 0.8598 1 0.491 0.3842 0.6097 0.6902 0.0304
Average number of cigarettes per day 0.5637
Never 9244 (59.2%) 5806 (60.1%) 1777 (45.9%) 1125 (46.1%) 1019 (46.8%) 578 (47.7%) 416 (47.9%) 240 (50.2%) 3591 (70.7%) 2431 (72.5%) 672 (57.6%) 427 (58.7%) 1057 (70.8%) 624 (69.4%) 712 (74.6%) 381 (69.9%)
<8 cigarettes 1599 (10.2%) 968 (10.0%) 0.99 0.91 - 1.09 335 (8.6%) 218 (8.9%) 1.01 0.84 - 1.23 314 (14.4%) 168 (13.8%) 0.96 0.77 - 1.19 76 (8.8%) 43 (9.0%) 0.98 0.65 - 1.49 325 (6.4%) 220 (6.6%) 1.04 0.86 - 1.24212 (18.2%) 114 (15.7%) 0.84 0.64 - 1.10 249 (16.7%) 157 (17.5%) 1.06 0.84 - 1.33 88 (9.2%) 48 (8.8%) 1.06 0.72 - 1.54
>=8 cigarettes 4769 (30.5%) 2884 (29.9%) 1.01 0.95 - 1.07 1763 (45.5%) 1097 (45.0%) 1.01 0.91 - 1.13 845 (38.8%) 467 (38.5%) 1 0.85 - 1.16 376 (43.3%) 195 (40.8%) 0.91 0.72 - 1.16 1161 (22.9%) 704 (21.0%) 0.94 0.84 - 1.06283 (24.3%) 187 (25.7%) 1.12 0.89 - 1.40 186 (12.5%) 118 (13.1%) 1.06 0.82 - 1.38 155 (16.2%) 116 (21.3%) 1.36** 1.03 - 1.79
Trend test p-value 0.848 0.8567 0.958 0.464 0.3642 0.5185 0.5681 0.0325
Packs of Cigarette per year 0.0648
Never 9244 (59.7%) 5806 (60.7%) 1777 (46.0%) 1125 (46.4%) 1019 (47.7%) 578 (48.6%) 416 (48.4%) 240 (51.0%) 3591 (71.1%) 2431 (73.0%) 672 (58.2%) 427 (59.1%) 1057 (72.2%) 624 (70.4%) 712 (75.2%) 381 (70.4%)
<12 3067 (19.8%) 1879 (19.7%) 1 0.94 - 1.07 795 (20.6%) 538 (22.2%) 1.07 0.93 - 1.22 590 (27.6%) 297 (25.0%) 0.88 0.74 - 1.06 174 (20.2%) 97 (20.6%) 0.97 0.72 - 1.30 733 (14.5%) 469 (14.1%) 0.98 0.86 - 1.12331 (28.7%) 193 (26.7%) 0.92 0.73 - 1.14 311 (21.3%) 212 (23.9%) 1.17 0.95 - 1.44 133 (14.0%) 73 (13.5%) 1.03 0.75 - 1.42
>=12 3164 (20.4%) 1877 (19.6%) 0.99 0.93 - 1.07 1289 (33.4%) 760 (31.4%) 0.97 0.86 - 1.09 529 (24.7%) 314 (26.4%) 1.06 0.89 - 1.27 270 (31.4%) 134 (28.5%) 0.9 0.69 - 1.17 728 (14.4%) 430 (12.9%) 0.92 0.81 - 1.06151 (13.1%) 102 (14.1%) 1.16 0.86 - 1.55 95 (6.5%) 50 (5.6%) 0.83 0.57 - 1.19 102 (10.8%) 87 (16.1%) 1.56*** 1.14 - 2.15
Trend test p-value 0.8803 0.6851 0.6932 0.4404 0.2738 0.6411 0.9013 0.0125
Alcohol (g/day) 0.3453
none 10179 (63.5%) 6322 (63.6%) 1537 (39.1%) 967 (38.9%) 1442 (64.1%) 787 (63.0%) 583 (65.7%) 289 (58.9%) 3994 (77.5%) 2681 (78.7%) 722 (59.9%) 451 (60.2%) 1158 (71.0%) 721 (72.3%) 743 (76.0%) 426 (76.3%)
<=14 4484 (28.0%) 2828 (28.5%) 1.04 0.98-1.1 1568 (39.9%) 1009 (40.6%) 1.05 0.94-1.18 636 (28.3%) 379 (30.3%) 1.09 0.93-1.27 231 (26.0%) 166 (33.8%) 1.45*** 1.14-1.86 1015 (19.7%) 656 (19.2%) 0.99 0.88-1.1 412 (34.2%) 251 (33.5%) 0.99 0.81-1.21 423 (26.0%) 250 (25.1%) 0.96 0.8-1.15 199 (20.3%) 117 (21.0%) 1.05 0.81-1.36
>14 1371 (8.6%) 789 (7.9%) 0.92 0.84-1.02 824 (21.0%) 511 (20.5%) 0.98 0.85-1.12 171 (7.6%) 83 (6.6%) 0.87 0.66-1.16 74 (8.3%) 36 (7.3%) 0.98 0.64-1.5 145 (2.8%) 71 (2.1%) 0.76* 0.57-1.02 72 (6.0%) 47 (6.3%) 1.09 0.74-1.61 49 (3.0%) 26 (2.6%) 0.87 0.53-1.43 36 (3.7%) 15 (2.7%) 0.69 0.37-1.29
Trend test p-value 0.0733 0.4763 0.3011 0.8126 0.0659 0.6595 0.5676 0.2539
Coffee: (Cups/day) 0.7755
none 5201 (32.4%) 3459 (34.8%) 1249 (31.8%) 846 (34.0%) 972 (43.2%) 564 (45.2%) 298 (33.6%) 193 (39.3%) 1410 (27.4%) 1041 (30.5%) 371 (30.8%) 238 (31.8%) 561 (34.4%) 370 (37.1%) 340 (34.8%) 207 (37.1%)
>=1 7317 (45.6%) 4541 (45.7%) 0.92*** 0.87-0.98 1519 (38.7%) 991 (39.8%) 0.94 0.83-1.06 1005 (44.7%) 558 (44.7%) 0.98 0.84-1.13 423 (47.6%) 218 (44.4%) 0.79* 0.62-1.01 2560 (49.7%) 1679 (49.3%) 0.88** 0.79-0.97 544 (45.1%) 342 (45.7%) 0.99 0.8-1.23 787 (48.3%) 477 (47.8%) 0.96 0.8-1.15 479 (49.0%) 276 (49.5%) 0.96 0.77-1.21
>1/<=4 2919 (18.2%) 1638 (16.5%) 0.84*** 0.78-0.91 939 (23.9%) 521 (20.9%) 0.82*** 0.71-0.95 227 (10.1%) 110 (8.8%) 0.85 0.66-1.1 128 (14.4%) 63 (12.8%) 0.78 0.55-1.1 1003 (19.5%) 601 (17.6%) 0.83*** 0.73-0.95 231 (19.2%) 149 (19.9%) 1.01 0.78-1.32 259 (15.9%) 133 (13.3%) 0.81 0.63-1.04 132 (13.5%) 61 (10.9%) 0.78 0.55-1.12
>4 597 (3.7%) 301 (3.0%) 0.78*** 0.68-0.91 222 (5.7%) 129 (5.2%) 0.89 0.7-1.13 45 (2.0%) 17 (1.4%) 0.65 0.37-1.16 39 (4.4%) 17 (3.5%) 0.72 0.4-1.31 181 (3.5%) 87 (2.6%) 0.71** 0.54-0.93 60 (5.0%) 20 (2.7%) 0.52** 0.3-0.89 23 (1.4%) 17 (1.7%) 1.15 0.6-2.19 27 (2.8%) 14 (2.5%) 0.86 0.44-1.68
Trend test p-value <0.0001 0.0136 0.1238 0.0689 0.0006 0.2423 0.2471 0.2386
Regular coffee (g/day) 0.9097
0-<240 7905 (49.3%) 5247 (52.8%) 1749 (44.5%) 1174 (47.2%) 1405 (62.5%) 835 (66.9%) 469 (52.8%) 277 (56.4%) 2314 (44.9%) 1688 (49.5%) 581 (48.2%) 374 (49.9%) 875 (53.7%) 575 (57.7%) 512 (52.4%) 324 (58.1%)
240-<961 8129 (50.7%) 4692 (47.2%) 0.86*** 0.81-0.9 2180 (55.5%) 1313 (52.8%) 0.89** 0.8-0.98 844 (37.5%) 414 (33.1%) 0.83** 0.72-0.96 419 (47.2%) 214 (43.6%) 0.87 0.7-1.09 2840 (55.1%) 1720 (50.5%) 0.83*** 0.76-0.91 625 (51.8%) 375 (50.1%) 0.93 0.77-1.11 755 (46.3%) 422 (42.3%) 0.87* 0.74-1.03 466 (47.6%) 234 (41.9%) 0.81** 0.65-0.99
Decaffeinated Coffee (g/day) 0.4036
0-<33.95 12116 (75.6%) 7317 (73.6%) 2933 (74.7%) 1815 (73.0%) 1703 (75.7%) 935 (74.9%) 697 (78.5%) 388 (79.0%) 4027 (78.1%) 2559 (75.1%) 912 (75.6%) 538 (71.8%) 1147 (70.4%) 677 (67.9%) 697 (71.3%) 405 (72.6%)
33.95-<600 3124 (19.5%) 2120 (21.3%) 1.10*** 1.03-1.17 689 (17.5%) 500 (20.1%) 1.12* 0.98-1.28 453 (20.1%) 262 (21.0%) 1.06 0.89-1.26 161 (18.1%) 87 (17.7%) 0.97 0.72-1.3 961 (18.6%) 702 (20.6%) 1.12** 1.01-1.26 231 (19.2%) 174 (23.2%) 1.24* 0.99-1.56 400 (24.5%) 270 (27.1%) 1.13 0.94-1.36 229 (23.4%) 125 (22.4%) 0.93 0.72-1.2
600-961 794 (5.0%) 502 (5.1%) 1.04 0.92-1.16 307 (7.8%) 172 (6.9%) 0.9 0.74-1.09 93 (4.1%) 52 (4.2%) 1.02 0.72-1.44 30 (3.4%) 16 (3.3%) 0.95 0.51-1.76 166 (3.2%) 147 (4.3%) 1.38*** 1.1-1.74 63 (5.2%) 37 (4.9%) 0.97 0.64-1.48 83 (5.1%) 50 (5.0%) 1 0.7-1.45 52 (5.3%) 28 (5.0%) 0.93 0.58-1.49
Trend test p-value 0.0402 0.8205 0.6613 0.8053 0.0011 0.3905 0.4453 0.5781
Black Tea (g/day) 0.2175
0-<33.94 11791 (73.5%) 7377 (74.2%) 2638 (67.1%) 1654 (66.5%) 1785 (79.4%) 1028 (82.3%) 618 (69.6%) 339 (69.0%) 3767 (73.1%) 2543 (74.6%) 909 (75.4%) 565 (75.4%) 1370 (84.0%) 829 (83.1%) 704 (72.0%) 419 (75.1%)
33.94-<240 2633 (16.4%) 1626 (16.4%) 0.99 0.92-1.06 708 (18.0%) 494 (19.9%) 1.11 0.98-1.27 331 (14.7%) 160 (12.8%) 0.84* 0.69-1.03 170 (19.1%) 106 (21.6%) 1.13 0.87-1.49 897 (17.4%) 562 (16.5%) 0.93 0.83-1.05 202 (16.7%) 121 (16.2%) 1 0.78-1.29 155 (9.5%) 108 (10.8%) 1.13 0.87-1.48 170 (17.4%) 75 (13.4%) 0.75* 0.56-1.01
240-<961 1610 (10.0%) 936 (9.4%) 0.92* 0.85-1.01 583 (14.8%) 339 (13.6%) 0.91 0.78-1.05 133 (5.9%) 61 (4.9%) 0.81 0.59-1.11 100 (11.3%) 46 (9.4%) 0.81 0.56-1.16 490 (9.5%) 303 (8.9%) 0.95 0.81-1.11 95 (7.9%) 63 (8.4%) 1.05 0.74-1.5 105 (6.4%) 60 (6.0%) 0.93 0.67-1.3 104 (10.6%) 64 (11.5%) 1.08 0.77-1.5
Trend test p-value 0.0783 0.3882 0.0614 0.4473 0.3395 0.796 0.9427 0.8878
Vigorous activity (vigorous work and sports) hours per day 0.0262
none 9001 (59.7%) 5648 (60.8%) 1943 (51.6%) 1281 (54.1%) 1327 (65.9%) 767 (67.2%) 370 (43.5%) 208 (44.7%) 3247 (65.5%) 2105 (64.5%) 674 (59.1%) 435 (63.1%) 897 (63.3%) 560 (66.7%) 543 (58.6%) 292 (55.4%)
<= 0.11 2466 (16.4%) 1488 (16.0%) 0.98 0.91 - 1.06 612 (16.3%) 371 (15.7%) 0.9 0.78 - 1.05 334 (16.6%) 189 (16.5%) 1.03 0.83 - 1.26 162 (19.0%) 93 (20.0%) 1.04 0.77 - 1.41 760 (15.3%) 519 (15.9%) 1.1 0.97 - 1.25193 (16.9%) 101 (14.7%) 0.82 0.62 - 1.10 214 (15.1%) 122 (14.5%) 0.85 0.65 - 1.12 191 (20.6%) 93 (17.6%) 0.98 0.73 - 1.32
> 0.11 - <=0.36 1706 (11.3%) 1054 (11.3%) 1.01 0.92 - 1.10 496 (13.2%) 336 (14.2%) 1.06 0.90 - 1.24 185 (9.2%) 86 (7.5%) 0.78* 0.59 - 1.03 141 (16.6%) 61 (13.1%) 0.77 0.54 - 1.09 512 (10.3%) 346 (10.6%) 1.1 0.95 - 1.28132 (11.6%) 81 (11.8%) 0.96 0.70 - 1.32 140 (9.9%) 71 (8.5%) 0.78 0.56 - 1.09 100 (10.8%) 73 (13.9%) 1.27 0.89 - 1.81
>0.36 1901 (12.6%) 1103 (11.9%) 0.96 0.88 - 1.05 712 (18.9%) 379 (16.0%) 0.83** 0.72 - 0.97 169 (8.4%) 100 (8.8%) 1.03 0.78 - 1.35 178 (20.9%) 103 (22.2%) 1.1 0.81 - 1.49 442 (8.9%) 293 (9.0%) 1.09 0.93 - 1.28142 (12.4%) 72 (10.4%) 0.81 0.59 - 1.12 166 (11.7%) 87 (10.4%) 0.76* 0.57 - 1.03 92 (9.9%) 69 (13.1%) 1.41* 0.99 - 2.02
Trend test p-value 0.4712 0.073 0.5504 0.9869 0.1033 0.2111 0.0305 0.0374
BMI (kg/m2) 0.0608
<25 8153 (51.7%) 4715 (48.2%) 2173 (55.6%) 1266 (51.1%) 503 (23.5%) 256 (21.4%) 275 (31.2%) 146 (30.5%) 3708 (73.0%) 2293 (68.1%) 401 (33.4%) 194 (26.0%) 520 (32.4%) 270 (27.6%) 573 (61.0%) 290 (53.4%)
25-<30 4740 (30.1%) 3123 (31.9%) 1.22*** 1.15-1.3 1097 (28.1%) 748 (30.2%) 1.18*** 1.05-1.33 821 (38.4%) 444 (37.1%) 1.06 0.88-1.29 312 (35.5%) 174 (36.4%) 1.06 0.81-1.4 1107 (21.8%) 871 (25.9%) 1.32*** 1.18-1.46 452 (37.6%) 315 (42.3%) 1.45***1.16-1.82 673 (41.9%) 412 (42.1%) 1.16 0.96-1.42 278 (29.6%) 159 (29.3%) 1.1 0.86-1.41
30+ 2862 (18.2%) 1948 (19.9%) 1.34*** 1.24-1.45 638 (16.3%) 464 (18.7%) 1.28*** 1.12-1.48 815 (38.1%) 496 (41.5%) 1.17 0.96-1.42 293 (33.3%) 158 (33.1%) 1.06 0.8-1.42 266 (5.2%) 203 (6.0%) 1.38*** 1.13-1.68 349 (29.0%) 236 (31.7%) 1.45***1.14-1.84 412 (25.7%) 297 (30.3%) 1.39*** 1.12-1.74 89 (9.5%) 94 (17.3%) 2.11*** 1.52-2.93
Trend test p-value <0.0001 0.0001 0.1085 0.6819 <0.0001 0.0037 0.0028 <0.0001
Calories (Kcal/day) 0.0054
427-<1324.27 4026 (25.1%) 2464 (24.8%) 984 (25.0%) 642 (25.8%) 726 (32.3%) 421 (33.8%) 161 (18.1%) 81 (16.5%) 1298 (25.2%) 746 (21.9%) 327 (27.1%) 207 (27.6%) 300 (18.4%) 231 (23.2%) 230 (23.5%) 136 (24.4%)
1324.27-<1749.475 4049 (25.3%) 2476 (24.9%) 1 0.93-1.07 1116 (28.4%) 728 (29.3%) 1.02 0.89-1.17 494 (22.0%) 239 (19.2%) 0.86 0.71-1.05 163 (18.4%) 101 (20.6%) 1.25 0.87-1.81 1515 (29.4%) 959 (28.1%) 1.08 0.96-1.22 248 (20.6%) 160 (21.4%) 1.06 0.81-1.39 299 (18.3%) 166 (16.6%) 0.76** 0.59-0.99 214 (21.9%) 123 (22.0%) 1.02 0.75-1.38
1749.475-<2345.409 3991 (24.9%) 2463 (24.8%) 1.01 0.94-1.09 1075 (27.4%) 654 (26.3%) 0.96 0.83-1.1 485 (21.6%) 248 (19.9%) 0.89 0.73-1.08 213 (24.0%) 114 (23.3%) 1.07 0.76-1.52 1398 (27.1%) 976 (28.6%) 1.20*** 1.06-1.35 246 (20.4%) 162 (21.6%) 1.12 0.85-1.47 357 (21.9%) 201 (20.2%) 0.76** 0.6-0.98 217 (22.2%) 108 (19.4%) 0.88 0.64-1.2
2345.409-7742 3968 (24.7%) 2533 (25.5%) 1.09** 1.01-1.17 754 (19.2%) 463 (18.6%) 0.98 0.84-1.14 544 (24.2%) 339 (27.2%) 1.11 0.92-1.33 351 (39.5%) 194 (39.6%) 1.11 0.81-1.53 943 (18.3%) 727 (21.3%) 1.37*** 1.2-1.57 385 (31.9%) 220 (29.4%) 0.97 0.75-1.24 674 (41.3%) 399 (40.0%) 0.79** 0.64-0.98 317 (32.4%) 191 (34.2%) 1.1 0.84-1.45
Trend test p-value 0.0124 0.5919 0.1921 0.8733 <0.0001 0.6782 0.1331 0.4607
Red meat excluding processed red meat (g/day) 0.4746
0-<12.91 4047 (25.2%) 2461 (24.8%) 1228 (31.3%) 783 (31.5%) 634 (28.2%) 356 (28.5%) 129 (14.5%) 77 (15.7%) 1249 (24.2%) 792 (23.2%) 243 (20.1%) 143 (19.1%) 332 (20.4%) 193 (19.4%) 232 (23.7%) 117 (21.0%)
12.91-<24.95 4009 (25.0%) 2491 (25.1%) 1.02 0.95-1.1 1037 (26.4%) 646 (26.0%) 0.99 0.86-1.13 549 (24.4%) 283 (22.7%) 0.92 0.76-1.12 181 (20.4%) 83 (16.9%) 0.77 0.53-1.13 1437 (27.9%) 969 (28.4%) 1.07 0.95-1.21 257 (21.3%) 162 (21.6%) 1.04 0.78-1.38 312 (19.1%) 214 (21.5%) 1.24 0.96-1.6 236 (24.1%) 134 (24.0%) 1.12 0.82-1.54
24.95-<42.98 4026 (25.1%) 2461 (24.8%) 1.03 0.96-1.11 908 (23.1%) 607 (24.4%) 1.08 0.94-1.25 549 (24.4%) 273 (21.9%) 0.91 0.75-1.1 253 (28.5%) 138 (28.1%) 0.92 0.65-1.3 1447 (28.1%) 930 (27.3%) 1.04 0.92-1.17 276 (22.9%) 171 (22.8%) 1.04 0.79-1.38 355 (21.8%) 207 (20.8%) 1.08 0.84-1.38 238 (24.3%) 135 (24.2%) 1.18 0.86-1.6
42.98-499 3952 (24.6%) 2526 (25.4%) 1.12*** 1.04-1.21 756 (19.2%) 451 (18.1%) 0.99 0.85-1.15 517 (23.0%) 337 (27.0%) 1.18* 0.98-1.43 325 (36.6%) 193 (39.3%) 1.03 0.74-1.44 1021 (19.8%) 717 (21.0%) 1.19** 1.04-1.36 430 (35.7%) 273 (36.4%) 1.13 0.87-1.47 631 (38.7%) 383 (38.4%) 1.11 0.89-1.39 272 (27.8%) 172 (30.8%) 1.31* 0.97-1.77
Trend test p-value 0.0015 0.9012 0.0426 0.2913 0.0163 0.3164 0.8253 0.0862
Processed red meat (g/day) 0.0711
0-<3.96 4005 (25.0%) 2484 (25.0%) 1253 (31.9%) 817 (32.9%) 545 (24.2%) 278 (22.3%) 111 (12.5%) 79 (16.1%) 1162 (22.5%) 754 (22.1%) 286 (23.7%) 178 (23.8%) 441 (27.1%) 253 (25.4%) 207 (21.2%) 125 (22.5%)
3.96-<8.96 4008 (25.0%) 2484 (25.0%) 1.01 0.94-1.09 1085 (27.6%) 688 (27.7%) 0.99 0.87-1.13 484 (21.5%) 269 (21.6%) 1.11 0.91-1.37 165 (18.6%) 78 (15.9%) 0.65** 0.44-0.98 1326 (25.7%) 845 (24.8%) 1 0.88-1.14 296 (24.5%) 209 (27.9%) 1.12 0.86-1.45 405 (24.8%) 257 (25.8%) 1.14 0.92-1.42 247 (25.3%) 138 (24.8%) 0.95 0.7-1.29
8.96-<17.18 4016 (25.0%) 2497 (25.1%) 1.03 0.96-1.1 889 (22.6%) 591 (23.8%) 1.05 0.92-1.21 552 (24.5%) 284 (22.8%) 1.04 0.84-1.27 230 (25.9%) 116 (23.6%) 0.69* 0.48-1 1457 (28.3%) 956 (28.1%) 1.03 0.91-1.17 298 (24.7%) 173 (23.1%) 0.97 0.74-1.27 351 (21.5%) 241 (24.2%) 1.25* 1-1.58 239 (24.4%) 136 (24.5%) 0.94 0.69-1.28
17.18-222 4005 (25.0%) 2471 (24.9%) 1.06 0.99-1.14 702 (17.9%) 391 (15.7%) 0.9 0.77-1.05 668 (29.7%) 417 (33.4%) 1.26** 1.04-1.53 382 (43.0%) 218 (44.4%) 0.82 0.59-1.15 1209 (23.5%) 853 (25.0%) 1.17** 1.02-1.33 326 (27.0%) 189 (25.2%) 0.97 0.74-1.27 433 (26.6%) 246 (24.7%) 1.03 0.82-1.28 285 (29.1%) 157 (28.2%) 0.96 0.71-1.3
Trend test p-value 0.1004 0.2382 0.0196 0.8257 0.0085 0.5156 0.9291 0.8629
Density for Vitamin D (IU/1000 kcal/day) 0.1847
0.44-38.02 4039 (25.2%) 2164 (21.8%) 696 (17.7%) 359 (14.4%) 558 (24.8%) 307 (24.6%) 182 (20.5%) 91 (18.5%) 1574 (30.5%) 874 (25.6%) 330 (27.4%) 194 (25.9%) 420 (25.8%) 223 (22.4%) 279 (28.5%) 116 (20.8%)
38.02-<60.85 4007 (25.0%) 2437 (24.5%) 1.13*** 1.05-1.21 846 (21.5%) 479 (19.3%) 1.08 0.91-1.29 611 (27.2%) 308 (24.7%) 0.93 0.76-1.13 215 (24.2%) 124 (25.3%) 1.17 0.84-1.65 1394 (27.0%) 934 (27.4%) 1.17** 1.04-1.32 281 (23.3%) 195 (26.0%) 1.15 0.89-1.5 404 (24.8%) 244 (24.5%) 1.16 0.92-1.46 256 (26.2%) 153 (27.4%) 1.42** 1.06-1.91
60.85-<91.87 4001 (25.0%) 2640 (26.6%) 1.21*** 1.13-1.31 1019 (25.9%) 692 (27.8%) 1.30*** 1.1-1.53 550 (24.5%) 336 (26.9%) 1.11 0.91-1.35 245 (27.6%) 142 (28.9%) 1.15 0.83-1.59 1225 (23.8%) 900 (26.4%) 1.28*** 1.13-1.44 302 (25.0%) 175 (23.4%) 0.96 0.74-1.25 429 (26.3%) 250 (25.1%) 1.09 0.87-1.38 231 (23.6%) 145 (26.0%) 1.44** 1.07-1.95
91.87-515 3987 (24.9%) 2698 (27.1%) 1.25*** 1.16-1.34 1368 (34.8%) 957 (38.5%) 1.33*** 1.14-1.56 530 (23.6%) 298 (23.9%) 1.03 0.84-1.27 246 (27.7%) 134 (27.3%) 1.06 0.76-1.48 961 (18.6%) 700 (20.5%) 1.27*** 1.11-1.45 293 (24.3%) 185 (24.7%) 1.01 0.77-1.31 377 (23.1%) 280 (28.1%) 1.40*** 1.11-1.76 212 (21.7%) 144 (25.8%) 1.56*** 1.16-2.11
Trend test p-value <0.0001 0.0001 0.4827 0.9683 0.0003 0.7104 0.0064 0.0087
Total Vegetables (g/day) 0.0583
0.15-<119.37 4015 (25.0%) 2469 (24.8%) 1002 (25.5%) 602 (24.2%) 682 (30.3%) 412 (33.0%) 229 (25.8%) 116 (23.6%) 1160 (22.5%) 793 (23.3%) 337 (27.9%) 204 (27.2%) 304 (18.7%) 180 (18.1%) 301 (30.8%) 162 (29.0%)
119.37-<162.63 4030 (25.1%) 2493 (25.1%) 0.98 0.92-1.06 982 (25.0%) 681 (27.4%) 1.13 0.98-1.3 539 (24.0%) 311 (24.9%) 0.96 0.79-1.16 211 (23.8%) 106 (21.6%) 0.97 0.7-1.35 1399 (27.1%) 875 (25.7%) 0.90* 0.79-1.02 297 (24.6%) 200 (26.7%) 1.07 0.83-1.38 360 (22.1%) 183 (18.4%) 0.86 0.67-1.12 242 (24.7%) 137 (24.6%) 1.06 0.8-1.41
162.63-<219.78 4004 (25.0%) 2522 (25.4%) 0.99 0.92-1.06 948 (24.1%) 622 (25.0%) 1.04 0.9-1.21 537 (23.9%) 267 (21.4%) 0.82** 0.68-0.99 218 (24.5%) 129 (26.3%) 1.15 0.84-1.57 1385 (26.9%) 922 (27.1%) 0.93 0.82-1.06 284 (23.5%) 162 (21.6%) 0.9 0.69-1.18 441 (27.1%) 296 (29.7%) 1.19 0.93-1.51 191 (19.5%) 124 (22.2%) 1.22 0.91-1.64
219.78-1131 3985 (24.9%) 2455 (24.7%) 0.96 0.9-1.03 997 (25.4%) 582 (23.4%) 0.92 0.8-1.07 491 (21.8%) 259 (20.7%) 0.85 0.7-1.04 230 (25.9%) 140 (28.5%) 1.18 0.86-1.62 1210 (23.5%) 818 (24.0%) 0.95 0.83-1.08 288 (23.9%) 183 (24.4%) 0.98 0.76-1.28 525 (32.2%) 338 (33.9%) 1.1 0.88-1.39 244 (24.9%) 135 (24.2%) 1.04 0.78-1.38
Trend test p-value 0.3195 0.0884 0.0546 0.2122 0.7398 0.6667 0.1473 0.683
Total Fruits and Juice (g/day) 0.1915
0-<101.18 3996 (24.9%) 2445 (24.6%) 1002 (25.5%) 616 (24.8%) 547 (24.3%) 353 (28.3%) 277 (31.2%) 141 (28.7%) 1206 (23.4%) 715 (21.0%) 353 (29.3%) 232 (31.0%) 401 (24.6%) 250 (25.1%) 210 (21.5%) 138 (24.7%)
101.18-<175.79 4014 (25.0%) 2458 (24.7%) 0.96 0.89-1.03 1062 (27.0%) 661 (26.6%) 0.96 0.83-1.1 526 (23.4%) 295 (23.6%) 0.88 0.72-1.07 213 (24.0%) 135 (27.5%) 1.19 0.88-1.62 1300 (25.2%) 818 (24.0%) 0.99 0.87-1.13 295 (24.5%) 186 (24.8%) 0.93 0.72-1.21 390 (23.9%) 244 (24.5%) 1.01 0.81-1.28 228 (23.3%) 119 (21.3%) 0.79 0.58-1.08
175.79-<272.92 3997 (24.9%) 2506 (25.2%) 0.95 0.88-1.02 985 (25.1%) 654 (26.3%) 0.99 0.85-1.14 529 (23.5%) 268 (21.5%) 0.77** 0.64-0.94 223 (25.1%) 101 (20.6%) 0.88 0.64-1.21 1386 (26.9%) 966 (28.3%) 1.07 0.94-1.21 275 (22.8%) 156 (20.8%) 0.78* 0.6-1.02 364 (22.3%) 235 (23.6%) 1.02 0.81-1.29 235 (24.0%) 126 (22.6%) 0.79 0.58-1.09
272.92-1219 4027 (25.1%) 2530 (25.5%) 0.94* 0.87-1.01 880 (22.4%) 556 (22.4%) 0.94 0.81-1.09 647 (28.8%) 333 (26.7%) 0.78** 0.64-0.95 175 (19.7%) 114 (23.2%) 1.21 0.87-1.69 1262 (24.5%) 909 (26.7%) 1.06 0.93-1.21 283 (23.5%) 175 (23.4%) 0.85 0.65-1.11 475 (29.1%) 268 (26.9%) 0.87 0.7-1.09 305 (31.2%) 175 (31.4%) 0.86 0.65-1.15
Trend test p-value 0.1171 0.4909 0.0098 0.4897 0.2741 0.1625 0.1762 0.5342
*** p<0.01, ** p<0.05, * p<0.1
Page | 25

4.1.2. Multivariate models of smoking for UI risk
Three models including different types of smoking variables were used to estimate the
relationship between smoking and risk of UI (Table 4), taking into consideration key variable
correlated with smoking use, such as alcohol, coffee, vigorous activity, and BMI (Table 5). No
statistically significant associations were observed between smoking variables and risk of UI. In
contrast, the inverse association between coffee and risk of UI remained with adjustment for xxx
with a statistically significant trend between higher intake of coffee and decreased risk of UI
(trend p<0.0001), that was present among whites, Japanese and African-American, but not
Hawaiians, Latinos, or women of other racial/ethnic groups. Intake of 14 g/day or less of alcohol
compared to no intake was associated with higher risk of UI among all women Hawaiians, but
not among other groups, and no association was observed with higher alcohol intake. Similarly,
BMI was still a risk factor for UI, and trend tests were statistically significant among Whites,
Japanese Americans and Latinos.

Page | 26

Table 4. Multivariate models of smoking for UI across ethnic groups

Total White Black Hawaiian Japanese L-us born L-foreign born Other Interaction p
MODEL 1 Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 16034 9939 3929 2487 2249 1249 888 491 5154 3408 1206 749 1630 997 978 558
Total number of years smoked 0.1466
Never 9244 (59.5%) 5806 (60.4%) 1777 (45.9%) 1125 (46.2%) 1019 (47.2%) 578 (48.2%) 416 (48.2%) 240 (50.5%) 3591 (71.0%) 2431 (72.9%) 672 (57.8%) 427 (58.7%) 1057 (72.0%) 624 (69.4%) 712 (74.9%) 381 (70.3%)
<25 years 2985 (19.2%) 1856 (19.3%) 1.03 0.96 - 1.10 915 (23.6%) 607 (24.9%) 1.08 0.95 - 1.23 515 (23.9%) 265 (22.1%) 0.88 0.73 - 1.07 175 (20.3%) 97 (20.4%) 0.97 0.71 - 1.32 737 (14.6%) 455 (13.6%) 0.95 0.83 - 1.09 272 (23.4%) 176 (24.2%) 1.04 0.82 - 1.32 252 (17.2%) 185 (20.6%) 1.25* 0.99 - 1.58 119 (12.5%) 71 (13.1%) 1.21 0.86 - 1.71
>=25 years 3300 (21.3%) 1951 (20.3%) 1.02 0.95 - 1.10 1178 (30.4%) 704 (28.9%) 1.01 0.89 - 1.15 623 (28.9%) 356 (29.7%) 1.08 0.90 - 1.30 272 (31.5%) 138 (29.1%) 0.91 0.68 - 1.21 728 (14.4%) 448 (13.4%) 1 0.87 - 1.15 219 (18.8%) 125 (17.2%) 0.92 0.70 - 1.20 160 (10.9%) 90 (10.0%) 0.89 0.66 - 1.20 120 (12.6%) 90 (16.6%) 1.59*** 1.13 - 2.22
Trend test p-value 0.4616 0.7294 0.5163 0.5094 0.8141 0.6657 0.8796 0.0059
alcohol (g/day) 0.2287
none 10179 (63.5%) 6322 (63.6%) 1537 (39.1%) 967 (38.9%) 1442 (64.1%) 787 (63.0%) 583 (65.7%) 289 (58.9%) 3994 (77.5%) 2681 (78.7%) 722 (59.9%) 451 (60.2%) 1158 (71.0%) 721 (72.3%) 743 (76.0%) 426 (76.3%)
<=14 4484 (28.0%) 2828 (28.5%) 1.08** 1.02 - 1.15 1568 (39.9%) 1009 (40.6%) 1.09 0.97 - 1.23 636 (28.3%) 379 (30.3%) 1.1 0.93 - 1.31 231 (26.0%) 166 (33.8%) 1.65*** 1.26 - 2.17 1015 (19.7%) 656 (19.2%) 1.04 0.93 - 1.17 412 (34.2%) 251 (33.5%) 1.01 0.82 - 1.25 423 (26.0%) 250 (25.1%) 1.02 0.82 - 1.25 199 (20.3%) 117 (21.0%) 1.08 0.81 - 1.43
>14 1371 (8.6%) 789 (7.9%) 0.98 0.89 - 1.09 824 (21.0%) 511 (20.5%) 1.02 0.88 - 1.18 171 (7.6%) 83 (6.6%) 0.96 0.71 - 1.30 74 (8.3%) 36 (7.3%) 1.09 0.70 - 1.72 145 (2.8%) 71 (2.1%) 0.81 0.60 - 1.09 72 (6.0%) 47 (6.3%) 1.15 0.76 - 1.73 49 (3.0%) 26 (2.6%) 0.92 0.53 - 1.59 36 (3.7%) 15 (2.7%) 0.65 0.34 - 1.25
Trend test p-value 0.2761 0.5867 0.6596 0.0265 0.7738 0.6256 0.9574 0.637
Coffee: (Cups/day) 0.6458
none 5201 (32.4%) 3459 (34.8%) 1249 (31.8%) 846 (34.0%) 972 (43.2%) 564 (45.2%) 298 (33.6%) 193 (39.3%) 1410 (27.4%) 1041 (30.5%) 371 (30.8%) 238 (31.8%) 561 (34.4%) 370 (37.1%) 340 (34.8%) 207 (37.1%)
>=1 7317 (45.6%) 4541 (45.7%) 0.91*** 0.85 - 0.97 1519 (38.7%) 991 (39.8%) 0.95 0.84 - 1.08 1005 (44.7%) 558 (44.7%) 0.97 0.82 - 1.14 423 (47.6%) 218 (44.4%) 0.75** 0.58 - 0.98 2560 (49.7%) 1679 (49.3%) 0.85*** 0.76 - 0.95 544 (45.1%) 342 (45.7%) 0.96 0.77 - 1.21 787 (48.3%) 477 (47.8%) 0.94 0.77 - 1.16 479 (49.0%) 276 (49.5%) 0.9 0.71 - 1.16
>1/<=4 2919 (18.2%) 1638 (16.5%) 0.82*** 0.76 - 0.89 939 (23.9%) 521 (20.9%) 0.82*** 0.71 - 0.94 227 (10.1%) 110 (8.8%) 0.77* 0.58 - 1.02 128 (14.4%) 63 (12.8%) 0.75 0.51 - 1.10 1003 (19.5%) 601 (17.6%) 0.83*** 0.72 - 0.95 231 (19.2%) 149 (19.9%) 0.96 0.73 - 1.26 259 (15.9%) 133 (13.3%) 0.77* 0.58 - 1.02 132 (13.5%) 61 (10.9%) 0.69* 0.47 - 1.02
>4 597 (3.7%) 301 (3.0%) 0.77*** 0.66 - 0.90 222 (5.7%) 129 (5.2%) 0.91 0.71 - 1.17 45 (2.0%) 17 (1.4%) 0.6 0.33 - 1.11 39 (4.4%) 17 (3.5%) 0.69 0.37 - 1.27 181 (3.5%) 87 (2.6%) 0.72** 0.54 - 0.95 60 (5.0%) 20 (2.7%) 0.47** 0.26 - 0.84 23 (1.4%) 17 (1.7%) 1.17 0.58 - 2.35 27 (2.8%) 14 (2.5%) 0.73 0.35 - 1.53
Trend test p-value <0.0001 0.0196 0.0437 0.0548 0.0007 0.1241 0.1952 0.066
BMI (kg/m2) 0.1113
<25 8153 (51.7%) 4715 (48.2%) 2173 (55.6%) 1266 (51.1%) 503 (23.5%) 256 (21.4%) 275 (31.2%) 146 (30.5%) 3708 (73.0%) 2293 (68.1%) 401 (33.4%) 194 (26.0%) 520 (32.4%) 270 (27.6%) 573 (61.0%) 290 (53.4%)
25-<30 4740 (30.1%) 3123 (31.9%) 1.23*** 1.16 - 1.31 1097 (28.1%) 748 (30.2%) 1.19*** 1.05 - 1.34 821 (38.4%) 444 (37.1%) 1.08 0.89 - 1.32 312 (35.5%) 174 (36.4%) 1.13 0.85 - 1.50 1107 (21.8%) 871 (25.9%) 1.30*** 1.17 - 1.45 452 (37.6%) 315 (42.3%) 1.50*** 1.18 - 1.89 673 (41.9%) 412 (42.1%) 1.23* 0.99 - 1.53 278 (29.6%) 159 (29.3%) 1.14 0.88 - 1.47
30+ 2862 (18.2%) 1948 (19.9%) 1.36*** 1.26 - 1.47 638 (16.3%) 464 (18.7%) 1.33*** 1.14 - 1.53 815 (38.1%) 496 (41.5%) 1.21* 0.99 - 1.48 293 (33.3%) 158 (33.1%) 1.11 0.82 - 1.50 266 (5.2%) 203 (6.0%) 1.37*** 1.12 - 1.67 349 (29.0%) 236 (31.7%) 1.46*** 1.13 - 1.88 412 (25.7%) 297 (30.3%) 1.47*** 1.15 - 1.87 89 (9.5%) 94 (17.3%) 2.10*** 1.50 - 2.94
Trend test p-value <0.0001 <0.0001 0.0609 0.4818 <0.0001 0.0033 0.0018 0.0001
MODEL 2
Average number of cigarettes per day 0.6023
Never 9244 (59.2%) 5806 (60.1%) 1777 (45.9%) 1125 (46.1%) 1019 (46.8%) 578 (47.7%) 416 (47.9%) 240 (50.2%) 3591 (70.7%) 2431 (72.5%) 672 (57.6%) 427 (58.7%) 1057 (70.8%) 624 (69.4%) 712 (74.6%) 381 (69.9%)
<8 cigarettes 1599 (10.2%) 968 (10.0%) 1 0.92 - 1.10 335 (8.6%) 218 (8.9%) 1.04 0.86 - 1.26 314 (14.4%) 168 (13.8%) 1 0.79 - 1.26 76 (8.8%) 43 (9.0%) 0.87 0.56 - 1.35 325 (6.4%) 220 (6.6%) 1.04 0.86 - 1.25 212 (18.2%) 114 (15.7%) 0.85 0.65 - 1.12 249 (16.7%) 157 (17.5%) 1.01 0.80 - 1.28 88 (9.2%) 48 (8.8%) 1.11 0.74 - 1.65
>=8 cigarettes 4769 (30.5%) 2884 (29.9%) 1.03 0.97 - 1.10 1763 (45.5%) 1097 (45.0%) 1.04 0.93 - 1.17 845 (38.8%) 467 (38.5%) 1.02 0.87 - 1.20 376 (43.3%) 195 (40.8%) 0.93 0.72 - 1.20 1161 (22.9%) 704 (21.0%) 0.97 0.86 - 1.09 283 (24.3%) 187 (25.7%) 1.12 0.89 - 1.42 186 (12.5%) 118 (13.1%) 1.06 0.81 - 1.39 155 (16.2%) 116 (21.3%) 1.54*** 1.14 - 2.08
Trend test p-value 0.3117 0.4557 0.823 0.5716 0.6482 0.4973 0.6921 0.0053
alcohol (g/day) 0.1503
none 10179 (63.5%) 6322 (63.6%) 1537 (39.1%) 967 (38.9%) 1442 (64.1%) 787 (63.0%) 583 (65.7%) 289 (58.9%) 3994 (77.5%) 2681 (78.7%) 722 (59.9%) 451 (60.2%) 1158 (71.0%) 721 (72.3%) 743 (76.0%) 426 (76.3%)
<=14 4484 (28.0%) 2828 (28.5%) 1.08** 1.01 - 1.15 1568 (39.9%) 1009 (40.6%) 1.09 0.97 - 1.23 636 (28.3%) 379 (30.3%) 1.11 0.93 - 1.31 231 (26.0%) 166 (33.8%) 1.72*** 1.31 - 2.26 1015 (19.7%) 656 (19.2%) 1.04 0.92 - 1.16 412 (34.2%) 251 (33.5%) 1.01 0.82 - 1.25 423 (26.0%) 250 (25.1%) 0.98 0.80 - 1.21 199 (20.3%) 117 (21.0%) 1.05 0.79 - 1.40
>14 1371 (8.6%) 789 (7.9%) 0.98 0.88 - 1.09 824 (21.0%) 511 (20.5%) 1 0.86 - 1.16 171 (7.6%) 83 (6.6%) 1 0.74 - 1.34 74 (8.3%) 36 (7.3%) 1.11 0.71 - 1.75 145 (2.8%) 71 (2.1%) 0.82 0.61 - 1.11 72 (6.0%) 47 (6.3%) 1.14 0.75 - 1.72 49 (3.0%) 26 (2.6%) 1 0.58 - 1.74 36 (3.7%) 15 (2.7%) 0.62 0.32 - 1.19
Trend test p-value 0.3346 0.735 0.5124 0.015 0.7546 0.6468 0.9062 0.4966
Coffee: (Cups/day) 0.5409
none 5201 (32.4%) 3459 (34.8%) 1249 (31.8%) 846 (34.0%) 972 (43.2%) 564 (45.2%) 298 (33.6%) 193 (39.3%) 1410 (27.4%) 1041 (30.5%) 371 (30.8%) 238 (31.8%) 561 (34.4%) 370 (37.1%) 340 (34.8%) 207 (37.1%)
>=1 7317 (45.6%) 4541 (45.7%) 0.91*** 0.85 - 0.97 1519 (38.7%) 991 (39.8%) 0.94 0.83 - 1.07 1005 (44.7%) 558 (44.7%) 0.98 0.84 - 1.15 423 (47.6%) 218 (44.4%) 0.74** 0.57 - 0.96 2560 (49.7%) 1679 (49.3%) 0.85*** 0.76 - 0.94 544 (45.1%) 342 (45.7%) 0.99 0.79 - 1.24 787 (48.3%) 477 (47.8%) 0.95 0.78 - 1.16 479 (49.0%) 276 (49.5%) 0.94 0.73 - 1.20
>1/<=4 2919 (18.2%) 1638 (16.5%) 0.82*** 0.76 - 0.89 939 (23.9%) 521 (20.9%) 0.81*** 0.70 - 0.94 227 (10.1%) 110 (8.8%) 0.77* 0.59 - 1.01 128 (14.4%) 63 (12.8%) 0.70* 0.48 - 1.02 1003 (19.5%) 601 (17.6%) 0.82*** 0.72 - 0.95 231 (19.2%) 149 (19.9%) 0.97 0.74 - 1.28 259 (15.9%) 133 (13.3%) 0.78* 0.59 - 1.03 132 (13.5%) 61 (10.9%) 0.68* 0.47 - 1.00
>4 597 (3.7%) 301 (3.0%) 0.78*** 0.67 - 0.91 222 (5.7%) 129 (5.2%) 0.93 0.72 - 1.18 45 (2.0%) 17 (1.4%) 0.64 0.35 - 1.17 39 (4.4%) 17 (3.5%) 0.69 0.38 - 1.28 181 (3.5%) 87 (2.6%) 0.72** 0.55 - 0.95 60 (5.0%) 20 (2.7%) 0.45*** 0.25 - 0.80 23 (1.4%) 17 (1.7%) 1.11 0.55 - 2.23 27 (2.8%) 14 (2.5%) 0.72 0.35 - 1.47
Trend test p-value <0.0001 0.0201 0.0607 0.0294 0.0007 0.1182 0.1967 0.066
BMI (kg/m2) 0.1561
<25 8153 (51.7%) 4715 (48.2%) 2173 (55.6%) 1266 (51.1%) 503 (23.5%) 256 (21.4%) 275 (31.2%) 146 (30.5%) 3708 (73.0%) 2293 (68.1%) 401 (33.4%) 194 (26.0%) 520 (32.4%) 270 (27.6%) 573 (61.0%) 290 (53.4%)
25-<30 4740 (30.1%) 3123 (31.9%) 1.23*** 1.16 - 1.31 1097 (28.1%) 748 (30.2%) 1.18*** 1.05 - 1.34 821 (38.4%) 444 (37.1%) 1.1 0.90 - 1.33 312 (35.5%) 174 (36.4%) 1.11 0.84 - 1.48 1107 (21.8%) 871 (25.9%) 1.30*** 1.17 - 1.45 452 (37.6%) 315 (42.3%) 1.46*** 1.16 - 1.84 673 (41.9%) 412 (42.1%) 1.22* 0.99 - 1.51 278 (29.6%) 159 (29.3%) 1.14 0.88 - 1.47
30+ 2862 (18.2%) 1948 (19.9%) 1.36*** 1.26 - 1.47 638 (16.3%) 464 (18.7%) 1.32*** 1.14 - 1.53 815 (38.1%) 496 (41.5%) 1.20* 0.98 - 1.47 293 (33.3%) 158 (33.1%) 1.12 0.83 - 1.51 266 (5.2%) 203 (6.0%) 1.38*** 1.13 - 1.68 349 (29.0%) 236 (31.7%) 1.46*** 1.13 - 1.87 412 (25.7%) 297 (30.3%) 1.46*** 1.15 - 1.85 89 (9.5%) 94 (17.3%) 2.10*** 1.50 - 2.95
Trend test p-value <0.0001 <0.0001 0.0687 0.4633 <0.0001 0.0031 0.0021 0.0001
MODEL 3
Packs of Cigarette per year 0.0455
Never 9244 (59.7%) 5806 (60.7%) 1777 (46.0%) 1125 (46.4%) 1019 (47.7%) 578 (48.6%) 416 (48.4%) 240 (51.0%) 3591 (71.1%) 2431 (73.0%) 672 (58.2%) 427 (59.1%) 1057 (72.2%) 624 (70.4%) 712 (75.2%) 381 (70.4%)
<12 3067 (19.8%) 1879 (19.7%) 1.02 0.95 - 1.09 795 (20.6%) 538 (22.2%) 1.1 0.96 - 1.27 590 (27.6%) 297 (25.0%) 0.91 0.75 - 1.10 174 (20.2%) 97 (20.6%) 0.93 0.68 - 1.27 733 (14.5%) 469 (14.1%) 0.99 0.86 - 1.13 331 (28.7%) 193 (26.7%) 0.91 0.72 - 1.14 311 (21.3%) 212 (23.9%) 1.15 0.93 - 1.43 133 (14.0%) 73 (13.5%) 1.11 0.80 - 1.56
>=12 3164 (20.4%) 1877 (19.6%) 1.02 0.95 - 1.10 1289 (33.4%) 760 (31.4%) 1 0.88 - 1.13 529 (24.7%) 314 (26.4%) 1.11 0.92 - 1.34 270 (31.4%) 134 (28.5%) 0.92 0.69 - 1.23 728 (14.4%) 430 (12.9%) 0.96 0.83 - 1.10 151 (13.1%) 102 (14.1%) 1.19 0.88 - 1.61 95 (6.5%) 50 (5.6%) 0.78 0.54 - 1.15 102 (10.8%) 87 (16.1%) 1.78*** 1.25 - 2.52
Trend test p-value 0.4904 0.9382 0.4018 0.5562 0.5524 0.5681 0.8704 0.0022
alcohol (g/day) 0.1844
none 10179 (63.5%) 6322 (63.6%) 1537 (39.1%) 967 (38.9%) 1442 (64.1%) 787 (63.0%) 583 (65.7%) 289 (58.9%) 3994 (77.5%) 2681 (78.7%) 722 (59.9%) 451 (60.2%) 1158 (71.0%) 721 (72.3%) 743 (76.0%) 426 (76.3%)
<=14 4484 (28.0%) 2828 (28.5%) 1.09** 1.02 - 1.16 1568 (39.9%) 1009 (40.6%) 1.09 0.97 - 1.23 636 (28.3%) 379 (30.3%) 1.1 0.93 - 1.30 231 (26.0%) 166 (33.8%) 1.69*** 1.28 - 2.22 1015 (19.7%) 656 (19.2%) 1.04 0.93 - 1.17 412 (34.2%) 251 (33.5%) 1.03 0.83 - 1.27 423 (26.0%) 250 (25.1%) 1 0.81 - 1.24 199 (20.3%) 117 (21.0%) 1.07 0.81 - 1.42
>14 1371 (8.6%) 789 (7.9%) 0.98 0.89 - 1.09 824 (21.0%) 511 (20.5%) 1.01 0.87 - 1.18 171 (7.6%) 83 (6.6%) 0.99 0.73 - 1.34 74 (8.3%) 36 (7.3%) 1.1 0.70 - 1.73 145 (2.8%) 71 (2.1%) 0.82 0.61 - 1.11 72 (6.0%) 47 (6.3%) 1.18 0.78 - 1.78 49 (3.0%) 26 (2.6%) 0.93 0.53 - 1.64 36 (3.7%) 15 (2.7%) 0.63 0.33 - 1.22
Trend test p-value 0.2645 0.6464 0.5839 0.0213 0.8312 0.5155 0.9209 0.5852
Coffee: (Cups/day) 0.6346
none 5201 (32.4%) 3459 (34.8%) 1249 (31.8%) 846 (34.0%) 972 (43.2%) 564 (45.2%) 298 (33.6%) 193 (39.3%) 1410 (27.4%) 1041 (30.5%) 371 (30.8%) 238 (31.8%) 561 (34.4%) 370 (37.1%) 340 (34.8%) 207 (37.1%)
>=1 7317 (45.6%) 4541 (45.7%) 0.91*** 0.85 - 0.97 1519 (38.7%) 991 (39.8%) 0.95 0.83 - 1.07 1005 (44.7%) 558 (44.7%) 0.97 0.82 - 1.14 423 (47.6%) 218 (44.4%) 0.77* 0.59 - 1.00 2560 (49.7%) 1679 (49.3%) 0.85*** 0.76 - 0.94 544 (45.1%) 342 (45.7%) 0.99 0.79 - 1.24 787 (48.3%) 477 (47.8%) 0.94 0.76 - 1.15 479 (49.0%) 276 (49.5%) 0.91 0.71 - 1.17
>1/<=4 2919 (18.2%) 1638 (16.5%) 0.82*** 0.76 - 0.89 939 (23.9%) 521 (20.9%) 0.81*** 0.70 - 0.94 227 (10.1%) 110 (8.8%) 0.77* 0.59 - 1.02 128 (14.4%) 63 (12.8%) 0.74 0.50 - 1.09 1003 (19.5%) 601 (17.6%) 0.83*** 0.72 - 0.95 231 (19.2%) 149 (19.9%) 0.96 0.73 - 1.27 259 (15.9%) 133 (13.3%) 0.79 0.59 - 1.05 132 (13.5%) 61 (10.9%) 0.68* 0.46 - 1.01
>4 597 (3.7%) 301 (3.0%) 0.77*** 0.66 - 0.90 222 (5.7%) 129 (5.2%) 0.93 0.72 - 1.19 45 (2.0%) 17 (1.4%) 0.59* 0.32 - 1.08 39 (4.4%) 17 (3.5%) 0.69 0.37 - 1.29 181 (3.5%) 87 (2.6%) 0.73** 0.55 - 0.96 60 (5.0%) 20 (2.7%) 0.45*** 0.25 - 0.81 23 (1.4%) 17 (1.7%) 1.12 0.56 - 2.26 27 (2.8%) 14 (2.5%) 0.71 0.34 - 1.47
Trend test p-value <0.0001 0.0215 0.0441 0.0541 0.001 0.1112 0.2229 0.0578
BMI (kg/m2) 0.1451
<25 8153 (51.7%) 4715 (48.2%) 2173 (55.6%) 1266 (51.1%) 503 (23.5%) 256 (21.4%) 275 (31.2%) 146 (30.5%) 3708 (73.0%) 2293 (68.1%) 401 (33.4%) 194 (26.0%) 520 (32.4%) 270 (27.6%) 573 (61.0%) 290 (53.4%)
25-<30 4740 (30.1%) 3123 (31.9%) 1.23*** 1.16 - 1.31 1097 (28.1%) 748 (30.2%) 1.19*** 1.06 - 1.34 821 (38.4%) 444 (37.1%) 1.09 0.89 - 1.32 312 (35.5%) 174 (36.4%) 1.13 0.85 - 1.49 1107 (21.8%) 871 (25.9%) 1.30*** 1.17 - 1.45 452 (37.6%) 315 (42.3%) 1.47*** 1.16 - 1.86 673 (41.9%) 412 (42.1%) 1.25** 1.00 - 1.55 278 (29.6%) 159 (29.3%) 1.16 0.90 - 1.49
30+ 2862 (18.2%) 1948 (19.9%) 1.36*** 1.26 - 1.47 638 (16.3%) 464 (18.7%) 1.33*** 1.15 - 1.54 815 (38.1%) 496 (41.5%) 1.21* 0.98 - 1.48 293 (33.3%) 158 (33.1%) 1.1 0.81 - 1.49 266 (5.2%) 203 (6.0%) 1.37*** 1.12 - 1.68 349 (29.0%) 236 (31.7%) 1.48*** 1.15 - 1.91 412 (25.7%) 297 (30.3%) 1.48*** 1.16 - 1.89 89 (9.5%) 94 (17.3%) 2.08*** 1.48 - 2.92
Trend test p-value <0.0001 <0.0001 0.0635 0.53 <0.0001 0.0023 0.0017 0.0001
*** p<0.01, ** p<0.05, * p<0.1
Page | 27

Table 5. Comparisons of population characteristics between smokers and non-smokers among each PFD subtype control group

Main PFDs
Non-smokers Smokers p-value Non-smokers Smokers p-value Non-smokers Smokers p-value
N 9244 6485 2693 1966 607 449
Ethnicity <0.0001 <0.0001 <0.0001
White 1777 (19.2%) 2115 (32.6%) 642 (23.8%) 736 (37.4%) 146 (24.1%) 178 (39.6%)
African-American 1019 (11.0%) 1188 (18.3%) 245 (9.1%) 303 (15.4%) 101 (16.6%) 92 (20.5%)
Hawaiian 416 (4.5%) 462 (7.1%) 105 (3.9%) 122 (6.2%) 39 (6.4%) 31 (6.9%)
Japanese American 3591 (38.8%) 1497 (23.1%) 782 (29.0%) 329 (16.7%) 215 (35.4%) 94 (20.9%)
Latinos-us born 672 (7.3%) 513 (7.9%) 303 (11.3%) 205 (10.4%) 41 (6.8%) 33 (7.3%)
Latinos-foreign born 1057 (11.4%) 461 (7.1%) 416 (15.4%) 191 (9.7%) 30 (4.9%) 8 (1.8%)
Other 712 (7.7%) 249 (3.8%) 200 (7.4%) 80 (4.1%) 35 (5.8%) 13 (2.9%)
Age at Birth of First Child <0.0001 <0.0001 0.0030
<19 years old 362 (5.6%) 424 (8.9%) 124 (6.4%) 142 (9.8%) 27 (6.2%) 29 (8.6%)
19 - 25 years old 4024 (61.8%) 3229 (67.8%) 1253 (65.1%) 1008 (69.5%) 274 (63.0%) 239 (70.9%)
26 - 32 years old 1570 (24.1%) 794 (16.7%) 389 (20.2%) 214 (14.7%) 93 (21.4%) 56 (16.6%)
>33 years old 557 (8.6%) 319 (6.7%) 158 (8.2%) 87 (6.0%) 41 (9.4%) 13 (3.9%)
Age that period stopped due to (surgery) hysterectomy but no oophorectomy 0.0104 0.39 0.54
< 50 years old 968 (91.6%) 836 (94.6%) 286 (91.1%) 265 (93.0%) 84 (91%) 62 (94%)
>=50 years old 89 (8.4%) 48 (5.4%) 28 (8.9%) 20 (7.0%) 8 (9%) 4 (6%)
Nulliparity 0.7 0.91 0.42
no (have 1 or more kids) 6704 (85.7%) 4893 (85.5%) 1975 (86.2%) 1496 (86.4%) 449 (85.4%) 348 (87.2%)
yes 1116 (14.3%) 830 (14.5%) 315 (13.8%) 236 (13.6%) 77 (14.6%) 51 (12.8%)
Number of children 0.0005 0.41 0.95
0 1322 (14.4%) 943 (14.7%) 364 (13.7%) 275 (14.1%) 84 (14.0%) 57 (12.8%)
1 962 (10.5%) 801 (12.4%) 292 (11.0%) 239 (12.2%) 68 (11.3%) 56 (12.6%)
2 2249 (24.6%) 1424 (22.1%) 591 (22.2%) 418 (21.4%) 141 (23.5%) 107 (24.0%)
3 1856 (20.3%) 1299 (20.2%) 529 (19.9%) 386 (19.8%) 133 (22.1%) 94 (21.1%)
4 1205 (13.2%) 820 (12.7%) 404 (15.2%) 268 (13.7%) 86 (14.3%) 62 (13.9%)
5 611 (6.7%) 477 (7.4%) 179 (6.7%) 156 (8.0%) 42 (7.0%) 27 (6.1%)
6 377 (4.1%) 272 (4.2%) 108 (4.1%) 84 (4.3%) 21 (3.5%) 18 (4.0%)
7 or more 577 (6.3%) 398 (6.2%) 191 (7.2%) 126 (6.5%) 26 (4.3%) 25 (5.6%)
Progesterone Use 0.17 0.60 0.0765
No 3176 (64.4%) 2331 (63.0%) 947 (64.8%) 695 (63.0%) 210 (62.9%) 167 (63.3%)
Yes, previously 659 (13.4%) 546 (14.8%) 204 (14.0%) 157 (14.2%) 50 (15.0%) 25 (9.5%)
Yes, currently 1093 (22.2%) 824 (22.3%) 310 (21.2%) 251 (22.8%) 74 (22.2%) 72 (27.3%)
Estrogen Use 0.0002 0.87 0.33
No 3978 (52.2%) 2738 (49.0%) 1164 (52.2%) 870 (51.5%) 253 (48.7%) 183 (46.9%)
Yes, previously 1276 (16.8%) 1060 (19.0%) 372 (16.7%) 291 (17.2%) 109 (21.0%) 72 (18.5%)
Yes, currently 2360 (31.0%) 1793 (32.1%) 693 (31.1%) 529 (31.3%) 157 (30.3%) 135 (34.6%)
Total Duration of Estrogen Use 0.75 0.11 0.0016
0.5 years 890 (21.9%) 693 (22.2%) 246 (20.3%) 184 (20.6%) 79 (27.4%) 44 (19.2%)
1.5 years 705 (17.4%) 504 (16.2%) 191 (15.8%) 155 (17.3%) 46 (16.0%) 40 (17.5%)
4 years 786 (19.4%) 598 (19.2%) 264 (21.8%) 168 (18.8%) 58 (20.1%) 40 (17.5%)
7.5 years 569 (14.0%) 466 (14.9%) 165 (13.6%) 137 (15.3%) 27 (9.4%) 43 (18.8%)
12 years 461 (11.4%) 369 (11.8%) 141 (11.6%) 123 (13.7%) 36 (12.5%) 22 (9.6%)
17 years 281 (6.9%) 204 (6.5%) 93 (7.7%) 47 (5.3%) 11 (3.8%) 22 (9.6%)
20 years 368 (9.1%) 286 (9.2%) 112 (9.2%) 81 (9.1%) 31 (10.8%) 18 (7.9%)
Total Duration of Progesterone Use 0.39 0.0854 0.0643
0.5 years 471 (24.3%) 367 (25.1%) 136 (23.7%) 101 (23.3%) 39 (30.5%) 21 (20.6%)
1.5 years 408 (21.1%) 293 (20.1%) 119 (20.7%) 89 (20.6%) 23 (18.0%) 22 (21.6%)
4 years 492 (25.4%) 358 (24.5%) 150 (26.1%) 108 (24.9%) 31 (24.2%) 21 (20.6%)
7.5 years 337 (17.4%) 264 (18.1%) 94 (16.4%) 91 (21.0%) 19 (14.8%) 27 (26.5%)
12 years 157 (8.1%) 138 (9.5%) 53 (9.2%) 39 (9.0%) 14 (10.9%) 6 (5.9%)
>= 17 years 72 (3.7%) 40 (2.7%) 22 (3.8%) 5 (1.2%) 2 (1.6%) 5 (4.9%)
Menopausal status 0.0053 0.66 0.81
Pre-Menopausal 658 (9.3%) 445 (8.5%) 169 (8.1%) 125 (7.8%) 40 (8.3%) 32 (8.8%)
Natural Menopause 4319 (60.9%) 3099 (59.0%) 1273 (61.2%) 963 (60.1%) 276 (57.4%) 214 (59.0%)
Surgical Menopause (Oophorectomy) or Hysterectomy 2119 (29.9%) 1705 (32.5%) 638 (30.7%) 513 (32.0%) 165 (34.3%) 117 (32.2%)
History of Asthma or Allergy <0.0001 0.0256 0.22
no 6640 (71.8%) 4328 (66.7%) 1896 (70.4%) 1324 (67.3%) 419 (69.0%) 294 (65.5%)
yes 2604 (28.2%) 2157 (33.3%) 797 (29.6%) 642 (32.7%) 188 (31.0%) 155 (34.5%)
Alcohol (g/day) <0.0001 <0.0001 <0.0001
none 6588 (71.3%) 3357 (51.8%) 1838 (68.3%) 966 (49.1%) 429 (70.7%) 221 (49.2%)
<=14 2257 (24.4%) 2167 (33.4%) 727 (27.0%) 685 (34.8%) 147 (24.2%) 163 (36.3%)
>14 399 (4.3%) 961 (14.8%) 128 (4.8%) 315 (16.0%) 31 (5.1%) 65 (14.5%)
UI POP FI
Page | 28

Coffee: (Cups/day) <0.0001 <0.0001 <0.0001
none 3303 (35.7%) 1789 (27.6%) 998 (37.1%) 507 (25.8%) 222 (36.6%) 114 (25.4%)
>=1 4389 (47.5%) 2783 (42.9%) 1211 (45.0%) 852 (43.3%) 285 (47.0%) 199 (44.3%)
>1/<=4 1380 (14.9%) 1496 (23.1%) 423 (15.7%) 469 (23.9%) 91 (15.0%) 105 (23.4%)
>4 172 (1.9%) 417 (6.4%) 61 (2.3%) 138 (7.0%) 9 (1.5%) 31 (6.9%)
Regular coffee (g/day) <0.0001 <0.0001 <0.0001
0-<240 4967 (53.7%) 2764 (42.6%) 1464 (54.4%) 818 (41.6%) 328 (54.0%) 188 (41.9%)
240-<961 4277 (46.3%) 3721 (57.4%) 1229 (45.6%) 1148 (58.4%) 279 (46.0%) 261 (58.1%)
Decaffeinated Coffee (g/day) <0.0001 0.0075 0.0026
0-<33.95 7025 (76.0%) 4870 (75.1%) 2016 (74.9%) 1490 (75.8%) 479 (78.9%) 323 (71.9%)
33.95-<600 1874 (20.3%) 1183 (18.2%) 549 (20.4%) 350 (17.8%) 108 (17.8%) 92 (20.5%)
600-961 345 (3.7%) 432 (6.7%) 128 (4.8%) 126 (6.4%) 20 (3.3%) 34 (7.6%)
Black Tea (g/day) 0.0837 0.17 0.72
0-<33.94 6836 (74.0%) 4720 (72.8%) 1998 (74.2%) 1413 (71.9%) 417 (68.7%) 302 (67.3%)
33.94-<240 1470 (15.9%) 1118 (17.2%) 446 (16.6%) 345 (17.5%) 124 (20.4%) 91 (20.3%)
240-<961 938 (10.1%) 647 (10.0%) 249 (9.2%) 208 (10.6%) 66 (10.9%) 56 (12.5%)
Vigorous activity (vigorous work and sports) hours per day <0.0001 0.0408 0.0330
none 5341 (61.5%) 3520 (57.1%) 1481 (58.9%) 1070 (57.6%) 338 (59.8%) 240 (56.7%)
<= 0.11 1421 (16.4%) 1015 (16.5%) 447 (17.8%) 303 (16.3%) 96 (17.0%) 64 (15.1%)
> 0.11 - <=0.36 960 (11.0%) 723 (11.7%) 289 (11.5%) 213 (11.5%) 47 (8.3%) 60 (14.2%)
>0.36 966 (11.1%) 908 (14.7%) 298 (11.8%) 273 (14.7%) 84 (14.9%) 59 (13.9%)
BMI (kg/m2) <0.0001 0.0046 0.65
<25 4903 (54.0%) 3137 (49.0%) 1336 (50.5%) 917 (47.2%) 290 (48.8%) 206 (46.8%)
25-<30 2680 (29.5%) 1951 (30.5%) 824 (31.1%) 595 (30.6%) 173 (29.1%) 140 (31.8%)
30+ 1492 (16.4%) 1308 (20.5%) 487 (18.4%) 432 (22.2%) 131 (22.1%) 94 (21.4%)
Calories (Kcal/day) 0.0431 0.45 0.77
427-<1324.27 2278 (24.6%) 1670 (25.8%) 639 (23.7%) 476 (24.2%) 167 (27.5%) 117 (26.1%)
1324.27-<1749.475 2417 (26.1%) 1569 (24.2%) 682 (25.3%) 458 (23.3%) 153 (25.2%) 105 (23.4%)
1749.475-<2345.409 2289 (24.8%) 1634 (25.2%) 686 (25.5%) 522 (26.6%) 136 (22.4%) 109 (24.3%)
2345.409-7742 2260 (24.4%) 1612 (24.9%) 686 (25.5%) 510 (25.9%) 151 (24.9%) 118 (26.3%)
Red meat excluding processed red meat (g/day) <0.0001 0.0102 0.54
0-<12.91 2422 (26.2%) 1541 (23.8%) 679 (25.2%) 448 (22.8%) 169 (27.8%) 117 (26.1%)
12.91-<24.95 2415 (26.1%) 1531 (23.6%) 694 (25.8%) 467 (23.8%) 157 (25.9%) 104 (23.2%)
24.95-<42.98 2290 (24.8%) 1664 (25.7%) 640 (23.8%) 477 (24.3%) 150 (24.7%) 120 (26.7%)
42.98-499 2117 (22.9%) 1749 (27.0%) 680 (25.3%) 574 (29.2%) 131 (21.6%) 108 (24.1%)
Processed red meat (g/day) <0.0001 0.0383 0.34
0-<3.96 2361 (25.5%) 1562 (24.1%) 704 (26.1%) 468 (23.8%) 143 (23.6%) 105 (23.4%)
3.96-<8.96 2386 (25.8%) 1544 (23.8%) 665 (24.7%) 489 (24.9%) 180 (29.7%) 112 (24.9%)
8.96-<17.18 2332 (25.2%) 1612 (24.9%) 692 (25.7%) 481 (24.5%) 141 (23.2%) 115 (25.6%)
17.18-222 2165 (23.4%) 1767 (27.2%) 632 (23.5%) 528 (26.9%) 143 (23.6%) 117 (26.1%)
Density for Vitamin D (IU/1000 kcal/day) 0.18 0.54 1.00
0.44-38.02 2273 (24.6%) 1692 (26.1%) 640 (23.8%) 492 (25.0%) 135 (22.2%) 101 (22.5%)
38.02-<60.85 2323 (25.1%) 1605 (24.7%) 656 (24.4%) 493 (25.1%) 160 (26.4%) 118 (26.3%)
60.85-<91.87 2311 (25.0%) 1605 (24.7%) 695 (25.8%) 477 (24.3%) 160 (26.4%) 120 (26.7%)
91.87-515 2337 (25.3%) 1583 (24.4%) 702 (26.1%) 504 (25.6%) 152 (25.0%) 110 (24.5%)
Total Vegetables (g/day) 0.0013 0.0106 0.17
0.15-<119.37 2212 (23.9%) 1724 (26.6%) 644 (23.9%) 542 (27.6%) 132 (21.7%) 119 (26.5%)
119.37-<162.63 2335 (25.3%) 1621 (25.0%) 655 (24.3%) 492 (25.0%) 154 (25.4%) 112 (24.9%)
162.63-<219.78 2369 (25.6%) 1559 (24.0%) 692 (25.7%) 446 (22.7%) 159 (26.2%) 96 (21.4%)
219.78-1131 2328 (25.2%) 1581 (24.4%) 702 (26.1%) 486 (24.7%) 162 (26.7%) 122 (27.2%)
Total Fruits and Juice (g/day) <0.0001 <0.0001 <0.0001
0-<101.18 1879 (20.3%) 2046 (31.5%) 568 (21.1%) 634 (32.2%) 116 (19.1%) 142 (31.6%)
101.18-<175.79 2281 (24.7%) 1656 (25.5%) 661 (24.5%) 511 (26.0%) 158 (26.0%) 109 (24.3%)
175.79-<272.92 2456 (26.6%) 1485 (22.9%) 716 (26.6%) 471 (24.0%) 160 (26.4%) 110 (24.5%)
272.92-1219 2628 (28.4%) 1298 (20.0%) 748 (27.8%) 350 (17.8%) 173 (28.5%) 88 (19.6%)
* P values were from chi-square test
Page | 29

4.1.3. Multivariate models of reproductive variables and UI risk
Two multivariate models including either estrogen use or total duration of estrogen use were
utilized to assess the correlation between factors related to reproductive history and the risk of UI
(Table 6). Positive associations between estrogen use and risk of UI were observed, with ORs
that were attenuated compared to the univariate models. Current estrogen users were 1.68 times
more likely to get UI compared to women who never used estrogen (95%CI: 1.44-1.97) (trend
p<0.0001). Comparable statistically significant positive associations were observed among
Whites and Japanese, non-significant positive associations were observed for African-
Americans, Hawaiians and US-born Latinos, but not association was observed among foreign-
born Latinos (heterogeneity p = 0.0602). The positive associations between progesterone use and
UI risk were still observed in this model, including all Latinos. Parity was an independent risk
factor in this model. The increasing risk of UI with parity was statistically significant among
Whites, Japanese Americans, and Latinos and marginally significant among African-Americans.
The model considering duration of estrogen use showed similar results, with a
statistically significant dose-response trend of positive association with increasing years of
estrogen use among Whites, Hawaiians, and Japanese women, but no evidence of association
among African-Americans and Latino women.

Page | 30

Table 6. Multivariate models of estrogen use for UI across ethnic groups
MODEL 1 Total White Black Hawaiian Japanese L-us born L-foreign born Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 16034 9939 3929 2487 2249 1249 888 491 5154 3408 1206 749 1630 997
Estrogen Use 0.0602
No 6787 (50.9%) 3101 (37.1%) 1481 (41.8%) 630 (27.9%) 1107 (58.1%) 519 (47.9%) 466 (58.7%) 168 (38.4%) 2308 (50.1%) 1031 (33.8%) 576 (52.5%) 275 (40.2%) 849 (60.9%) 478 (57.5%)
Yes, previously 2375 (17.8%) 1538 (18.4%) 1.21** 1.04 - 1.41 661 (18.6%) 414 (18.3%) 1.3 0.95 - 1.78 450 (23.6%) 291 (26.8%) 0.97 0.69 - 1.38 125 (15.7%) 92 (21.0%) 1.6 0.81 - 3.14 636 (13.8%) 415 (13.6%) 1.45** 1.08 - 1.95 208 (19.0%) 139 (20.3%) 1.3 0.79 - 2.14 295 (21.1%) 187 (22.5%) 1.08 0.71 - 1.62
Yes, currently 4178 (31.3%) 3713 (44.5%) 1.68*** 1.44 - 1.97 1405 (39.6%) 1216 (53.8%) 1.82*** 1.33 - 2.47 347 (18.2%) 274 (25.3%) 1.32 0.87 - 2.00 203 (25.6%) 178 (40.6%) 1.58 0.80 - 3.11 1659 (36.0%) 1608 (52.7%) 2.38*** 1.77 - 3.21 313 (28.5%) 270 (39.5%) 1.44 0.89 - 2.35 251 (18.0%) 167 (20.1%) 0.98 0.62 - 1.55
Trend test p-value <0.0001 <0.0001 0.1873 0.2697 <0.0001 0.1513 0.9572
Menopausal status 0.1492
Pre-Menopausal 1111 (8.9%) 508 (6.5%) 305 (9.1%) 117 (5.5%) 131 (7.5%) 54 (5.3%) 90 (12.2%) 31 (7.7%) 432 (10.1%) 215 (7.5%) 76 (7.5%) 41 (6.6%) 77 (5.7%) 50 (6.2%)
Natural Menopause 7509 (60.1%) 4311 (55.1%) 0.87 0.66 - 1.16 1975 (59.0%) 1126 (52.9%) 1.05 0.59 - 1.85 834 (47.6%) 437 (43.2%) 1.11 0.47 - 2.61 412 (56.0%) 214 (53.0%) 1.21 0.40 - 3.69 2802 (65.2%) 1723 (60.5%) 0.7 0.42 - 1.19 570 (56.3%) 292 (46.9%) 0.58 0.23 - 1.46 916 (68.0%) 519 (64.4%) 0.66 0.31 - 1.40
Surgical Menopause (Oophorectomy) or Hysterectomy 3872 (31.0%) 3002 (38.4%) 1.07 0.80 - 1.44 1070 (31.9%) 885 (41.6%) 1.46 0.82 - 2.62 786 (44.9%) 521 (51.5%) 1.06 0.44 - 2.58 234 (31.8%) 159 (39.4%) 1.51 0.46 - 5.01 1062 (24.7%) 911 (32.0%) 0.73 0.42 - 1.26 366 (36.2%) 289 (46.5%) 0.93 0.36 - 2.35 354 (26.3%) 237 (29.4%) 0.81 0.36 - 1.81
Trend test p-value 0.0037 0.0019 0.8838 0.3463 0.747 0.0924 0.5313
Progesterone Use 0.8353
No 5565 (63.9%) 3683 (58.7%) 1402 (56.5%) 941 (52.5%) 948 (80.3%) 598 (78.0%) 317 (68.9%) 184 (58.0%) 1686 (57.4%) 1203 (52.4%) 498 (70.3%) 327 (65.4%) 714 (75.2%) 430 (71.2%)
Yes, previously 1225 (14.1%) 1071 (17.1%) 1.48*** 1.29 - 1.69 439 (17.7%) 380 (21.2%) 1.38*** 1.11 - 1.72 139 (11.8%) 114 (14.9%) 1.70** 1.13 - 2.57 65 (14.1%) 62 (19.6%) 1.52 0.86 - 2.70 343 (11.7%) 329 (14.3%) 1.48*** 1.15 - 1.91 95 (13.4%) 87 (17.4%) 1.44 0.88 - 2.36 144 (15.2%) 99 (16.4%) 1.66** 1.05 - 2.62
Yes, currently 1925 (22.1%) 1522 (24.3%) 1.17** 1.01 - 1.36 642 (25.9%) 470 (26.2%) 1.14 0.88 - 1.47 93 (7.9%) 55 (7.2%) 0.84 0.49 - 1.46 78 (17.0%) 71 (22.4%) 1.62 0.84 - 3.13 906 (30.9%) 765 (33.3%) 1.06 0.82 - 1.37 115 (16.2%) 86 (17.2%) 1.21 0.72 - 2.06 91 (9.6%) 75 (12.4%) 1.64* 0.94 - 2.86
Trend test p-value 0.0006 0.0909 0.4989 0.0878 0.2674 0.3051 0.0223
Parity 0.2149
0 2291 (14.5%) 1005 (10.2%) 705 (18.1%) 320 (13.0%) 316 (14.4%) 154 (12.6%) 65 (7.4%) 28 (5.7%) 771 (15.1%) 348 (10.3%) 132 (11.1%) 55 (7.5%) 164 (10.4%) 53 (5.5%)
1 1785 (11.3%) 1008 (10.3%) 1.19* 0.99 - 1.42 482 (12.4%) 267 (10.8%) 0.89 0.66 - 1.21 325 (14.8%) 190 (15.6%) 1.55* 0.95 - 2.55 60 (6.8%) 30 (6.2%) 0.65 0.17 - 2.51 590 (11.6%) 352 (10.4%) 1.36* 0.99 - 1.85 80 (6.7%) 41 (5.6%) 1.56 0.59 - 4.13 157 (9.9%) 73 (7.6%) 1.64 0.81 - 3.31
2 3716 (23.5%) 2447 (24.9%) 1.37*** 1.18 - 1.59 983 (25.2%) 643 (26.1%) 1.18 0.91 - 1.53 407 (18.5%) 224 (18.3%) 1.73** 1.07 - 2.79 116 (13.2%) 83 (17.0%) 1.97 0.67 - 5.82 1605 (31.4%) 1119 (33.1%) 1.28** 1.01 - 1.63 213 (17.9%) 119 (16.1%) 2.05* 0.99 - 4.26 209 (13.2%) 118 (12.2%) 2.03** 1.05 - 3.95
3+ 8023 (50.7%) 5350 (54.5%) 1.53*** 1.33 - 1.76 1724 (44.3%) 1231 (50.0%) 1.32** 1.05 - 1.67 1153 (52.4%) 653 (53.5%) 1.52** 1.00 - 2.31 637 (72.6%) 346 (71.0%) 1.26 0.48 - 3.28 2141 (41.9%) 1566 (46.3%) 1.54*** 1.21 - 1.95 763 (64.2%) 523 (70.9%) 2.31** 1.20 - 4.45 1051 (66.5%) 722 (74.7%) 2.64*** 1.53 - 4.56
Trend test p-value <0.0001 0.0019 0.1672 0.7731 0.0008 0.0075 0.0001
MODEL 2
Total duration of estrogen use 0.1863
Never 6787 (48.3%) 3101 (34.7%) 1481 (39.9%) 630 (26.5%) 1107 (56.4%) 519 (46.1%) 466 (57.0%) 168 (37.1%) 2308 (48.8%) 1031 (32.3%) 576 (51.6%) 275 (39.3%) 849 (61.2%) 478 (57.7%)
< 4 years 2833 (20.1%) 1810 (20.2%) 1.28*** 1.10 - 1.49 717 (19.3%) 414 (17.4%) 1.37** 1.00 - 1.88 439 (22.4%) 275 (24.4%) 0.99 0.69 - 1.42 155 (18.9%) 105 (23.2%) 1.3 0.65 - 2.60 809 (17.1%) 546 (17.1%) 1.65*** 1.24 - 2.19 216 (19.4%) 154 (22.0%) 1.3 0.80 - 2.10 339 (24.4%) 201 (24.3%) 1.04 0.69 - 1.57
>= 4 years 4445 (31.6%) 4037 (45.1%) 1.60*** 1.37 - 1.86 1510 (40.7%) 1332 (56.1%) 1.69*** 1.25 - 2.29 418 (21.3%) 332 (29.5%) 1.14 0.77 - 1.69 197 (24.1%) 180 (39.7%) 1.94* 0.98 - 3.83 1613 (34.1%) 1615 (50.6%) 2.20*** 1.64 - 2.93 324 (29.0%) 270 (38.6%) 1.39 0.84 - 2.29 200 (14.4%) 149 (18.0%) 0.99 0.61 - 1.59
Trend Test p-value <0.0001 0.0004 0.4472 0.0371 <0.0001 0.223 0.9666
Menopausal status 0.1284
Pre-Menopausal 1111 (8.9%) 508 (6.5%) 305 (9.1%) 117 (5.5%) 131 (7.5%) 54 (5.3%) 90 (12.2%) 31 (7.7%) 432 (10.1%) 215 (7.5%) 76 (7.5%) 41 (6.6%) 77 (5.7%) 50 (6.2%)
Natural Menopause 7509 (60.1%) 4311 (55.1%) 0.89 0.67 - 1.19 1975 (59.0%) 1126 (52.9%) 1.12 0.63 - 1.99 834 (47.6%) 437 (43.2%) 1.1 0.47 - 2.60 412 (56.0%) 214 (53.0%) 1.42 0.46 - 4.37 2802 (65.2%) 1723 (60.5%) 0.71 0.42 - 1.21 570 (56.3%) 292 (46.9%) 0.58 0.23 - 1.46 916 (68.0%) 519 (64.4%) 0.59 0.27 - 1.28
Surgical Menopause (Oophorectomy) or Hysterectomy 3872 (31.0%) 3002 (38.4%) 1.13 0.84 - 1.52 1070 (31.9%) 885 (41.6%) 1.62 0.90 - 2.90 786 (44.9%) 521 (51.5%) 1.11 0.45 - 2.69 234 (31.8%) 159 (39.4%) 1.46 0.45 - 4.78 1062 (24.7%) 911 (32.0%) 0.78 0.45 - 1.35 366 (36.2%) 289 (46.5%) 0.96 0.38 - 2.43 354 (26.3%) 237 (29.4%) 0.77 0.34 - 1.77
Trend Test p-value 0.0005 0.0003 0.9043 0.668 0.8161 0.0728 0.4895
Progesterone Use 0.8845
No 5565 (63.9%) 3683 (58.7%) 1402 (56.5%) 941 (52.5%) 948 (80.3%) 598 (78.0%) 317 (68.9%) 184 (58.0%) 1686 (57.4%) 1203 (52.4%) 498 (70.3%) 327 (65.4%) 714 (75.2%) 430 (71.2%)
Yes, previously 1225 (14.1%) 1071 (17.1%) 1.45*** 1.26 - 1.66 439 (17.7%) 380 (21.2%) 1.34*** 1.08 - 1.67 139 (11.8%) 114 (14.9%) 1.82*** 1.19 - 2.77 65 (14.1%) 62 (19.6%) 1.44 0.81 - 2.58 343 (11.7%) 329 (14.3%) 1.37** 1.07 - 1.76 95 (13.4%) 87 (17.4%) 1.42 0.87 - 2.34 144 (15.2%) 99 (16.4%) 1.80** 1.12 - 2.88
Yes, currently 1925 (22.1%) 1522 (24.3%) 1.29*** 1.12 - 1.48 642 (25.9%) 470 (26.2%) 1.22 0.96 - 1.56 93 (7.9%) 55 (7.2%) 1.03 0.61 - 1.72 78 (17.0%) 71 (22.4%) 1.34 0.71 - 2.56 906 (30.9%) 765 (33.3%) 1.24* 0.98 - 1.56 115 (16.2%) 86 (17.2%) 1.29 0.78 - 2.13 91 (9.6%) 75 (12.4%) 1.69* 0.98 - 2.91
Trend Test p-value <0.0001 0.0504 0.263 0.2674 0.0506 0.2387 0.0194
Parity 0.2429
0 2291 (14.5%) 1005 (10.2%) 705 (18.1%) 320 (13.0%) 316 (14.4%) 154 (12.6%) 65 (7.4%) 28 (5.7%) 771 (15.1%) 348 (10.3%) 132 (11.1%) 55 (7.5%) 164 (10.4%) 53 (5.5%)
1 1785 (11.3%) 1008 (10.3%) 1.19* 0.99 - 1.44 482 (12.4%) 267 (10.8%) 0.87 0.64 - 1.19 325 (14.8%) 190 (15.6%) 1.5 0.91 - 2.48 60 (6.8%) 30 (6.2%) 0.64 0.16 - 2.53 590 (11.6%) 352 (10.4%) 1.37* 1.00 - 1.87 80 (6.7%) 41 (5.6%) 1.61 0.61 - 4.29 157 (9.9%) 73 (7.6%) 2.11** 1.00 - 4.43
2 3716 (23.5%) 2447 (24.9%) 1.37*** 1.18 - 1.60 983 (25.2%) 643 (26.1%) 1.18 0.91 - 1.53 407 (18.5%) 224 (18.3%) 1.69** 1.05 - 2.75 116 (13.2%) 83 (17.0%) 1.99 0.66 - 5.98 1605 (31.4%) 1119 (33.1%) 1.30** 1.02 - 1.66 213 (17.9%) 119 (16.1%) 2.05* 0.99 - 4.25 209 (13.2%) 118 (12.2%) 2.07** 1.04 - 4.15
3+ 8023 (50.7%) 5350 (54.5%) 1.52*** 1.32 - 1.75 1724 (44.3%) 1231 (50.0%) 1.30** 1.03 - 1.65 1153 (52.4%) 653 (53.5%) 1.45* 0.94 - 2.22 637 (72.6%) 346 (71.0%) 1.26 0.48 - 3.34 2141 (41.9%) 1566 (46.3%) 1.55*** 1.22 - 1.97 763 (64.2%) 523 (70.9%) 2.33** 1.21 - 4.48 1051 (66.5%) 722 (74.7%) 2.83*** 1.60 - 5.00
Trend Test p-value <0.0001 0.0026 0.2583 0.7618 0.0006 0.0079 0.0002
*** p<0.01, ** p<0.05, * p<0.1
Page | 31

4.1.4. Multivariate models of factors related to diet and lifestyle and UI risk
A model including all factors related to diet and lifestyle was used to select important modifiable
risk factors for UI (Table 7). In this model, we observed that regular coffee, BMI, and vitamin D
intake remained statistically significant risk factors for UI. Women taking over 91.87 IU/1000
kcal/day Vitamin D having 1.22 times the risk of having UI compared to women taking less than
38.02 IU/1000 kcal/day (95%CI: 1.13-1.32). There was a significant dose-response trend of
positive association with increasing intake among Whites, Japanese, and Latinos – foreign born.
Overweight and obese women were more likely to get UI compared to women with BMI less
than 25kg/m
2
with odds ratios of 1.23 and 1.34, respectively. The risk increased with higher BMI
among Whites, Japanese American, and Latinos. Women who drank 14 g/day alcohol were
1.08 times to be diagnosed of UI compared to those who never drank alcohol (95%CI: 1.01-
1.15), but no significant association was found among women drank more than 14 g/day.
Women who drank more than 240g regular coffee per day had lower risk of UI (OR=0.86,
95%CI: 0.81-0.90), and this association was statistically significant for all ethnic groups except
Hawaiians and Latinos. The association between decaffeinated coffee and UI was inconsistent
among different ethnic groups. Red meat excluding processed red meat, processed red meat, total
vegetables, total fruits and juice and physical activity were also considered in this model, but no
more than 10% change occurred in estimates.

Page | 32

Table 7. Multivariate models of factors related to diet and lifestyle for UI across ethnic groups
Total White Black Hawaiian Japanese L-us born L-foreign born Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 16034 9939 3929 2487 2249 1249 888 491 5154 3408 1206 749 1630 997
Density for Vitamin D (IU/1000 kcal/day) 0.3726
0.44-38.02 4039 (25.2%) 2164 (21.8%) 696 (17.7%) 359 (14.4%) 558 (24.8%) 307 (24.6%) 182 (20.5%) 91 (18.5%) 1574 (30.5%) 874 (25.6%) 330 (27.4%) 194 (25.9%) 420 (25.8%) 223 (22.4%)
38.02-<60.85 4007 (25.0%) 2437 (24.5%) 1.11** 1.02 - 1.20 846 (21.5%) 479 (19.3%) 1.07 0.89 - 1.28 611 (27.2%) 308 (24.7%) 0.95 0.77 - 1.18 215 (24.2%) 124 (25.3%) 1.01 0.71 - 1.45 1394 (27.0%) 934 (27.4%) 1.11* 0.98 - 1.26 281 (23.3%) 195 (26.0%) 1.16 0.88 - 1.53 404 (24.8%) 244 (24.5%) 1.29* 0.99 - 1.69
60.85-<91.87 4001 (25.0%) 2640 (26.6%) 1.18*** 1.09 - 1.27 1019 (25.9%) 692 (27.8%) 1.24** 1.05 - 1.47 550 (24.5%) 336 (26.9%) 1.07 0.86 - 1.33 245 (27.6%) 142 (28.9%) 1.05 0.75 - 1.49 1225 (23.8%) 900 (26.4%) 1.20*** 1.05 - 1.36 302 (25.0%) 175 (23.4%) 0.97 0.73 - 1.29 429 (26.3%) 250 (25.1%) 1.21 0.92 - 1.58
91.87-515 3987 (24.9%) 2698 (27.1%) 1.22*** 1.13 - 1.32 1368 (34.8%) 957 (38.5%) 1.29*** 1.10 - 1.52 530 (23.6%) 298 (23.9%) 1.04 0.83 - 1.30 246 (27.7%) 134 (27.3%) 0.95 0.66 - 1.35 961 (18.6%) 700 (20.5%) 1.22*** 1.06 - 1.40 293 (24.3%) 185 (24.7%) 0.93 0.70 - 1.24 377 (23.1%) 280 (28.1%) 1.54*** 1.19 - 2.00
Trend Test p-value <0.0001 0.0004 0.5229 0.8164 0.0018 0.42 0.0033
Calories (Kcal/day) 0.0033
427-<1324.27 4026 (25.1%) 2464 (24.8%) 984 (25.0%) 642 (25.8%) 726 (32.3%) 421 (33.8%) 161 (18.1%) 81 (16.5%) 1298 (25.2%) 746 (21.9%) 327 (27.1%) 207 (27.6%) 300 (18.4%) 231 (23.2%)
1324.27-<1749.475 4049 (25.3%) 2476 (24.9%) 1.01 0.93 - 1.08 1116 (28.4%) 728 (29.3%) 1.03 0.89 - 1.18 494 (22.0%) 239 (19.2%) 0.92 0.74 - 1.13 163 (18.4%) 101 (20.6%) 1.31 0.88 - 1.95 1515 (29.4%) 959 (28.1%) 1.08 0.95 - 1.23 248 (20.6%) 160 (21.4%) 1.09 0.82 - 1.45 299 (18.3%) 166 (16.6%) 0.63*** 0.47 - 0.85
1749.475-<2345.409 3991 (24.9%) 2463 (24.8%) 1.01 0.94 - 1.10 1075 (27.4%) 654 (26.3%) 0.97 0.84 - 1.12 485 (21.6%) 248 (19.9%) 0.91 0.73 - 1.13 213 (24.0%) 114 (23.3%) 1.05 0.72 - 1.53 1398 (27.1%) 976 (28.6%) 1.19*** 1.05 - 1.36 246 (20.4%) 162 (21.6%) 1.06 0.79 - 1.43 357 (21.9%) 201 (20.2%) 0.74** 0.56 - 0.98
2345.409-7742 3968 (24.7%) 2533 (25.5%) 1.09** 1.01 - 1.18 754 (19.2%) 463 (18.6%) 0.97 0.82 - 1.14 544 (24.2%) 339 (27.2%) 1.22* 0.99 - 1.50 351 (39.5%) 194 (39.6%) 1.1 0.77 - 1.58 943 (18.3%) 727 (21.3%) 1.37*** 1.19 - 1.58 385 (31.9%) 220 (29.4%) 0.92 0.70 - 1.20 674 (41.3%) 399 (40.0%) 0.75** 0.59 - 0.97
Trend Test p-value 0.0317 0.5166 0.1028 0.9941 <0.0001 0.4503 0.1216
BMI (kg/m2) 0.1609
<25 8153 (51.7%) 4715 (48.2%) 2173 (55.6%) 1266 (51.1%) 503 (23.5%) 256 (21.4%) 275 (31.2%) 146 (30.5%) 3708 (73.0%) 2293 (68.1%) 401 (33.4%) 194 (26.0%) 520 (32.4%) 270 (27.6%)
25-<30 4740 (30.1%) 3123 (31.9%) 1.23*** 1.15 - 1.31 1097 (28.1%) 748 (30.2%) 1.18*** 1.05 - 1.34 821 (38.4%) 444 (37.1%) 1.06 0.87 - 1.30 312 (35.5%) 174 (36.4%) 1.12 0.84 - 1.49 1107 (21.8%) 871 (25.9%) 1.28*** 1.15 - 1.43 452 (37.6%) 315 (42.3%) 1.49*** 1.17 - 1.89 673 (41.9%) 412 (42.1%) 1.26** 1.01 - 1.57
30+ 2862 (18.2%) 1948 (19.9%) 1.34*** 1.24 - 1.45 638 (16.3%) 464 (18.7%) 1.34*** 1.15 - 1.55 815 (38.1%) 496 (41.5%) 1.17 0.96 - 1.44 293 (33.3%) 158 (33.1%) 1.1 0.80 - 1.49 266 (5.2%) 203 (6.0%) 1.33*** 1.09 - 1.63 349 (29.0%) 236 (31.7%) 1.50*** 1.16 - 1.94 412 (25.7%) 297 (30.3%) 1.53*** 1.19 - 1.96
Trend Test p-value <0.0001 <0.0001 0.115 0.5504 <0.0001 0.0021 0.0008
Packs of Cigarette per year 0.0367
Never 9244 (59.7%) 5806 (60.7%) 1777 (46.0%) 1125 (46.4%) 1019 (47.7%)578 (48.6%) 416 (48.4%) 240 (51.0%) 3591 (71.1%) 2431 (73.0%) 672 (58.2%) 427 (59.1%) 1057 (72.2%) 624 (70.4%)
< 12 3067 (19.8%) 1879 (19.7%) 1.02 0.95 - 1.09 795 (20.6%) 538 (22.2%) 1.11 0.96 - 1.27 590 (27.6%) 297 (25.0%) 0.9 0.75 - 1.09 174 (20.2%) 97 (20.6%) 0.93 0.67 - 1.27 733 (14.5%) 469 (14.1%) 0.99 0.86 - 1.13 331 (28.7%) 193 (26.7%) 0.89 0.70 - 1.12 311 (21.3%) 212 (23.9%) 1.16 0.93 - 1.44
>= 12 3164 (20.4%) 1877 (19.6%) 1.03 0.96 - 1.11 1289 (33.4%) 760 (31.4%) 1 0.88 - 1.13 529 (24.7%) 314 (26.4%) 1.11 0.92 - 1.34 270 (31.4%) 134 (28.5%) 0.91 0.68 - 1.21 728 (14.4%) 430 (12.9%) 0.97 0.85 - 1.12 151 (13.1%) 102 (14.1%) 1.13 0.84 - 1.54 95 (6.5%) 50 (5.6%) 0.82 0.56 - 1.21
Trend Test p-value 0.3952 0.8719 0.4014 0.512 0.7027 0.8196 0.9615
alcohol (g/day) 0.2028
none 10179 (63.5%) 6322 (63.6%) 1537 (39.1%) 967 (38.9%) 1442 (64.1%)787 (63.0%) 583 (65.7%) 289 (58.9%) 3994 (77.5%) 2681 (78.7%) 722 (59.9%) 451 (60.2%) 1158 (71.0%) 721 (72.3%)
<=14 4484 (28.0%) 2828 (28.5%) 1.08** 1.01 - 1.15 1568 (39.9%) 1009 (40.6%) 1.08 0.96 - 1.22 636 (28.3%) 379 (30.3%) 1.12 0.94 - 1.33 231 (26.0%) 166 (33.8%) 1.63*** 1.24 - 2.14 1015 (19.7%) 656 (19.2%) 1.02 0.91 - 1.15 412 (34.2%) 251 (33.5%) 1.01 0.82 - 1.25 423 (26.0%) 250 (25.1%) 1 0.81 - 1.24
>14 1371 (8.6%) 789 (7.9%) 1 0.90 - 1.11 824 (21.0%) 511 (20.5%) 1.03 0.89 - 1.20 171 (7.6%) 83 (6.6%) 0.99 0.73 - 1.35 74 (8.3%) 36 (7.3%) 1.11 0.70 - 1.75 145 (2.8%) 71 (2.1%) 0.81 0.60 - 1.10 72 (6.0%) 47 (6.3%) 1.24 0.81 - 1.88 49 (3.0%) 26 (2.6%) 1.02 0.57 - 1.80
Trend Test p-value 0.2303 0.5301 0.4816 0.0278 0.6432 0.485 0.9833
Regular coffee (g/day) 0.8413
0-<240 7905 (49.3%) 5247 (52.8%) 1749 (44.5%) 1174 (47.2%) 1405 (62.5%)835 (66.9%) 469 (52.8%) 277 (56.4%) 2314 (44.9%) 1688 (49.5%) 581 (48.2%) 374 (49.9%) 875 (53.7%) 575 (57.7%)
240-<961 8129 (50.7%) 4692 (47.2%) 0.86*** 0.81 - 0.90 2180 (55.5%) 1313 (52.8%) 0.88** 0.79 - 0.98 844 (37.5%) 414 (33.1%) 0.83** 0.71 - 0.98 419 (47.2%) 214 (43.6%) 0.87 0.68 - 1.11 2840 (55.1%) 1720 (50.5%) 0.83*** 0.75 - 0.91 625 (51.8%) 375 (50.1%) 0.94 0.77 - 1.16 755 (46.3%) 422 (42.3%) 0.86 0.72 - 1.04
Decaffeinated Coffee (g/day) 0.491
0-<33.95 12116 (75.6%) 7317 (73.6%) 2933 (74.7%) 1815 (73.0%) 1703 (75.7%)935 (74.9%) 697 (78.5%) 388 (79.0%) 4027 (78.1%) 2559 (75.1%) 912 (75.6%) 538 (71.8%) 1147 (70.4%) 677 (67.9%)
33.95-<600 3124 (19.5%) 2120 (21.3%) 1.08** 1.01 - 1.16 689 (17.5%) 500 (20.1%) 1.08 0.94 - 1.24 453 (20.1%) 262 (21.0%) 1.1 0.91 - 1.33 161 (18.1%) 87 (17.7%) 0.93 0.68 - 1.27 961 (18.6%) 702 (20.6%) 1.1 0.98 - 1.24 231 (19.2%) 174 (23.2%) 1.28* 1.00 - 1.65 400 (24.5%) 270 (27.1%) 1.04 0.84 - 1.28
600-961 794 (5.0%) 502 (5.1%) 0.99 0.88 - 1.12 307 (7.8%) 172 (6.9%) 0.85 0.69 - 1.04 93 (4.1%) 52 (4.2%) 1.02 0.70 - 1.47 30 (3.4%) 16 (3.3%) 0.9 0.45 - 1.81 166 (3.2%) 147 (4.3%) 1.29** 1.01 - 1.64 63 (5.2%) 37 (4.9%) 0.89 0.56 - 1.41 83 (5.1%) 50 (5.0%) 1.05 0.69 - 1.60
Trend Test p-value 0.204 0.4825 0.4962 0.5948 0.0155 0.4074 0.686
Black Tea (g/day) 0.2847
0-<33.94 11791 (73.5%) 7377 (74.2%) 2638 (67.1%) 1654 (66.5%) 1785 (79.4%)1028 (82.3%) 618 (69.6%) 339 (69.0%) 3767 (73.1%) 2543 (74.6%) 909 (75.4%) 565 (75.4%) 1370 (84.0%) 829 (83.1%)
33.94-<240 2633 (16.4%) 1626 (16.4%) 0.95 0.88 - 1.02 708 (18.0%) 494 (19.9%) 1.09 0.95 - 1.25 331 (14.7%) 160 (12.8%) 0.82* 0.66 - 1.03 170 (19.1%) 106 (21.6%) 1.12 0.84 - 1.50 897 (17.4%) 562 (16.5%) 0.89* 0.79 - 1.01 202 (16.7%) 121 (16.2%) 0.95 0.73 - 1.24 155 (9.5%) 108 (10.8%) 1.03 0.76 - 1.40
240-<961 1610 (10.0%) 936 (9.4%) 0.89** 0.81 - 0.97 583 (14.8%) 339 (13.6%) 0.89 0.76 - 1.04 133 (5.9%) 61 (4.9%) 0.8 0.56 - 1.13 100 (11.3%) 46 (9.4%) 0.83 0.55 - 1.25 490 (9.5%) 303 (8.9%) 0.89 0.76 - 1.05 95 (7.9%) 63 (8.4%) 0.98 0.67 - 1.42 105 (6.4%) 60 (6.0%) 0.83 0.58 - 1.21
Trend Test p-value 0.0066 0.439 0.0495 0.7044 0.0447 0.7816 0.4591
*** p<0.01, ** p<0.05, * p<0.1
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4.1.5. Multivariate models of all variables for UI risk
A multivariate model with 15 independent variables was fitted, and we observed that estrogen
use remained statistically significantly associated with UI risk, with current estrogen user having
1.89 risk compared to never users (95% CI: 1.60-2.24) (Table 8). This association was
significant among whites who were 2.10 times more likely to get UI compared to women who
never took estrogen (95%CI: 1.50-2.93), and Japanese Americans who had a 2.54-fold increase
risk of having UI among (95%CI: 1.85-3.48). Positive associations were observed among other
groups but they did not reach statistically significance (heterogeneity p = 0.0613). Current
progesterone use was no longer associated with UI risk. However, previous progesterone use was
still associated with 1.45-fold increase in the risk of UI compared to women who never used
progesterone (95%CI: 1.26-1.67), this was consistent across all racial/ethnic groups. Parity was
still a risk factor for UI with the risk of getting UI among women who never had a child reduced
by 27% compared to women who had one or more children. The associations between nulliparity
and UI were significant for Japanese Americans, and Latinos – foreign born. Among Latinos –
foreign born, women who had children were 2.44 times to get UI, and among Latinos born in
US, it was 1.89-fold increase in the likelihood of UI for women who had children, but the
association was not significant for Latinos born in US.
Density of vitamin D intake was no longer associated with UI risk as observed in the
univariate analyses and multivariate model of diet and lifestyle variables. Similarly, a positive
association with high caloric intake was only observed among Japanese. BMI was still a
significant risk factor. However, the association was only statistically significant among Whites,
Japanese Americans, and Latinos – foreign born.
Page | 34

The association with alcohol was restricted to Hawaiians, with women who drank no
more than 14 g/day having 1.99 times the risk of UI compared to those who never drank alcohol
(95%CI: 1.16-3.43). The previously observed inverse association with coffee intake was still
present (trend p=0.0009), especially for Hawaiians, and Japanese. Vigorous physical activity was
only statistically significantly inversely associated with UI risk among whites. Red meat
excluding processed red meat, processed red meat, vegetables, and fruits and juices were also
considered in this model, but no more than 10% change occur in estimates.

Page | 35

Table 8. Multivariate models of all variables for UI across ethnic groups
Total White Black Hawaiian Japanese L-us born L-foreign born Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 16034 9939 3929 2487 2249 1249 888 491 5154 3408 1206 749 1630 997
Estrogen Use 0.0613
No 6787 (50.9%) 3101 (37.1%) 1481 (41.8%) 630 (27.9%) 1107 (58.1%) 519 (47.9%) 466 (58.7%) 168 (38.4%) 2308 (50.1%) 1031 (33.8%) 576 (52.5%) 275 (40.2%) 849 (60.9%) 478 (57.5%)
Yes, previously 2375 (17.8%) 1538 (18.4%) 1.27*** 1.08 - 1.50 661 (18.6%) 414 (18.3%) 1.39* 0.99 - 1.96 450 (23.6%) 291 (26.8%) 0.9 0.60 - 1.34 125 (15.7%) 92 (21.0%) 1.9 0.85 - 4.27 636 (13.8%) 415 (13.6%) 1.47** 1.07 - 2.01 208 (19.0%) 139 (20.3%) 1.27 0.71 - 2.25 295 (21.1%) 187 (22.5%) 1.02 0.61 - 1.71
Yes, currently 4178 (31.3%) 3713 (44.5%) 1.89*** 1.60 - 2.24 1405 (39.6%) 1216 (53.8%) 2.10*** 1.50 - 2.93 347 (18.2%) 274 (25.3%) 1.38 0.85 - 2.24 203 (25.6%) 178 (40.6%) 2.33** 1.02 - 5.30 1659 (36.0%) 1608 (52.7%) 2.54*** 1.85 - 3.48 313 (28.5%) 270 (39.5%) 1.43 0.81 - 2.54 251 (18.0%) 167 (20.1%) 1.35 0.76 - 2.41
Trend Test p-value <0.0001 <0.0001 0.1833 0.0522 <0.0001 0.2258 0.3231
Menopausal status 0.3362
Pre-Menopausal 1111 (8.9%) 508 (6.5%) 305 (9.1%) 117 (5.5%) 131 (7.5%) 54 (5.3%) 90 (12.2%) 31 (7.7%) 432 (10.1%) 215 (7.5%) 76 (7.5%) 41 (6.6%) 77 (5.7%) 50 (6.2%)
Natural Menopause 7509 (60.1%) 4311 (55.1%) 0.84 0.62 - 1.14 1975 (59.0%) 1126 (52.9%) 0.97 0.53 - 1.75 834 (47.6%) 437 (43.2%) 1.15 0.43 - 3.09 412 (56.0%) 214 (53.0%) 0.79 0.22 - 2.84 2802 (65.2%) 1723 (60.5%) 0.71 0.40 - 1.24 570 (56.3%) 292 (46.9%) 0.87 0.30 - 2.54 916 (68.0%) 519 (64.4%) 0.45* 0.18 - 1.15
Surgical Menopause 3872 (31.0%) 3002 (38.4%) 0.97 0.70 - 1.33 1070 (31.9%) 885 (41.6%) 1.21 0.66 - 2.23 786 (44.9%) 521 (51.5%) 1.07 0.39 - 2.98 234 (31.8%) 159 (39.4%) 1.05 0.27 - 4.03 1062 (24.7%) 911 (32.0%) 0.7 0.39 - 1.26 366 (36.2%) 289 (46.5%) 1.47 0.50 - 4.38 354 (26.3%) 237 (29.4%) 0.56 0.20 - 1.52
Trend Test p-value 0.111 0.0673 0.8116 0.5007 0.5303 0.0309 0.9925
Progesterone Use 0.511
No 5565 (63.9%) 3683 (58.7%) 1402 (56.5%) 941 (52.5%) 948 (80.3%) 598 (78.0%) 317 (68.9%) 184 (58.0%) 1686 (57.4%) 1203 (52.4%) 498 (70.3%) 327 (65.4%) 714 (75.2%) 430 (71.2%)
Yes, previously 1225 (14.1%) 1071 (17.1%) 1.45*** 1.26 - 1.67 439 (17.7%) 380 (21.2%) 1.37*** 1.09 - 1.73 139 (11.8%) 114 (14.9%) 1.65** 1.05 - 2.61 65 (14.1%) 62 (19.6%) 1.65 0.86 - 3.18 343 (11.7%) 329 (14.3%) 1.44*** 1.10 - 1.89 95 (13.4%) 87 (17.4%) 1.54 0.89 - 2.65 144 (15.2%) 99 (16.4%) 1.61 0.89 - 2.91
Yes, currently 1925 (22.1%) 1522 (24.3%) 1.12 0.96 - 1.31 642 (25.9%) 470 (26.2%) 1.01 0.77 - 1.32 93 (7.9%) 55 (7.2%) 0.68 0.37 - 1.28 78 (17.0%) 71 (22.4%) 1.27 0.58 - 2.82 906 (30.9%) 765 (33.3%) 1.07 0.82 - 1.40 115 (16.2%) 86 (17.2%) 1.42 0.79 - 2.55 91 (9.6%) 75 (12.4%) 1.84* 0.92 - 3.69
Trend Test p-value 0.0098 0.4222 0.962 0.3309 0.3003 0.1559 0.0435
Nulliparity 0.3566
no (have 1 or more kids) 11748 (85.7%) 7661 (89.8%) 2956 (82.4%) 1980 (87.0%) 1704 (85.9%) 975 (87.5%) 758 (92.7%) 417 (93.7%) 3998 (85.0%) 2796 (89.9%) 995 (88.7%) 646 (93.1%) 1337 (89.1%)847 (94.7%)
yes 1967 (14.3%) 871 (10.2%) 0.73*** 0.63 - 0.84 631 (17.6%) 296 (13.0%) 0.87 0.69 - 1.10 280 (14.1%) 139 (12.5%) 0.63* 0.40 - 1.01 60 (7.3%) 28 (6.3%) 0.59 0.19 - 1.83 705 (15.0%) 313 (10.1%) 0.73*** 0.58 - 0.93 127 (11.3%) 48 (6.9%) 0.53* 0.26 - 1.08 164 (10.9%) 47 (5.3%) 0.41** 0.21 - 0.81
Density for Vitamin D (IU/1000 kcal/day) 0.262
0.44-38.02 4039 (25.2%) 2164 (21.8%) 696 (17.7%) 359 (14.4%) 558 (24.8%) 307 (24.6%) 182 (20.5%) 91 (18.5%) 1574 (30.5%) 874 (25.6%) 330 (27.4%) 194 (25.9%) 420 (25.8%) 223 (22.4%)
38.02-<60.85 4007 (25.0%) 2437 (24.5%) 1.05 0.91 - 1.20 846 (21.5%) 479 (19.3%) 1.04 0.78 - 1.39 611 (27.2%) 308 (24.7%) 1.04 0.69 - 1.57 215 (24.2%) 124 (25.3%) 1.44 0.67 - 3.10 1394 (27.0%) 934 (27.4%) 1.07 0.87 - 1.33 281 (23.3%) 195 (26.0%) 0.99 0.59 - 1.67 404 (24.8%) 244 (24.5%) 1.02 0.58 - 1.80
60.85-<91.87 4001 (25.0%) 2640 (26.6%) 1.08 0.94 - 1.23 1019 (25.9%) 692 (27.8%) 1.22 0.93 - 1.59 550 (24.5%) 336 (26.9%) 1.28 0.84 - 1.95 245 (27.6%) 142 (28.9%) 0.86 0.41 - 1.83 1225 (23.8%) 900 (26.4%) 1.15 0.92 - 1.43 302 (25.0%) 175 (23.4%) 0.72 0.43 - 1.20 429 (26.3%) 250 (25.1%) 0.94 0.55 - 1.59
91.87-515 3987 (24.9%) 2698 (27.1%) 1.14* 0.99 - 1.30 1368 (34.8%) 957 (38.5%) 1.23 0.95 - 1.59 530 (23.6%) 298 (23.9%) 1.11 0.74 - 1.67 246 (27.7%) 134 (27.3%) 0.86 0.42 - 1.76 961 (18.6%) 700 (20.5%) 1.08 0.85 - 1.37 293 (24.3%) 185 (24.7%) 0.7 0.41 - 1.19 377 (23.1%) 280 (28.1%) 1.83** 1.05 - 3.16
Trend Test p-value 0.0651 0.0597 0.4397 0.2455 0.3817 0.0838 0.0521
Calories (Kcal/day) 0.1337
427-<1324.27 4026 (25.1%) 2464 (24.8%) 984 (25.0%) 642 (25.8%) 726 (32.3%) 421 (33.8%) 161 (18.1%) 81 (16.5%) 1298 (25.2%) 746 (21.9%) 327 (27.1%) 207 (27.6%) 300 (18.4%) 231 (23.2%)
1324.27-<1749.475 4049 (25.3%) 2476 (24.9%) 1 0.88 - 1.14 1116 (28.4%) 728 (29.3%) 1.03 0.82 - 1.30 494 (22.0%) 239 (19.2%) 0.70* 0.46 - 1.06 163 (18.4%) 101 (20.6%) 1.61 0.80 - 3.23 1515 (29.4%) 959 (28.1%) 1.13 0.91 - 1.39 248 (20.6%) 160 (21.4%) 1 0.61 - 1.66 299 (18.3%) 166 (16.6%) 0.52** 0.28 - 0.97
1749.475-<2345.409 3991 (24.9%) 2463 (24.8%) 1.07 0.94 - 1.23 1075 (27.4%) 654 (26.3%) 1.02 0.81 - 1.28 485 (21.6%) 248 (19.9%) 0.8 0.53 - 1.21 213 (24.0%) 114 (23.3%) 0.95 0.47 - 1.92 1398 (27.1%) 976 (28.6%) 1.25** 1.00 - 1.56 246 (20.4%) 162 (21.6%) 1.04 0.59 - 1.81 357 (21.9%) 201 (20.2%) 0.88 0.48 - 1.59
2345.409-7742 3968 (24.7%) 2533 (25.5%) 1.15** 1.00 - 1.32 754 (19.2%) 463 (18.6%) 0.96 0.75 - 1.24 544 (24.2%) 339 (27.2%) 1.1 0.74 - 1.65 351 (39.5%) 194 (39.6%) 1.49 0.76 - 2.89 943 (18.3%) 727 (21.3%) 1.43*** 1.12 - 1.81 385 (31.9%) 220 (29.4%) 0.98 0.61 - 1.56 674 (41.3%) 399 (40.0%) 0.84 0.50 - 1.41
Trend Test p-value 0.0285 0.7898 0.5941 0.5466 0.0023 0.9308 0.9439
BMI (kg/m2) 0.5105
<25 8153 (51.7%) 4715 (48.2%) 2173 (55.6%) 1266 (51.1%) 503 (23.5%) 256 (21.4%) 275 (31.2%) 146 (30.5%) 3708 (73.0%) 2293 (68.1%) 401 (33.4%) 194 (26.0%) 520 (32.4%) 270 (27.6%)
25-<30 4740 (30.1%) 3123 (31.9%) 1.30*** 1.17 - 1.46 1097 (28.1%) 748 (30.2%) 1.40*** 1.15 - 1.70 821 (38.4%) 444 (37.1%) 0.87 0.59 - 1.27 312 (35.5%) 174 (36.4%) 1.18 0.69 - 2.04 1107 (21.8%) 871 (25.9%) 1.34*** 1.11 - 1.63 452 (37.6%) 315 (42.3%) 1.18 0.77 - 1.81 673 (41.9%) 412 (42.1%) 1.59** 1.03 - 2.45
30+ 2862 (18.2%) 1948 (19.9%) 1.40*** 1.22 - 1.62 638 (16.3%) 464 (18.7%) 1.42*** 1.12 - 1.81 815 (38.1%) 496 (41.5%) 0.99 0.67 - 1.48 293 (33.3%) 158 (33.1%) 1.09 0.57 - 2.07 266 (5.2%) 203 (6.0%) 1.44* 0.99 - 2.10 349 (29.0%) 236 (31.7%) 1.56* 0.97 - 2.51 412 (25.7%) 297 (30.3%) 1.73** 1.05 - 2.85
Trend Test p-value <0.0001 0.0004 0.9289 0.747 0.001 0.0673 0.0257
Packs of Cigarette per year 0.3627
Never 9244 (59.7%) 5806 (60.7%) 1777 (46.0%) 1125 (46.4%) 1019 (47.7%) 578 (48.6%) 416 (48.4%) 240 (51.0%) 3591 (71.1%) 2431 (73.0%) 672 (58.2%) 427 (59.1%) 1057 (72.2%)624 (70.4%)
< 12 3067 (19.8%) 1879 (19.7%) 0.96 0.85 - 1.08 795 (20.6%) 538 (22.2%) 0.96 0.77 - 1.19 590 (27.6%) 297 (25.0%) 0.97 0.67 - 1.39 174 (20.2%) 97 (20.6%) 0.76 0.41 - 1.39 733 (14.5%) 469 (14.1%) 0.93 0.74 - 1.17 331 (28.7%) 193 (26.7%) 0.82 0.56 - 1.22 311 (21.3%) 212 (23.9%) 1.39 0.88 - 2.19
>= 12 3164 (20.4%) 1877 (19.6%) 1.1 0.97 - 1.25 1289 (33.4%) 760 (31.4%) 0.97 0.79 - 1.18 529 (24.7%) 314 (26.4%) 1.55** 1.08 - 2.22 270 (31.4%) 134 (28.5%) 1.06 0.59 - 1.89 728 (14.4%) 430 (12.9%) 1.11 0.87 - 1.43 151 (13.1%) 102 (14.1%) 1.32 0.74 - 2.33 95 (6.5%) 50 (5.6%) 0.74 0.34 - 1.62
Trend Test p-value 0.2563 0.7369 0.0248 0.8849 0.607 0.7774 0.8027
alcohol (g/day) 0.1944
none 10179 (63.5%) 6322 (63.6%) 1537 (39.1%) 967 (38.9%) 1442 (64.1%) 787 (63.0%) 583 (65.7%) 289 (58.9%) 3994 (77.5%) 2681 (78.7%) 722 (59.9%) 451 (60.2%) 1158 (71.0%)721 (72.3%)
<=14 4484 (28.0%) 2828 (28.5%) 1.01 0.91 - 1.13 1568 (39.9%) 1009 (40.6%) 1.11 0.92 - 1.35 636 (28.3%) 379 (30.3%) 0.87 0.63 - 1.20 231 (26.0%) 166 (33.8%) 1.99** 1.16 - 3.43 1015 (19.7%) 656 (19.2%) 0.94 0.77 - 1.14 412 (34.2%) 251 (33.5%) 1 0.68 - 1.46 423 (26.0%) 250 (25.1%) 0.73 0.48 - 1.13
>14 1371 (8.6%) 789 (7.9%) 0.92 0.77 - 1.10 824 (21.0%) 511 (20.5%) 0.96 0.76 - 1.21 171 (7.6%) 83 (6.6%) 0.87 0.49 - 1.55 74 (8.3%) 36 (7.3%) 2.48* 0.92 - 6.68 145 (2.8%) 71 (2.1%) 0.84 0.49 - 1.45 72 (6.0%) 47 (6.3%) 0.98 0.48 - 2.00 49 (3.0%) 26 (2.6%) 1.08 0.35 - 3.31
Trend Test p-value 0.5776 0.9126 0.4135 0.0071 0.4001 0.9688 0.3052
Coffee: (Cups/day) 0.2671
none 5201 (32.4%) 3459 (34.8%) 1249 (31.8%) 846 (34.0%) 972 (43.2%) 564 (45.2%) 298 (33.6%) 193 (39.3%) 1410 (27.4%) 1041 (30.5%) 371 (30.8%) 238 (31.8%) 561 (34.4%) 370 (37.1%)
>=1 7317 (45.6%) 4541 (45.7%) 0.87** 0.78 - 0.97 1519 (38.7%) 991 (39.8%) 0.9 0.73 - 1.10 1005 (44.7%) 558 (44.7%) 1 0.73 - 1.39 423 (47.6%) 218 (44.4%) 0.48** 0.27 - 0.86 2560 (49.7%) 1679 (49.3%) 0.77*** 0.64 - 0.93 544 (45.1%) 342 (45.7%) 1.18 0.77 - 1.82 787 (48.3%) 477 (47.8%) 1.02 0.67 - 1.55
>1/<=4 2919 (18.2%) 1638 (16.5%) 0.86** 0.75 - 0.99 939 (23.9%) 521 (20.9%) 0.94 0.75 - 1.19 227 (10.1%) 110 (8.8%) 0.55** 0.32 - 0.95 128 (14.4%) 63 (12.8%) 0.38** 0.17 - 0.89 1003 (19.5%) 601 (17.6%) 0.75** 0.59 - 0.95 231 (19.2%) 149 (19.9%) 1.43 0.86 - 2.40 259 (15.9%) 133 (13.3%) 1.12 0.63 - 1.99
>4 597 (3.7%) 301 (3.0%) 0.66*** 0.51 - 0.86 222 (5.7%) 129 (5.2%) 0.81 0.54 - 1.22 45 (2.0%) 17 (1.4%) 0.59 0.20 - 1.73 39 (4.4%) 17 (3.5%) 0.39 0.11 - 1.38 181 (3.5%) 87 (2.6%) 0.66* 0.41 - 1.05 60 (5.0%) 20 (2.7%) 0.33** 0.13 - 0.86 23 (1.4%) 17 (1.7%) 0.48 0.14 - 1.68
Trend Test p-value 0.0009 0.3547 0.0687 0.0117 0.0042 0.666 0.8439
0.1659
none 9001 (59.7%) 5648 (60.8%) 1943 (51.6%) 1281 (54.1%) 1327 (65.9%) 767 (67.2%) 370 (43.5%) 208 (44.7%) 3247 (65.5%) 2105 (64.5%) 674 (59.1%) 435 (63.1%) 897 (63.3%) 560 (66.7%)
<= 0.11 2466 (16.4%) 1488 (16.0%) 0.98 0.86 - 1.12 612 (16.3%) 371 (15.7%) 0.99 0.78 - 1.26 334 (16.6%) 189 (16.5%) 0.87 0.60 - 1.27 162 (19.0%) 93 (20.0%) 1.76* 0.93 - 3.32 760 (15.3%) 519 (15.9%) 1.04 0.82 - 1.30 193 (16.9%) 101 (14.7%) 0.72 0.43 - 1.21 214 (15.1%) 122 (14.5%) 0.86 0.49 - 1.52
> 0.11 - <=0.36 1706 (11.3%) 1054 (11.3%) 0.87* 0.75 - 1.01 496 (13.2%) 336 (14.2%) 1 0.77 - 1.28 185 (9.2%) 86 (7.5%) 0.68 0.40 - 1.17 141 (16.6%) 61 (13.1%) 0.77 0.41 - 1.46 512 (10.3%) 346 (10.6%) 0.81 0.63 - 1.05 132 (11.6%) 81 (11.8%) 0.76 0.42 - 1.38 140 (9.9%) 71 (8.5%) 0.7 0.36 - 1.37
>0.36 1901 (12.6%) 1103 (11.9%) 0.92 0.79 - 1.06 712 (18.9%) 379 (16.0%) 0.77** 0.61 - 0.98 169 (8.4%) 100 (8.8%) 1.42 0.87 - 2.32 178 (20.9%) 103 (22.2%) 1.69 0.88 - 3.25 442 (8.9%) 293 (9.0%) 1 0.76 - 1.31 142 (12.4%) 72 (10.4%) 0.84 0.48 - 1.45 166 (11.7%) 87 (10.4%) 0.74 0.40 - 1.38
Trend Test p-value 0.0866 0.0672 0.6405 0.3692 0.476 0.3353 0.2345
*** p<0.01, ** p<0.05, * p<0.1
Vigorous activity (vigorous work and sports) hours per day
Page | 36

4.1.6. Summary of findings for UI
Table 9 summarizes our strongest findings for each variable we considered and each racial/ethnic
group. Red means that there is a statistically significantly positive association between the
variables and risk of UI, and pink means a positive but non-significant association. Green means
a statistically significantly inverse association, and Lighter shade of green indicated that the
association was negative but not significant.

Page | 37

Table 9. Summary for the association between reproductive, lifestyle, dietary factors and risk of UI
Total White Black Hawaiian Japanese L-us born L-foreign born
Reproductive factors
Estrogen Use
Progesterone use
Menopausal status Positive and sig
Nulliparity Positive but not-sig
no association
Lifestyle Negtive but not-sig
Smoking Negtive and sig
Alcohol
Coffee
Vitamin D
BMI
Physical activity
Diet
Red meat excluding processed red meat
Processed red meat
Total vegetables
Total fruits and juice
Page | 38

4.2. Risk factors for POP
Among 2928 POP women cases, 870 (29.71%) were White, 307 (10.48%) were African-
American, 126 (4.30%) were Hawaiian, 752 (25.68%) were Japanese Americans, 319 (10.89%)
were Latinos born in US. 391 (13.35%) were Latinos – foreign born, and 163 (5.57%) were from
other racial/ethnical groups. POP women controls were comprised of 1,390 (29.23%) White, 560
(11.77%) African-American, 229 (4.81%) Hawaiian, 1,119 (23.53%) Japanese Americans, 514
(10.81%) Latinos born in US, 656 (13.79%) Latinos – foreign born, and 288 (6.06%) from other
racial/ethnical groups.

4.2.1. Univariate analyses for POP
Table 10 shows the distribution of cases and controls for POP, and univariate analyses results.
Parity was statistically significantly associated with higher risk of POP, with women with more
than 7 kids being 3.87 times more likely to be diagnosed of POP compared to women who never
had kids (95%CI: 2.96-5.06). There was a positive association with increasing number of kids
associated with higher risk of POP (trend p<0.0001), but the risk attenuated when women had 6
or more children. The trend test was statistically significant among all ethnic groups except
Hawaiians (trend p=0.1089), with a test of heterogeneity that did not reach statistical significance
(p=0.7412).
Previous progesterone use lead to 1.48-fold increase in the risk of POP, and current
progesterone users were 1.34 times more likely to get POP compared to women who never used
progesterone. However, the positive association only existed in Hawaiians and Latinos – foreign
born, and the test of heterogeneity was not statistically significant (p=0.2369). Progesterone
duration dose-response trend was not statistically significant for all women combined, or any
Page | 39

racial/ethnic groups. Similarly, current estrogen use at baseline was also positively associated
with POP, with the same effect on risk of POP as progesterone use. Raised estrogen use was
related to higher risk of POP (trend p<0.0001), and the dose-response trend was statistically
significant among Whites, Japanese, and Latinos born in US with a test of heterogeneity not
statistically significant (p=0.8681).
History of asthma or allergy was significantly associated with the risk of POP. Women
with history of asthma or allergy was 1.16 times to get POP compared to those who never had
history (95%CI: 1.05-1.29), and the positive association existed among Whites and Latinos –
foreign born with a test of heterogeneity significant (p=0.0205). Smoking was inversely
associated with risk of POP with current smoking was 0.60 times to get POP compared to
women who never smoked (95%CI: 0.5-0.71). The association was significant for Whites,
African-American, and Latinos – foreign born. The association between smoking and POP was
consistent when total number of years smoked, average number of cigarette per day, and packs
of cigarette per year were used as independent variables. Higher levels of smoking showed a
significantly inverse association with risk of POP compared to non-smokers, with all dose-
response trend significant.
The risk of POP for women who drank more than 14 g/day alcohol was reduced by 26%
compared to women who never drank alcohol (OR=0.74, 95%CI: 0.61-0.89). Alcohol intake was
related to reduced risk of developing POP in a dose-dependent manner (trend p=0.0023) for all
women combined. The inverse association was only statistically significant among Whites,
although similar direction of effects was seen in other groups, and the test for heterogeneity was
not statistically significance (p=0.9675). Coffee was also found to be inversely associated with
risk of POP. Women who drank coffee more than 4 cups/day were 0.62 times to get POP
Page | 40

(95%CI: 0.47-0.81) compared to women who never drank coffee. Raised consumption of coffee
was statistically associated with lower probability of POP (trend p<0.0001). The dose-response
trend was significant among Whites and Hawaiians with no significant heterogeneity across
racial/ethnic groups (p=0.5138). The inverse association between coffee and risk of POP seemed
driven by regular coffee, rather than decaffeinated coffee.
Women with BMI between 25 kg/m
2
and 30 kg/m
2
were 1.30 times to get POP compared
to women with BMI less than 25 kg/m
2
(95%CI: 1.16-1.45). However, no statistically significant
association was revealed for women with BMI more than 30 kg/m
2
. The similar association
existed among African-American and Japanese, but not women from other racial/ethnic groups
where a 2.70-fold increase of POP risk for BMI over 30 kg/m
2
was found (heterogeneity
p=0.017). Vitamin D was also positively associated with risk of POP. Women who took more
than 38.02 IU/kcal/day vitamin D were about 1.21 times to get POP compared to those who took
less than 38.02 IU/1000 kcal/day (95%CI: 1.05-1.38). There was a statistically significant dose-
response association (P=0.0033), while the trend was only significant for foreign-born Latinos
and women from other racial/ethnic groups with the test of heterogeneity significant (p=0.0141).
No associations between red meat excluding processed red meat, processed red meat, black tea,
total vegetables, total fruits and juice, vigorous activity and POP were identified.

Page | 41

Table 10. Univariate analyses to compare risk factors between women with Prolapse and controls across ethnic groups

Total White Black Hawaiian Japanese L-us born L-foreign born Other Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 4756 2928 1390 870 560 307 229 126 1119 752 514 319 656 391 288 163
Area 0.0003
Hawaiian 2295 (48.3%) 1422 (48.6%) 940 (67.6%) 575 (66.1%) 13 (2.3%) 3 (1.0%) 229 (100.0%) 126 (100.0%) 873 (78.0%) 613 (81.5%) 45 (8.8%) 26 (8.2%) 2 (0.3%) 2 (0.5%) 193 (67.0%) 77 (47.2%)
Los Angeles 2461 (51.7%) 1506 (51.4%) 1.04 0.91-1.18 450 (32.4%) 295 (33.9%) 1.03 0.86-1.25 547 (97.7%)304 (99.0%) 2.92 0.81-10.58 0 (0.0%) 0 (0.0%) / / 246 (22.0%) 139 (18.5%) 0.78** 0.61-0.98 469 (91.2%) 293 (91.8%) 1.02 0.62-1.69 654 (99.7%) 389 (99.5%) 0.59 0.08-4.3 95 (33.0%) 86 (52.8%) 2.23*** 1.49-3.34
Place of Birth 0.0606
USA 3595 (75.8%) 2227 (76.4%) 1233 (89.0%) 770 (88.7%) 534 (96.4%)291 (95.7%) 228 (100.0%) 125 (99.2%) 979 (87.6%) 666 (89.2%) 502 (97.9%) 318 (99.7%) 119 (41.6%) 57 (35.4%)
Outside of USA 1145 (24.2%) 689 (23.6%) 1.01 0.85-1.2 153 (11.0%) 98 (11.3%) 1 0.76-1.32 20 (3.6%) 13 (4.3%) 1.22 0.6-2.46 0 (0.0%) 1 (0.8%) / / 138 (12.4%) 81 (10.8%) 0.9 0.66-1.22 11 (2.1%) 1 (0.3%) 0.15 0.02-1.15 656 (100.0%) 391 (100.0%) / / 167 (58.4%) 104 (64.6%)1.36 0.89-2.07
Years in the United States 0.1503
<=15 years 201 (4.3%) 120 (4.2%) 14 (1.0%) 13 (1.5%) 3 (0.6%) 4 (1.4%) 7 (0.6%) 5 (0.7%) 2 (0.4%) 0 (0.0%) 119 (18.2%) 77 (19.8%) 56 (19.9%) 21 (13.2%)
16-25 years 315 (6.8%) 181 (6.3%) 0.95 0.71-1.28 26 (1.9%) 14 (1.6%) 0.55 0.2-1.51 11 (2.1%) 3 (1.1%) 0.16 0.02-1.33 / / 30 (2.7%) 12 (1.6%) 0.57 0.15-2.17 6 (1.2%) 1 (0.3%) 0.99 0.69-1.43 194 (29.7%) 126 (32.4%) 48 (17.1%) 25 (15.7%) 1.4 0.69-2.87
>=26 years 4137 (88.9%) 2561 (89.5%) 0.97 0.75-1.25 1335 (97.1%) 830 (96.8%) 0.6 0.28-1.27 501 (97.3%)278 (97.5%) 0.28 0.05-1.53 228 (100.0%) 125 (100.0%)/ / 1079 (96.7%) 730 (97.7%) 0.85 0.27-2.71 477 (98.4%) 299 (99.7%) 0.87 0.62-1.23 340 (52.1%) 186 (47.8%) 177 (63.0%) 113 (71.1%)1.71* 0.96-3.05
Trend test p-value 0.8764 0.3061 0.4608 / 0.8179 0.3904 0.0596
Year of Cohort Entry 0.0664
1993 1695 (35.6%) 993 (33.9%) 457 (32.9%) 265 (30.5%) 392 (70.0%)234 (76.2%) 69 (30.1%) 38 (30.2%) 280 (25.0%) 196 (26.1%) 202 (39.3%) 123 (38.6%) 206 (31.4%) 87 (22.3%) 89 (30.9%) 50 (30.7%)
1994 2440 (51.3%) 1578 (53.9%) 1.05 0.94-1.18 788 (56.7%) 511 (58.7%) 1.13 0.93-1.37 73 (13.0%) 31 (10.1%) 0.59** 0.36-0.98 121 (52.8%) 74 (58.7%) 1.11 0.68-1.83 694 (62.0%) 481 (64.0%) 0.98 0.79-1.22 275 (53.5%) 170 (53.3%) 0.97 0.71-1.32 323 (49.2%) 227 (58.1%) 1.68*** 1.2-2.35 166 (57.6%) 84 (51.5%) 0.87 0.56-1.35
1995 361 (7.6%) 189 (6.5%) 0.86 0.7-1.05 73 (5.3%) 47 (5.4%) 1.15 0.77-1.72 87 (15.5%) 40 (13.0%) 0.64* 0.4-1.01 28 (12.2%) 9 (7.1%) 0.59 0.25-1.38 144 (12.9%) 73 (9.7%) 0.71** 0.51-0.99 4 (0.8%) 3 (0.9%) 0.99 0.21-4.54 3 (0.5%) 2 (0.5%) 1.67 0.27-10.28 22 (7.6%) 15 (9.2%) 1.15 0.54-2.41
>=1996 260 (5.5%) 168 (5.7%) 1.23* 0.98-1.56 72 (5.2%) 47 (5.4%) 1.28 0.83-1.96 8 (1.4%) 2 (0.7%) 0.33 0.07-1.63 11 (4.8%) 5 (4.0%) 0.83 0.28-2.49 1 (0.1%) 2 (0.3%) 3.18 0.28-36.24 33 (6.4%) 23 (7.2%) 1.27 0.69-2.33 124 (18.9%) 75 (19.2%) 1.50* 0.98-2.29 11 (3.8%) 14 (8.6%) 2.53** 1.04-6.14
Trend test p-value 0.4942 0.1558 0.0141 0.4317 0.1346 0.5823 0.0563 0.1275
Age at Birth of First Child 0.0068
<19 years old 272 (8.0%) 190 (7.9%) 55 (5.2%) 38 (5.0%) 76 (18.3%) 47 (19.2%) 17 (9.0%) 9 (8.1%) 7 (0.8%) 8 (1.2%) 55 (13.3%) 36 (12.8%) 62 (12.0%) 52 (15.6%)
19 - 25 years old 2287 (66.9%) 1550 (64.8%) 0.84 0.67-1.04 755 (71.6%) 527 (68.7%) 0.81 0.51-1.28 285 (68.7%)161 (65.7%) 0.75 0.46-1.21 152 (80.4%) 91 (82.0%) 0.98 0.36-2.64 478 (57.5%) 339 (51.9%) 0.52 0.19-1.47 296 (71.7%) 205 (72.7%) 1.18 0.71-1.96 321 (62.1%) 227 (68.0%) 0.87 0.56-1.36
26 - 32 years old 609 (17.8%) 466 (19.5%) 0.9 0.7-1.16 180 (17.1%) 133 (17.3%) 0.86 0.51-1.43 36 (8.7%) 22 (9.0%) 0.79 0.39-1.61 16 (8.5%) 6 (5.4%) 0.57 0.15-2.16 252 (30.3%) 245 (37.5%) 0.72 0.25-2.06 46 (11.1%) 26 (9.2%) 0.91 0.44-1.86 79 (15.3%) 34 (10.2%) 0.53** 0.29-0.96
>33 years old 252 (7.4%) 186 (7.8%) 0.89 0.66-1.2 65 (6.2%) 69 (9.0%) 1.36 0.76-2.44 18 (4.3%) 15 (6.1%) 0.97 0.38-2.52 4 (2.1%) 5 (4.5%) 1.67 0.32-8.82 94 (11.3%) 61 (9.3%) 0.39* 0.13-1.15 16 (3.9%) 15 (5.3%) 2.05 0.85-4.95 55 (10.6%) 21 (6.3%) 0.57* 0.3-1.09
Trend test p-value 0.8624 0.1113 0.5945 0.9210 0.8880 0.3296 0.0165
Age that period stopped due to (surgery) hysterectomy but not oophorectomy 0.1525
< 40 years old 448 (73.4%) 327 (69.9%) 162 (74.3%) 112 (67.5%) 78 (77.2%) 45 (81.8%) 24 (75%) 16 (73%) 49 (59%) 54 (61%) 68 (78%) 59 (82%) 67 (75%) 41 (63%)
>= 40 years old 162 (26.6%) 141 (30.1%) 0.98 0.54-1.79 56 (25.7%) 54 (32.5%) 0.78 0.31-1.94 23 (22.8%) 10 (18.2%) 2 0.18-22.06 8 (25%) 6 (27%) / / 34 (41%) 34 (39%) 1.5 0.25-8.98 19 (22%) 13 (18%) 0.2 0.02-1.71 22 (25%) 24 (37%) 3.5 0.73-16.8
Nulliparity 0.8407
no 3519 (86.4%) 2437 (95.3%) 1078 (83.6%) 779 (95.1%) 429 (87.7%)252 (93.0%) 197 (94.3%) 114 (98.3%) 857 (84.9%) 662 (95.1%) 420 (88.4%) 289 (96.0%) 538 (89.4%) 341 (96.6%)
yes 555 (13.6%) 119 (4.7%) 0.29*** 0.23-0.36 212 (16.4%) 40 (4.9%) 0.27*** 0.19-0.39 60 (12.3%) 19 (7.0%) 0.40*** 0.22-0.75 12 (5.7%) 2 (1.7%) 0.13* 0.02-1.05 152 (15.1%) 34 (4.9%) 0.27*** 0.18-0.42 55 (11.6%) 12 (4.0%) 0.30*** 0.16-0.59 64 (10.6%) 12 (3.4%) 0.33*** 0.17-0.62
Number of children 0.7412
0 645 (13.8%) 131 (4.5%) 229 (16.6%) 43 (5.0%) 69 (12.7%) 22 (7.4%) 17 (7.6%) 2 (1.6%) 173 (15.6%) 35 (4.7%) 58 (11.5%) 12 (3.8%) 64 (10.0%) 14 (3.7%) 35 (12.4%) 3 (1.9%)
1 539 (11.5%) 267 (9.2%) 2.51*** 1.97-3.22 164 (11.9%) 82 (9.5%) 2.81*** 1.83-4.32 94 (17.3%) 45 (15.1%) 1.58 0.84-2.97 14 (6.2%) 5 (4.0%) 2.86 0.47-17.57 127 (11.4%) 74 (9.9%) 2.78*** 1.72-4.5 38 (7.5%) 21 (6.6%) 2.90** 1.25-6.73 67 (10.5%) 28 (7.4%) 1.77 0.84-3.73 35 (12.4%) 12 (7.4%) 3.54* 0.91-13.75
2 1022 (21.8%) 680 (23.5%) 3.21*** 2.58-3.99 355 (25.8%) 233 (27.0%) 3.44*** 2.38-4.99 98 (18.0%) 70 (23.4%) 2.31*** 1.27-4.23 34 (15.1%) 16 (12.8%) 3.39 0.69-16.7 320 (28.8%) 233 (31.3%) 3.56*** 2.35-5.4 73 (14.5%) 54 (17.1%) 3.68*** 1.77-7.66 82 (12.9%) 36 (9.5%) 1.84* 0.91-3.74 60 (21.2%) 38 (23.5%) 7.22*** 1.97-26.41
3 929 (19.8%) 644 (22.3%) 3.43*** 2.75-4.28 296 (21.5%) 221 (25.6%) 3.97*** 2.72-5.8 79 (14.5%) 37 (12.4%) 1.48 0.78-2.8 52 (23.1%) 34 (27.2%) 5.46** 1.16-25.67 258 (23.2%) 213 (28.6%) 4.11*** 2.68-6.28 90 (17.8%) 59 (18.7%) 3.28*** 1.58-6.81 94 (14.8%) 48 (12.7%) 2.39** 1.21-4.72 60 (21.2%) 32 (19.8%) 5.96*** 1.68-21.2
4 681 (14.5%) 519 (18.0%) 3.81*** 3.03-4.79 188 (13.7%) 158 (18.3%) 4.40*** 2.95-6.57 74 (13.6%) 38 (12.7%) 1.74 0.9-3.37 36 (16.0%) 29 (23.2%) 6.43** 1.35-30.65 158 (14.2%) 122 (16.4%) 3.79*** 2.41-5.98 100 (19.8%) 71 (22.5%) 3.61*** 1.75-7.43 89 (14.0%) 67 (17.7%) 3.28*** 1.68-6.41 36 (12.7%) 34 (21.0%) 10.45***2.8-38.9
5 338 (7.2%) 272 (9.4%) 4.10*** 3.18-5.3 70 (5.1%) 69 (8.0%) 5.19*** 3.21-8.39 51 (9.4%) 33 (11.0%) 2.07** 1.04-4.13 27 (12.0%) 13 (10.4%) 3.8 0.74-19.59 57 (5.1%) 51 (6.8%) 4.39*** 2.54-7.57 52 (10.3%) 37 (11.7%) 3.75*** 1.71-8.22 61 (9.6%) 48 (12.7%) 3.23*** 1.62-6.4 20 (7.1%) 21 (13.0%) 12.01***3.1-46.55
6 198 (4.2%) 142 (4.9%) 4.04*** 3-5.45 33 (2.4%) 30 (3.5%) 4.95*** 2.69-9.14 30 (5.5%) 19 (6.4%) 2.25** 1.03-4.92 17 (7.6%) 12 (9.6%) 5.84** 1.15-29.67 13 (1.2%) 15 (2.0%) 6.54*** 2.81-15.25 38 (7.5%) 27 (8.5%) 4.00*** 1.7-9.39 58 (9.1%) 31 (8.2%) 2.46** 1.19-5.08 9 (3.2%) 8 (4.9%) 10.85***2.19-53.83
7 or more 329 (7.0%) 235 (8.1%) 3.87*** 2.96-5.06 42 (3.1%) 28 (3.2%) 3.93*** 2.15-7.19 49 (9.0%) 35 (11.7%) 2.47** 1.23-4.93 28 (12.4%) 14 (11.2%) 4.13* 0.8-21.34 4 (0.4%) 2 (0.3%) 2.41 0.42-13.93 56 (11.1%) 35 (11.1%) 3.06*** 1.41-6.62 122 (19.2%) 107 (28.2%) 3.62*** 1.92-6.81 28 (9.9%) 14 (8.6%) 4.78** 1.21-18.87
Trend test p-value <0.0001 <0.0001 0.0270 0.1089 <0.0001 0.0223 <0.0001 0.0046
Parity 0.5082
0 645 (13.8%) 131 (4.5%) 229 (16.6%) 43 (5.0%) 69 (12.7%) 22 (7.4%) 17 (7.6%) 2 (1.6%) 173 (15.6%) 35 (4.7%) 58 (11.5%) 12 (3.8%) 64 (10.0%) 14 (3.7%) 35 (12.4%) 3 (1.9%)
1 539 (11.5%) 267 (9.2%) 2.51*** 1.96-3.21 164 (11.9%) 82 (9.5%) 2.80*** 1.82-4.31 94 (17.3%) 45 (15.1%) 1.56 0.83-2.92 14 (6.2%) 5 (4.0%) 3.06 0.51-18.59 127 (11.4%) 74 (9.9%) 2.79*** 1.72-4.51 38 (7.5%) 21 (6.6%) 2.90** 1.25-6.72 67 (10.5%) 28 (7.4%) 1.78 0.84-3.76 35 (12.4%) 12 (7.4%) 3.76* 0.98-14.46
2 1022 (21.8%) 680 (23.5%) 3.22*** 2.59-4 355 (25.8%) 233 (27.0%) 3.44*** 2.37-4.99 98 (18.0%) 70 (23.4%) 2.32*** 1.27-4.23 34 (15.1%) 16 (12.8%) 3.58 0.73-17.54 320 (28.8%) 233 (31.3%) 3.55*** 2.35-5.38 73 (14.5%) 54 (17.1%) 3.62*** 1.74-7.54 82 (12.9%) 36 (9.5%) 1.87* 0.92-3.78 60 (21.2%) 38 (23.5%) 7.17*** 1.98-26.02
3+ 2475 (52.9%) 1812 (62.7%) 3.71*** 3.02-4.56 629 (45.7%) 506 (58.6%) 4.28*** 3-6.12 283 (52.0%)162 (54.2%) 1.86** 1.07-3.24 160 (71.1%) 102 (81.6%) 5.34** 1.19-23.97 490 (44.1%) 403 (54.1%) 4.07*** 2.71-6.13 336 (66.5%) 229 (72.5%) 3.45*** 1.77-6.72 424 (66.6%) 301 (79.4%) 3.13*** 1.73-5.68 153 (54.1%) 109 (67.3%)7.59*** 2.25-25.61
Trend test p-value <0.0001 <0.0001 0.0447 0.0047 <0.0001 0.0008 <0.0001 0.0001
Progesterone Use 0.2369
No 1663 (64.1%) 1087 (59.3%) 490 (55.2%) 344 (54.3%) 227 (82.5%)139 (77.2%) 80 (69.6%) 39 (52.0%) 356 (56.3%) 257 (53.3%) 212 (70.7%) 137 (64.0%) 298 (77.6%) 171 (68.7%)
Yes, previously 368 (14.2%) 321 (17.5%) 1.48*** 1.21-1.82 159 (17.9%) 114 (18.0%) 1.04 0.76-1.44 29 (10.5%) 26 (14.4%) 1.94* 0.99-3.79 16 (13.9%) 19 (25.3%) 3.64** 1.36-9.73 73 (11.6%) 78 (16.2%) 1.47* 0.94-2.3 42 (14.0%) 40 (18.7%) 1.59 0.85-2.96 49 (12.8%) 44 (17.7%) 2.45*** 1.36-4.41
Yes, currently 562 (21.7%) 426 (23.2%) 1.34*** 1.12-1.61 238 (26.8%) 176 (27.8%) 1.2 0.91-1.59 19 (6.9%) 15 (8.3%) 1.41 0.61-3.24 19 (16.5%) 17 (22.7%) 1.7 0.66-4.4 203 (32.1%) 147 (30.5%) 1.23 0.88-1.73 46 (15.3%) 37 (17.3%) 1.4 0.8-2.44 37 (9.6%) 34 (13.7%) 1.98** 1.03-3.8
Trend test p-value 0.0003 0.2076 0.1063 0.0685 0.1843 0.1722 0.0033
Estrogen Use 0.3177
No 2055 (51.9%) 996 (39.8%) 535 (41.8%) 252 (31.0%) 300 (62.8%)132 (50.0%) 127 (63.8%) 50 (43.9%) 501 (50.8%) 249 (36.6%) 256 (54.9%) 122 (41.4%) 336 (61.2%) 191 (56.8%)
Yes, previously 676 (17.1%) 407 (16.3%) 1.48*** 1.21-1.82 223 (17.4%) 124 (15.3%) 1.09 0.82-1.46 97 (20.3%) 65 (24.6%) 1.38 0.92-2.06 29 (14.6%) 19 (16.7%) 1.87* 0.94-3.73 126 (12.8%) 74 (10.9%) 1.02 0.71-1.46 87 (18.7%) 42 (14.2%) 1.03 0.66-1.62 114 (20.8%) 83 (24.7%) 1.33 0.93-1.92
Yes, currently 1226 (31.0%) 1099 (43.9%) 1.34*** 1.12-1.61 521 (40.7%) 436 (53.7%) 1.79*** 1.45-2.22 81 (16.9%) 67 (25.4%) 2.06*** 1.37-3.11 43 (21.6%) 45 (39.5%) 2.76*** 1.54-4.92 359 (36.4%) 358 (52.6%) 1.90*** 1.51-2.4 123 (26.4%) 131 (44.4%) 2.15*** 1.51-3.06 99 (18.0%) 62 (18.5%) 1.25 0.84-1.86
Trend test p-value <0.0001 <0.0001 0.0004 0.0003 <0.0001 <0.0001 0.1576
Total Duration of Estrogen Use 0.8681
0.5 years 441 (20.6%) 288 (17.5%) 135 (17.0%) 80 (13.7%) 58 (29.7%) 32 (21.9%) 17 (21%) 13 (18%) 79 (15.0%) 58 (12.8%) 49 (22.4%) 35 (19.7%) 76 (35.7%) 46 (32.4%) 27 (24.1%) 24 (32.9%)
1.5 years 353 (16.5%) 237 (14.4%) 1.05 0.78-1.4 106 (13.4%) 63 (10.8%) 1.04 0.64-1.69 45 (23.1%) 28 (19.2%) 0.93 0.38-2.27 19 (23%) 15 (21%) 1.75 0.38-8.08 79 (15.0%) 55 (12.1%) 0.97 0.52-1.82 38 (17.4%) 25 (14.0%) 1.3 0.48-3.54 45 (21.1%) 37 (26.1%) 1.32 0.58-2.98 21 (18.8%) 14 (19.2%) 0.42 0.09-1.92
4 years 435 (20.4%) 286 (17.3%) 1.04 0.79-1.37 155 (19.6%) 103 (17.6%) 1.3 0.83-2.02 34 (17.4%) 28 (19.2%) 1.83 0.66-5.13 20 (25%) 8 (11%) 0.43 0.07-2.76 116 (22.1%) 83 (18.3%) 0.81 0.47-1.42 42 (19.2%) 28 (15.7%) 1.12 0.48-2.61 45 (21.1%) 28 (19.7%) 1.01 0.4-2.5 23 (20.5%) 8 (11.0%) 0.28* 0.06-1.2
7.5 years 308 (14.4%) 228 (13.8%) 1.02 0.75-1.38 118 (14.9%) 88 (15.0%) 1.28 0.81-2.03 18 (9.2%) 9 (6.2%) 0.73 0.19-2.84 10 (12%) 14 (20%) 1.92 0.4-9.13 88 (16.8%) 74 (16.3%) 0.8 0.43-1.51 34 (15.5%) 23 (12.9%) 0.89 0.32-2.46 22 (10.3%) 12 (8.5%) 0.88 0.27-2.87 18 (16.1%) 8 (11.0%) 0.22* 0.04-1.18
12 years 267 (12.5%) 209 (12.7%) 0.92 0.68-1.24 120 (15.2%) 86 (14.7%) 1.03 0.65-1.64 18 (9.2%) 18 (12.3%) 0.99 0.36-2.79 7 (9%) 8 (11%) 0.77 0.16-3.83 77 (14.7%) 59 (13.0%) 0.72 0.39-1.34 24 (11.0%) 22 (12.4%) 1.18 0.42-3.31 14 (6.6%) 9 (6.3%) 0.5 0.13-1.94 7 (6.2%) 7 (9.6%) 0.55 0.11-2.92
17 years 140 (6.6%) 167 (10.1%) 1.79*** 1.27-2.51 58 (7.3%) 67 (11.5%) 1.94** 1.16-3.25 8 (4.1%) 15 (10.3%) 4.12* 0.76-22.26 4 (5%) 6 (8%) 0.54 0.05-6 47 (9.0%) 50 (11.0%) 1.22 0.62-2.38 11 (5.0%) 20 (11.2%) 3.21** 1.04-9.91 4 (1.9%) 5 (3.5%) 2.22 0.47-10.41 8 (7.1%) 4 (5.5%) 1.24 0.19-7.87
20 years 193 (9.0%) 234 (14.2%) 1.78*** 1.29-2.45 100 (12.6%) 98 (16.8%) 1.54* 0.95-2.48 14 (7.2%) 16 (11.0%) 2.12 0.67-6.74 4 (5%) 7 (10%) 6.72 0.62-72.49 39 (7.4%) 75 (16.5%) 2.13** 1.07-4.24 21 (9.6%) 25 (14.0%) 2.59 0.81-8.3 7 (3.3%) 5 (3.5%) 1.83 0.37-9.11 8 (7.1%) 8 (11.0%) 1.04 0.24-4.62
Trend test p-value <0.0001 0.0204 0.1226 0.3268 0.0314 0.0227 0.7865 0.7991
Total Duration of Progesterone Use 0.6212
0.5 years 243 (23.9%) 212 (26.5%) 85 (20.6%) 67 (22.7%) 23 (42%) 16 (36%) 5 (14%) 11 (29%) 53 (18.8%) 47 (20.5%) 31 (35%) 24 (31%) 29 (33%) 30 (38%) 17 (30%) 17 (46%)
1.5 years 209 (20.6%) 159 (19.9%) 1.37 0.83-2.25 81 (19.6%) 55 (18.6%) 1.29 0.62-2.71 9 (16%) 12 (27%) / / 9 (26%) 12 (32%) 1.2 0.15-9.57 51 (18.1%) 36 (15.7%) 1.47 0.51-4.25 18 (20%) 17 (22%) 5.89 0.53-65.84 24 (27%) 21 (27%) 1.25 0.3-5.26 17 (30%) 6 (16%) 0.25 0.01-5.3
4 years 259 (25.5%) 195 (24.4%) 1.04 0.66-1.65 106 (25.7%) 82 (27.8%) 1.38 0.67-2.85 9 (16%) 5 (11%) / / 11 (31%) 5 (13%) / /- 76 (27.0%) 66 (28.8%) 1.07 0.44-2.6 23 (26%) 19 (25%) 0.84 0.25-2.86 21 (24%) 13 (16%) 0.51 0.08-3.07 13 (23%) 5 (14%) 0.3 0.02-6
>4 years 306 (30.1%) 234 (29.2%) 0.96 0.59-1.57 141 (34.1%) 91 (30.8%) 0.95 0.51-1.76 14 (25%) 12 (27%) / / 10 (29%) 10 (26%) 0.57 0.04-8.91 102 (36.2%) 80 (34.9%) 1.1 0.49-2.47 16 (18%) 17 (22%) 2.06 0.32-13.48 14 (16%) 15 (19%) 1.54 0.25-9.33 9 (16%) 9 (24%) 1.19 0.06-22.18
Trend test p-value 0.8994 0.6026 / 0.9092 0.9964 0.9561 0.9397 0.5636
Menopausal status 0.551
Pre-Menopausal 300 (8.1%) 160 (6.8%) 100 (8.2%) 48 (6.3%) 45 (10.2%) 17 (6.7%) 15 (8.1%) 6 (5.7%) 75 (8.2%) 48 (7.5%) 32 (7.4%) 20 (7.4%) 33 (6.2%) 21 (6.3%)
Natural Menopause 2258 (60.6%) 1320 (55.7%) 0.86 0.66 - 1.13 715 (58.8%) 412 (53.9%) 0.92 0.59 - 1.44 207 (46.7%)123 (48.2%) 1.78 0.78 - 4.07 107 (57.8%) 62 (59.0%) 0.82 0.25 - 2.70 628 (68.3%) 376 (58.8%) 0.60* 0.33 - 1.07 247 (57.4%) 134 (49.3%) 0.75 0.37 - 1.53 354 (66.5%) 213 (64.2%) 0.86 0.41 - 1.79
Surgical Menopause 1167 (31.3%) 888 (37.5%) 1.12 0.86 - 1.47 401 (33.0%) 305 (39.9%) 1.2 0.76 - 1.89 191 (43.1%)115 (45.1%) 1.81 0.81 - 4.03 63 (34.1%) 37 (35.2%) 0.86 0.25 - 2.92 216 (23.5%) 215 (33.6%) 0.92 0.52 - 1.66 151 (35.1%) 118 (43.4%) 1.07 0.52 - 2.21 145 (27.3%) 98 (29.5%) 0.97 0.45 - 2.09
Trend test p-value 0.0005 0.0299 0.3378 1 0.0127 0.1559 0.6131
History of Asthma or Allergy 0.0205
no 3307 (69.5%) 1945 (66.4%) 897 (64.5%) 516 (59.3%) 390 (69.6%)196 (63.8%) 159 (69.4%) 90 (71.4%) 752 (67.2%) 516 (68.6%) 368 (71.6%) 219 (68.7%) 535 (81.6%) 287 (73.4%) 206 (71.5%) 121 (74.2%)
yes 1449 (30.5%) 983 (33.6%) 1.16*** 1.05-1.29 493 (35.5%) 354 (40.7%) 1.30*** 1.09-1.56 170 (30.4%)111 (36.2%) 1.32* 0.97-1.8 70 (30.6%) 36 (28.6%) 0.88 0.55-1.4 367 (32.8%) 236 (31.4%) 0.94 0.77-1.15 146 (28.4%) 100 (31.3%) 1.11 0.82-1.5 121 (18.4%) 104 (26.6%) 1.68*** 1.23-2.29 82 (28.5%) 42 (25.8%) 0.87 0.56-1.35
Smoking status 0.8303
No 2693 (57.8%) 1781 (62.3%) 642 (46.6%) 421 (48.7%) 245 (44.7%)158 (52.5%) 105 (46.3%) 72 (57.6%) 782 (70.4%) 544 (73.8%) 303 (59.6%) 200 (63.9%) 416 (68.5%) 265 (73.8%) 200 (71.4%) 121 (76.1%)
Yes and quit smoking 1360 (29.2%) 848 (29.7%) 0.95 0.85-1.06 525 (38.1%) 367 (42.5%) 1.08 0.9-1.3 198 (36.1%)105 (34.9%) 0.82 0.6-1.13 71 (31.3%) 36 (28.8%) 0.78 0.48-1.28 244 (22.0%) 151 (20.5%) 0.88 0.69-1.11 144 (28.3%) 91 (29.1%) 0.98 0.71-1.36 125 (20.6%) 72 (20.1%) 0.93 0.66-1.3 53 (18.9%) 26 (16.4%) 0.77 0.45-1.3
Yes and currently smoking 606 (13.0%) 229 (8.0%) 0.60*** 0.5-0.71 211 (15.3%) 76 (8.8%) 0.57*** 0.43-0.77 105 (19.2%)38 (12.6%) 0.55*** 0.35-0.85 51 (22.5%) 17 (13.6%) 0.49** 0.25-0.96 85 (7.7%) 42 (5.7%) 0.75 0.51-1.13 61 (12.0%) 22 (7.0%) 0.59* 0.35-1 66 (10.9%) 22 (6.1%) 0.54** 0.32-0.93 27 (9.6%) 12 (7.5%) 0.78 0.37-1.64
Trend test p-value <0.0001 0.0142 0.0069 0.0312 0.0966 0.1151 0.0411 0.2956
Page | 42

Total number of years smoked 0.1052
Never 2693 (58.7%) 1781 (63.1%) 642 (46.9%) 421 (49.1%) 245 (46.2%)158 (53.4%) 105 (47.1%) 72 (59.5%) 782 (70.8%) 544 (74.4%) 303 (61.3%) 200 (64.9%) 416 (70.5%) 265 (75.7%) 200 (72.2%) 121 (76.1%)
<25 years 904 (19.7%) 573 (20.3%) 0.96 0.85 - 1.09 323 (23.6%) 246 (28.7%) 1.20* 0.97 - 1.48 138 (26.0%)60 (20.3%) 0.66** 0.45 - 0.96 51 (22.9%) 18 (14.9%) 0.56* 0.31 - 1.02 160 (14.5%) 100 (13.7%) 0.89 0.67 - 1.17 100 (20.2%) 70 (22.7%) 1.09 0.76 - 1.56 94 (15.9%) 58 (16.6%) 0.94 0.65 - 1.37 38 (13.7%) 21 (13.2%) 0.89 0.50 - 1.58
>=25 years 991 (21.6%) 469 (16.6%) 0.73*** 0.64 - 0.83 404 (29.5%) 191 (22.3%) 0.73*** 0.58 - 0.90 147 (27.7%)78 (26.4%) 0.84 0.60 - 1.19 67 (30.0%) 31 (25.6%) 0.75 0.44 - 1.26 163 (14.8%) 87 (11.9%) 0.78* 0.59 - 1.04 91 (18.4%) 38 (12.3%) 0.62** 0.40 - 0.96 80 (13.6%) 27 (7.7%) 0.56** 0.34 - 0.90 39 (14.1%) 17 (10.7%) 0.71 0.39 - 1.32
Trend test p-value <0.0001 0.0166 0.2143 0.1842 0.0753 0.094 0.0286 0.2699
Average number of cigarettes per day 0.8648
Never 2693 (58.3%) 1781 (62.9%) 642 (46.7%) 421 (49.0%) 245 (45.3%)158 (53.0%) 105 (47.1%) 72 (59.0%) 782 (70.6%) 544 (74.1%) 303 (60.6%) 200 (64.9%) 416 (69.7%) 265 (75.5%) 200 (71.9%) 121 (76.1%)
<8 cigarettes 518 (11.2%) 277 (9.8%) 0.82** 0.69 - 0.96 121 (8.8%) 73 (8.5%) 0.9 0.65 - 1.24 85 (15.7%) 39 (13.1%) 0.71 0.45 - 1.12 16 (7.2%) 6 (4.9%) 0.58 0.22 - 1.54 65 (5.9%) 43 (5.9%) 0.92 0.61 - 1.40 93 (18.6%) 46 (14.9%) 0.77 0.52 - 1.14 109 (18.3%) 59 (16.8%) 0.86 0.60 - 1.22 29 (10.4%) 11 (6.9%) 0.63 0.30 - 1.32
>=8 cigarettes 1409 (30.5%) 774 (27.3%) 0.85*** 0.76 - 0.95 611 (44.5%) 366 (42.6%) 0.95 0.79 - 1.13 211 (39.0%)101 (33.9%) 0.75* 0.55 - 1.02 102 (45.7%) 44 (36.1%) 0.69 0.43 - 1.09 260 (23.5%) 147 (20.0%) 0.82* 0.65 - 1.04 104 (20.8%) 62 (20.1%) 0.97 0.66 - 1.42 72 (12.1%) 27 (7.7%) 0.62* 0.38 - 1.00 49 (17.6%) 27 (17.0%) 0.86 0.51 - 1.45
Trend test p-value 0.0021 0.5481 0.063 0.1065 0.0964 0.6243 0.0426 0.4385
Packs of Cigarette per year 0.4621
Never 2693 (58.9%) 1781 (63.4%) 642 (47.0%) 421 (49.2%) 245 (46.5%)158 (53.7%) 105 (47.3%) 72 (60.0%) 782 (70.8%) 544 (74.6%) 303 (61.8%) 200 (65.6%) 416 (70.9%) 265 (76.8%) 200 (72.5%) 121 (76.1%)
<12 938 (20.5%) 557 (19.8%) 0.91 0.80 - 1.03 278 (20.3%) 205 (23.9%) 1.15 0.92 - 1.44 150 (28.5%)75 (25.5%) 0.77 0.54 - 1.10 43 (19.4%) 20 (16.7%) 0.72 0.39 - 1.34 163 (14.8%) 89 (12.2%) 0.76* 0.57 - 1.02 128 (26.1%) 77 (25.2%) 0.92 0.65 - 1.29 129 (22.0%) 68 (19.7%) 0.84 0.60 - 1.18 47 (17.0%) 23 (14.5%) 0.8 0.46 - 1.40
>=12 942 (20.6%) 470 (16.7%) 0.76*** 0.67 - 0.87 447 (32.7%) 230 (26.9%) 0.81** 0.66 - 0.99 132 (25.0%)61 (20.7%) 0.72* 0.50 - 1.05 74 (33.3%) 28 (23.3%) 0.61* 0.36 - 1.03 159 (14.4%) 96 (13.2%) 0.88 0.67 - 1.17 59 (12.0%) 28 (9.2%) 0.75 0.44 - 1.27 42 (7.2%) 12 (3.5%) 0.45** 0.23 - 0.89 29 (10.5%) 15 (9.4%) 0.8 0.42 - 1.55
Trend test p-value 0.0001 0.0700 0.0626 0.0542 0.1772 0.2853 0.0206 0.3782
alcohol (g/day) 0.9675
none 2879 (60.5%) 1868 (63.8%) 509 (36.6%) 357 (41.0%) 353 (63.0%)204 (66.4%) 154 (67.2%) 86 (68.3%) 882 (78.8%) 605 (80.5%) 310 (60.3%) 206 (64.6%) 461 (70.3%) 289 (73.9%) 210 (72.9%) 121 (74.2%)
<=14 1432 (30.1%) 843 (28.8%) 0.92 0.82-1.02 580 (41.7%) 352 (40.5%) 0.87 0.72-1.06 169 (30.2%)85 (27.7%) 0.87 0.63-1.19 57 (24.9%) 36 (28.6%) 1.13 0.7-1.85 208 (18.6%) 133 (17.7%) 0.98 0.77-1.25 175 (34.0%) 102 (32.0%) 0.93 0.67-1.28 176 (26.8%) 97 (24.8%) 0.9 0.68-1.2 67 (23.3%) 38 (23.3%) 0.99 0.63-1.57
>14 445 (9.4%) 217 (7.4%) 0.74*** 0.61-0.89 301 (21.7%) 161 (18.5%) 0.76** 0.6-0.97 38 (6.8%) 18 (5.9%) 0.82 0.46-1.46 18 (7.9%) 4 (3.2%) 0.4 0.13-1.24 29 (2.6%) 14 (1.9%) 0.75 0.39-1.44 29 (5.6%) 11 (3.4%) 0.64 0.3-1.36 19 (2.9%) 5 (1.3%) 0.47 0.17-1.28 11 (3.8%) 4 (2.5%) 0.62 0.2-1.98
Trend test p-value 0.0023 0.0613 0.5254 0.0858 0.3807 0.2373 0.0995 0.4097
Coffee: (Cups/day) 0.5138
none 1529 (32.1%) 1042 (35.6%) 430 (30.9%) 311 (35.7%) 244 (43.6%)144 (46.9%) 78 (34.1%) 55 (43.7%) 299 (26.7%) 212 (28.2%) 150 (29.2%) 98 (30.7%) 234 (35.7%) 160 (40.9%) 94 (32.6%) 62 (38.0%)
>=1 2110 (44.4%) 1320 (45.1%) 0.91 0.82-1.02 543 (39.1%) 345 (39.7%) 0.86 0.7-1.05 232 (41.4%)126 (41.0%) 0.94 0.7-1.28 107 (46.7%) 59 (46.8%) 0.75 0.47-1.21 548 (49.0%) 383 (50.9%) 1.02 0.82-1.27 236 (45.9%) 148 (46.4%) 0.96 0.69-1.33 299 (45.6%) 180 (46.0%) 0.93 0.7-1.23 145 (50.3%) 79 (48.5%) 0.84 0.55-1.29
>1/<=4 914 (19.2%) 484 (16.5%) 0.79*** 0.68-0.9 316 (22.7%) 175 (20.1%) 0.78** 0.62-0.99 70 (12.5%) 36 (11.7%) 0.89 0.57-1.4 36 (15.7%) 9 (7.1%) 0.34** 0.15-0.79 235 (21.0%) 141 (18.8%) 0.9 0.69-1.19 106 (20.6%) 64 (20.1%) 0.96 0.63-1.45 108 (16.5%) 43 (11.0%) 0.61** 0.4-0.93 43 (14.9%) 16 (9.8%) 0.58* 0.3-1.11
>4 203 (4.3%) 82 (2.8%) 0.62*** 0.47-0.81 101 (7.3%) 39 (4.5%) 0.56*** 0.38-0.84 14 (2.5%) 1 (0.3%) 0.13** 0.02-0.99 8 (3.5%) 3 (2.4%) 0.5 0.13-2 37 (3.3%) 16 (2.1%) 0.67 0.36-1.25 22 (4.3%) 9 (2.8%) 0.67 0.29-1.55 15 (2.3%) 8 (2.0%) 0.83 0.35-2.02 6 (2.1%) 6 (3.7%) 1.67 0.48-5.78
Trend test p-value <0.0001 0.0015 0.1553 0.0160 0.2550 0.5276 0.0551 0.3482
Regular coffee (g/day) 0.8276
0-<240 2324 (48.9%) 1537 (52.5%) 619 (44.5%) 432 (49.7%) 345 (61.6%)202 (65.8%) 120 (52.4%) 74 (58.7%) 499 (44.6%) 349 (46.4%) 239 (46.5%) 149 (46.7%) 356 (54.3%) 240 (61.4%) 146 (50.7%) 91 (55.8%)
240-<961 2432 (51.1%) 1391 (47.5%) 0.86*** 0.78-0.94 771 (55.5%) 438 (50.3%) 0.81** 0.69-0.97 215 (38.4%)105 (34.2%) 0.83 0.62-1.13 109 (47.6%) 52 (41.3%) 0.8 0.5-1.26 620 (55.4%) 403 (53.6%) 0.93 0.78-1.13 275 (53.5%) 170 (53.3%) 0.98 0.74-1.3 300 (45.7%) 151 (38.6%) 0.77* 0.59-1.01 142 (49.3%) 72 (44.2%) 0.8 0.54-1.2
Decaffeinated Coffee (g/day) 0.7904
0-<33.95 3573 (75.1%) 2184 (74.6%) 1061 (76.3%) 653 (75.1%) 430 (76.8%)231 (75.2%) 174 (76.0%) 100 (79.4%) 845 (75.5%) 582 (77.4%) 394 (76.7%) 229 (71.8%) 466 (71.0%) 282 (72.1%) 203 (70.5%) 107 (65.6%)
33.95-<600 923 (19.4%) 610 (20.8%) 1.06 0.95-1.19 218 (15.7%) 165 (19.0%) 1.2 0.96-1.51 109 (19.5%)65 (21.2%) 1.1 0.78-1.56 49 (21.4%) 24 (19.0%) 0.81 0.47-1.41 236 (21.1%) 147 (19.5%) 0.9 0.71-1.14 89 (17.3%) 71 (22.3%) 1.31 0.92-1.88 149 (22.7%) 91 (23.3%) 0.97 0.72-1.31 73 (25.3%) 47 (28.8%) 1.19 0.77-1.85
600-961 260 (5.5%) 134 (4.6%) 0.83* 0.67-1.03 111 (8.0%) 52 (6.0%) 0.77 0.54-1.09 21 (3.8%) 11 (3.6%) 0.93 0.44-1.94 6 (2.6%) 2 (1.6%) 0.58 0.12-2.89 38 (3.4%) 23 (3.1%) 0.82 0.48-1.4 31 (6.0%) 19 (6.0%) 1.05 0.57-1.93 41 (6.2%) 18 (4.6%) 0.72 0.4-1.29 12 (4.2%) 9 (5.5%) 1.31 0.54-3.16
Trend test p-value 0.4362 0.5503 0.8588 0.3263 0.2850 0.3814 0.3301 0.3574
Black Tea (g/day) 0.1995
0-<33.94 3483 (73.2%) 2191 (74.8%) 929 (66.8%) 576 (66.2%) 428 (76.4%)251 (81.8%) 169 (73.8%) 84 (66.7%) 836 (74.7%) 575 (76.5%) 372 (72.4%) 248 (77.7%) 546 (83.2%) 336 (85.9%) 203 (70.5%) 121 (74.2%)
33.94-<240 809 (17.0%) 475 (16.2%) 0.94 0.83-1.07 250 (18.0%) 182 (20.9%) 1.18 0.95-1.47 96 (17.1%) 41 (13.4%) 0.70* 0.47-1.06 39 (17.0%) 28 (22.2%) 1.38 0.81-2.35 190 (17.0%) 117 (15.6%) 0.92 0.71-1.19 101 (19.6%) 45 (14.1%) 0.67* 0.45-1.01 73 (11.1%) 38 (9.7%) 0.87 0.57-1.31 60 (20.8%) 24 (14.7%) 0.72 0.43-1.2
240-<961 464 (9.8%) 262 (8.9%) 0.88 0.75-1.04 211 (15.2%) 112 (12.9%) 0.83 0.64-1.06 36 (6.4%) 15 (4.9%) 0.76 0.41-1.41 21 (9.2%) 14 (11.1%) 1.27 0.62-2.6 93 (8.3%) 60 (8.0%) 0.99 0.7-1.4 41 (8.0%) 26 (8.2%) 0.9 0.53-1.51 37 (5.6%) 17 (4.3%) 0.73 0.41-1.33 25 (8.7%) 18 (11.0%) 1.26 0.65-2.44
Trend test p-value 0.0982 0.2653 0.1415 0.3614 0.7944 0.3203 0.2325 0.8605
0.8731
none 2599 (58.4%) 1656 (60.5%) 704 (53.1%) 420 (51.0%) 330 (64.2%)200 (69.9%) 107 (49.1%) 58 (47.5%) 697 (65.0%) 488 (67.3%) 275 (57.1%) 182 (60.9%) 331 (59.3%) 217 (66.0%) 155 (55.8%) 91 (60.3%)
<= 0.11 761 (17.1%) 446 (16.3%) 0.93 0.81 - 1.06 223 (16.8%) 149 (18.1%) 1.11 0.87 - 1.43 83 (16.1%) 40 (14.0%) 0.82 0.53 - 1.28 34 (15.6%) 18 (14.8%) 0.96 0.49 - 1.87 170 (15.8%) 106 (14.6%) 0.92 0.69 - 1.22 90 (18.7%) 57 (19.1%) 0.94 0.63 - 1.40 94 (16.8%) 47 (14.3%) 0.73 0.47 - 1.12 67 (24.1%) 29 (19.2%) 0.75 0.45 - 1.24
> 0.11 - <=0.36 508 (11.4%) 311 (11.4%) 0.99 0.84 - 1.16 154 (11.6%) 103 (12.5%) 1.2 0.91 - 1.60 43 (8.4%) 23 (8.0%) 0.89 0.51 - 1.56 32 (14.7%) 18 (14.8%) 1.01 0.51 - 1.99 125 (11.6%) 82 (11.3%) 0.98 0.72 - 1.32 50 (10.4%) 32 (10.7%) 0.93 0.56 - 1.54 70 (12.5%) 34 (10.3%) 0.79 0.49 - 1.27 34 (12.2%) 19 (12.6%) 0.91 0.47 - 1.77
>0.36 582 (13.1%) 323 (11.8%) 0.91 0.77 - 1.06 246 (18.5%) 152 (18.4%) 1.11 0.86 - 1.42 58 (11.3%) 23 (8.0%) 0.65 0.38 - 1.10 45 (20.6%) 28 (23.0%) 1.13 0.62 - 2.04 81 (7.5%) 49 (6.8%) 0.93 0.64 - 1.36 67 (13.9%) 28 (9.4%) 0.64* 0.38 - 1.07 63 (11.3%) 31 (9.4%) 0.74 0.46 - 1.20 22 (7.9%) 12 (7.9%) 0.88 0.41 - 1.91
Trend test p-value 0.2587 0.2743 0.0997 0.7078 0.6456 0.1237 0.1113 0.5828
BMI (kg/m2) 0.017
<25 2286 (48.8%) 1313 (45.4%) 781 (56.4%) 460 (52.9%) 118 (22.2%)52 (17.9%) 63 (27.6%) 31 (25.0%) 786 (71.5%) 482 (64.7%) 169 (33.0%) 103 (32.3%) 202 (31.1%) 109 (28.1%) 167 (60.1%) 76 (48.4%)
25-<30 1459 (31.2%) 1039 (35.9%) 1.30*** 1.16-1.45 391 (28.3%) 271 (31.2%) 1.19* 0.97-1.45 185 (34.8%)137 (47.2%) 1.58** 1.05-2.39 74 (32.5%) 55 (44.4%) 1.54 0.86-2.76 244 (22.2%) 219 (29.4%) 1.51*** 1.22-1.88 194 (37.9%) 138 (43.3%) 1.17 0.84-1.63 287 (44.2%) 168 (43.3%) 1 0.73-1.36 84 (30.2%) 51 (32.5%) 1.3 0.82-2.08
30+ 937 (20.0%) 540 (18.7%) 1.09 0.96-1.26 212 (15.3%) 138 (15.9%) 1.1 0.87-1.41 228 (42.9%)101 (34.8%) 0.99 0.66-1.49 91 (39.9%) 38 (30.6%) 0.9 0.49-1.65 70 (6.4%) 44 (5.9%) 1.11 0.74-1.67 149 (29.1%) 78 (24.5%) 0.84 0.58-1.21 160 (24.7%) 111 (28.6%) 1.26 0.89-1.79 27 (9.7%) 30 (19.1%) 2.70*** 1.4-5.19
Trend test p-value 0.0428 0.2396 0.3192 0.5117 0.0106 0.3491 0.2030 0.0028
Calories (Kcal/day) 0.4305
427-<1324.27 1135 (23.9%) 761 (26.0%) 347 (25.0%) 222 (25.5%) 177 (31.6%)113 (36.8%) 38 (16.6%) 23 (18.3%) 277 (24.8%) 183 (24.3%) 109 (21.2%) 92 (28.8%) 116 (17.7%) 92 (23.5%) 71 (24.7%) 36 (22.1%)
1324.27-<1749.475 1163 (24.5%) 721 (24.6%) 0.92 0.8-1.05 385 (27.7%) 250 (28.7%) 1.04 0.82-1.31 124 (22.1%)66 (21.5%) 0.82 0.56-1.2 45 (19.7%) 21 (16.7%) 0.72 0.33-1.57 313 (28.0%) 216 (28.7%) 1.01 0.78-1.3 106 (20.6%) 73 (22.9%) 0.8 0.52-1.22 124 (18.9%) 62 (15.9%) 0.66** 0.44-0.99 66 (22.9%) 33 (20.2%) 1.07 0.59-1.94
1749.475-<2345.409 1235 (26.0%) 664 (22.7%) 0.79*** 0.69-0.91 393 (28.3%) 230 (26.4%) 0.95 0.74-1.2 121 (21.6%)44 (14.3%) 0.56*** 0.37-0.85 54 (23.6%) 25 (19.8%) 0.7 0.34-1.43 324 (29.0%) 191 (25.4%) 0.85 0.65-1.1 128 (24.9%) 59 (18.5%) 0.54*** 0.35-0.83 155 (23.6%) 79 (20.2%) 0.67** 0.46-0.98 60 (20.8%) 36 (22.1%) 1.31 0.71-2.43
2345.409-7742 1223 (25.7%) 782 (26.7%) 0.98 0.86-1.12 265 (19.1%) 168 (19.3%) 1.03 0.79-1.33 138 (24.6%)84 (27.4%) 0.97 0.67-1.4 92 (40.2%) 57 (45.2%) 0.99 0.54-1.81 205 (18.3%) 162 (21.5%) 1.16 0.88-1.52 171 (33.3%) 95 (29.8%) 0.68* 0.46-1 261 (39.8%) 158 (40.4%) 0.78 0.56-1.1 91 (31.6%) 58 (35.6%) 1.37 0.79-2.38
Trend test p-value 0.8410 0.9935 0.7239 0.5728 0.4170 0.0625 0.5106 0.2347
0.8573
0-<12.91 1148 (24.1%) 759 (25.9%) 422 (30.4%) 273 (31.4%) 168 (30.0%)96 (31.3%) 24 (10.5%) 15 (11.9%) 260 (23.2%) 187 (24.9%) 76 (14.8%) 67 (21.0%) 131 (20.0%) 85 (21.7%) 67 (23.3%) 36 (22.1%)
12.91-<24.95 1179 (24.8%) 706 (24.1%) 0.92 0.81-1.05 376 (27.1%) 237 (27.2%) 0.98 0.78-1.23 133 (23.8%)77 (25.1%) 1.02 0.69-1.5 50 (21.8%) 21 (16.7%) 0.68 0.3-1.53 316 (28.2%) 185 (24.6%) 0.84 0.64-1.08 109 (21.2%) 77 (24.1%) 0.8 0.52-1.25 129 (19.7%) 72 (18.4%) 0.95 0.63-1.43 66 (22.9%) 37 (22.7%) 1.08 0.6-1.93
24.95-<42.98 1144 (24.1%) 710 (24.2%) 0.96 0.84-1.1 323 (23.2%) 196 (22.5%) 0.97 0.76-1.23 130 (23.2%)64 (20.8%) 0.87 0.59-1.3 74 (32.3%) 40 (31.7%) 0.82 0.37-1.8 295 (26.4%) 211 (28.1%) 1 0.78-1.3 125 (24.3%) 74 (23.2%) 0.69* 0.44-1.07 136 (20.7%) 89 (22.8%) 1.1 0.73-1.64 61 (21.2%) 36 (22.1%) 1.16 0.63-2.15
42.98-499 1285 (27.0%) 753 (25.7%) 0.93 0.81-1.06 269 (19.4%) 164 (18.9%) 0.98 0.77-1.26 129 (23.0%)70 (22.8%) 0.96 0.65-1.42 81 (35.4%) 50 (39.7%) 1.01 0.49-2.12 248 (22.2%) 169 (22.5%) 0.99 0.76-1.3 204 (39.7%) 101 (31.7%) 0.59** 0.39-0.88 260 (39.6%) 145 (37.1%) 0.92 0.65-1.31 94 (32.6%) 54 (33.1%) 1.08 0.62-1.88
Trend test p-value 0.4338 0.8827 0.7486 0.4196 0.6036 0.0105 0.6282 0.8560
Processed red meat (g/day) 0.8136
0-<3.96 1193 (25.1%) 780 (26.6%) 443 (31.9%) 273 (31.4%) 139 (24.8%)86 (28.0%) 24 (10.5%) 16 (12.7%) 241 (21.5%) 164 (21.8%) 112 (21.8%) 93 (29.2%) 175 (26.7%) 106 (27.1%) 59 (20.5%) 42 (25.8%)
3.96-<8.96 1179 (24.8%) 737 (25.2%) 0.96 0.85-1.1 390 (28.1%) 251 (28.9%) 1.05 0.84-1.3 127 (22.7%)70 (22.8%) 0.93 0.63-1.37 42 (18.3%) 22 (17.5%) 0.73 0.31-1.74 275 (24.6%) 181 (24.1%) 0.98 0.74-1.3 125 (24.3%) 76 (23.8%) 0.75 0.5-1.13 150 (22.9%) 102 (26.1%) 1.16 0.81-1.65 70 (24.3%) 35 (21.5%) 0.72 0.41-1.24
8.96-<17.18 1200 (25.2%) 723 (24.7%) 0.92 0.81-1.05 321 (23.1%) 212 (24.4%) 1.06 0.84-1.34 135 (24.1%)65 (21.2%) 0.8 0.54-1.19 68 (29.7%) 36 (28.6%) 0.8 0.35-1.83 334 (29.8%) 221 (29.4%) 0.96 0.74-1.25 124 (24.1%) 71 (22.3%) 0.72 0.48-1.1 150 (22.9%) 89 (22.8%) 1.04 0.72-1.5 68 (23.6%) 29 (17.8%) 0.58* 0.32-1.05
17.18-222 1184 (24.9%) 688 (23.5%) 0.91 0.8-1.05 236 (17.0%) 134 (15.4%) 0.95 0.73-1.23 159 (28.4%)86 (28.0%) 0.88 0.6-1.29 95 (41.5%) 52 (41.3%) 0.82 0.39-1.73 269 (24.0%) 186 (24.7%) 1.06 0.8-1.41 153 (29.8%) 79 (24.8%) 0.65** 0.44-0.96 181 (27.6%) 94 (24.0%) 0.86 0.6-1.23 91 (31.6%) 57 (35.0%) 0.85 0.51-1.44
Trend test p-value 0.1963 0.6651 0.5608 0.9197 0.5768 0.0558 0.2232 0.9841
0.0141
0.44-38.02 1155 (24.3%) 615 (21.0%) 238 (17.1%) 128 (14.7%) 135 (24.1%)58 (18.9%) 41 (17.9%) 15 (11.9%) 333 (29.8%) 205 (27.3%) 146 (28.4%) 88 (27.6%) 176 (26.8%) 95 (24.4%) 86 (29.9%) 26 (16.0%)
38.02-<60.85 1176 (24.7%) 695 (23.7%) 1.09 0.95-1.25 297 (21.4%) 167 (19.2%) 1.01 0.75-1.35 144 (25.7%)77 (25.1%) 1.23 0.81-1.89 60 (26.2%) 32 (25.4%) 1.43 0.69-2.94 309 (27.6%) 206 (27.4%) 1.06 0.83-1.36 104 (20.2%) 81 (25.4%) 1.27 0.85-1.88 186 (28.4%) 91 (23.3%) 0.89 0.62-1.28 76 (26.4%) 41 (25.2%) 1.57 0.85-2.92
60.85-<91.87 1198 (25.2%) 791 (27.0%) 1.21*** 1.05-1.38 347 (25.0%) 247 (28.4%) 1.28* 0.97-1.68 139 (24.8%)95 (30.9%) 1.60** 1.05-2.44 68 (29.7%) 44 (34.9%) 1.7 0.86-3.38 274 (24.5%) 200 (26.6%) 1.1 0.85-1.42 138 (26.8%) 72 (22.6%) 0.84 0.57-1.25 155 (23.6%) 97 (24.9%) 1.13 0.79-1.62 77 (26.7%) 36 (22.1%) 1.38 0.73-2.63
91.87-515 1227 (25.8%) 826 (28.2%) 1.22*** 1.07-1.4 508 (36.5%) 328 (37.7%) 1.14 0.88-1.47 142 (25.4%)77 (25.1%) 1.25 0.81-1.95 60 (26.2%) 35 (27.8%) 1.59 0.76-3.37 203 (18.1%) 141 (18.8%) 1.06 0.79-1.4 126 (24.5%) 78 (24.5%) 0.94 0.63-1.39 139 (21.2%) 107 (27.4%) 1.37* 0.96-1.94 49 (17.0%) 60 (36.8%) 3.41*** 1.92-6.09
Trend test p-value 0.0033 0.2943 0.3417 0.2893 0.6862 0.3950 0.0306 <0.0001
Total Vegetables (g/day) 0.4494
0.15-<119.37 1214 (25.5%) 719 (24.6%) 361 (26.0%) 214 (24.6%) 199 (35.5%)97 (31.6%) 63 (27.5%) 26 (20.6%) 248 (22.2%) 187 (24.9%) 134 (26.1%) 77 (24.1%) 110 (16.8%) 67 (17.1%) 99 (34.4%) 51 (31.3%)
119.37-<162.63 1173 (24.7%) 737 (25.2%) 1.03 0.9-1.18 359 (25.8%) 232 (26.7%) 1.04 0.82-1.33 120 (21.4%)80 (26.1%) 1.37* 0.94-2 53 (23.1%) 29 (23.0%) 1.31 0.68-2.53 294 (26.3%) 193 (25.7%) 0.85 0.65-1.12 143 (27.8%) 90 (28.2%) 1.03 0.7-1.52 134 (20.4%) 68 (17.4%) 0.85 0.55-1.3 70 (24.3%) 45 (27.6%) 1.28 0.78-2.12
162.63-<219.78 1157 (24.3%) 754 (25.8%) 1.07 0.94-1.22 321 (23.1%) 231 (26.6%) 1.19 0.93-1.53 120 (21.4%)68 (22.1%) 1.14 0.77-1.69 60 (26.2%) 31 (24.6%) 1.27 0.69-2.35 309 (27.6%) 194 (25.8%) 0.8 0.61-1.05 112 (21.8%) 84 (26.3%) 1.22 0.82-1.83 173 (26.4%) 115 (29.4%) 1.11 0.75-1.63 62 (21.5%) 31 (19.0%) 0.97 0.58-1.64
219.78-1131 1212 (25.5%) 718 (24.5%) 0.97 0.85-1.11 349 (25.1%) 193 (22.2%) 0.9 0.7-1.16 121 (21.6%)62 (20.2%) 1.03 0.69-1.54 53 (23.1%) 40 (31.7%) 1.79* 0.95-3.39 268 (23.9%) 178 (23.7%) 0.85 0.64-1.13 125 (24.3%) 68 (21.3%) 0.86 0.56-1.31 239 (36.4%) 141 (36.1%) 0.97 0.66-1.41 57 (19.8%) 36 (22.1%) 1.31 0.77-2.25
Trend test p-value 0.5962 0.4374 0.9316 0.0804 0.3246 0.5290 0.9033 0.4749
Total Fruits and Juice (g/day) 0.1058
0-<101.18 1225 (25.8%) 702 (24.0%) 366 (26.3%) 220 (25.3%) 136 (24.3%)78 (25.4%) 65 (28.4%) 35 (27.8%) 265 (23.7%) 153 (20.3%) 160 (31.1%) 86 (27.0%) 173 (26.4%) 94 (24.0%) 60 (20.8%) 36 (22.1%)
101.18-<175.79 1197 (25.2%) 678 (23.2%) 0.95 0.84-1.09 375 (27.0%) 207 (23.8%) 0.88 0.69-1.12 135 (24.1%)64 (20.8%) 0.82 0.54-1.24 57 (24.9%) 32 (25.4%) 1.12 0.6-2.09 279 (24.9%) 174 (23.1%) 1.03 0.78-1.36 126 (24.5%) 59 (18.5%) 0.8 0.53-1.21 158 (24.1%) 96 (24.6%) 1.12 0.77-1.63 67 (23.3%) 46 (28.2%) 1.17 0.67-2.05
175.79-<272.92 1206 (25.4%) 749 (25.6%) 1.01 0.89-1.16 364 (26.2%) 228 (26.2%) 0.96 0.75-1.22 136 (24.3%)63 (20.5%) 0.77 0.52-1.15 71 (31.0%) 23 (18.3%) 0.58* 0.31-1.1 306 (27.3%) 223 (29.7%) 1.19 0.91-1.56 114 (22.2%) 83 (26.0%) 1.22 0.81-1.82 144 (22.0%) 94 (24.0%) 1.19 0.83-1.71 71 (24.7%) 35 (21.5%) 0.84 0.46-1.56
272.92-1219 1128 (23.7%) 799 (27.3%) 1.16** 1.01-1.33 285 (20.5%) 215 (24.7%) 1.15 0.89-1.48 153 (27.3%)102 (33.2%) 1.11 0.75-1.65 36 (15.7%) 36 (28.6%) 2.12** 1.06-4.27 269 (24.0%) 202 (26.9%) 1.19 0.9-1.58 114 (22.2%) 91 (28.5%) 1.36 0.92-2.04 181 (27.6%) 107 (27.4%) 1.03 0.72-1.47 90 (31.2%) 46 (28.2%) 0.87 0.49-1.55
Trend test p-value 0.0110 0.1389 0.3889 0.1512 0.1577 0.0520 0.9404 0.4139
*** p<0.01, ** p<0.05, * p<0.1
Vigorous activity (vigorous work and sports) hours per day
Red meat excluding processed red meat (g/day)
Density for Vitamin D (IU/1000 kcal/day)
Page | 43

4.2.2. Multivariate models of smoking for POP risk
In the smoking models (Table 11), there was an inverse association between smoking and risk of
POP with women who smoked no less than 25 years having 0.77 times of getting POP compared
to women who never smoked (95%CI: 0.67-0.88). The inverse association was shown in Whites,
African-American, and all Latinos. There was a significant inverse does-response trend, with a
heterogeneity test that was insignificant (p=0.0593). When considering average number of
cigarettes per day or packs of cigarette per year, the inverse association of smoking on POP was
also found, but it was only significant among foreign-born Latinos. Alcohol was still inversely
associated with risk of POP with increase ORs compared to univariate analyses. However, only
drinking alcohol more than 14 g/day showed an inverse association with the risk of getting POP.
The trend test was significant for all women combined, but was not observed among any
racial/ethnic groups (heterogeneity p=0.8773). Coffee was also found to be inversely associated
with risk of POP. Raised consumption of coffee could reduce the risk of POP, especially for
Whites. Also, women with BMI between 25 kg/m
2
and 30 kg/m
2
were about 1.30 times to get
POP compared to those with BMI less than 25 kg/m
2
. However, no significant association for
women with BMI over 30 kg/m
2
was found, and no trend test of BMI for all women combined
was significant, which was consistent in these models.

Page | 44

Table 11. Multivariate models of smoking for Prolapse across ethnic groups

Total White Black Hawaiian Japanese L-us born L-foreign born Other Interaction p
MODEL 1 Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 4756 2928 1390 870 560 307 229 126 1119 752 514 319 656 391 288 163
Total number of years smoked 0.0593
Never 2693 (58.7%) 1781 (63.1%) 642 (46.9%) 421 (49.1%) 245 (46.2%) 158 (53.4%) 105 (47.1%) 72 (59.5%) 782 (70.8%) 544 (74.4%) 303 (61.3%) 200 (64.9%) 416 (70.5%) 265 (75.7%) 200 (72.2%) 121 (76.1%)
< 25 years 904 (19.7%) 573 (20.3%) 0.99 0.87 - 1.12 323 (23.6%) 246 (28.7%) 1.27** 1.03 - 1.58 138 (26.0%) 60 (20.3%) 0.62** 0.42 - 0.92 51 (22.9%) 18 (14.9%) 0.68 0.35 - 1.32 160 (14.5%) 100 (13.7%) 0.9 0.67 - 1.20 100 (20.2%) 70 (22.7%) 1.11 0.77 - 1.60 94 (15.9%) 58 (16.6%) 0.96 0.65 - 1.41 38 (13.7%) 21 (13.2%) 0.77 0.42 - 1.42
>= 25 years 991 (21.6%) 469 (16.6%) 0.77*** 0.67 - 0.88 404 (29.5%) 191 (22.3%) 0.80* 0.64 - 1.00 147 (27.7%) 78 (26.4%) 0.88 0.59 - 1.30 67 (30.0%) 31 (25.6%) 0.93 0.52 - 1.66 163 (14.8%) 87 (11.9%) 0.83 0.61 - 1.12 91 (18.4%) 38 (12.3%) 0.61** 0.39 - 0.96 80 (13.6%) 27 (7.7%) 0.53** 0.32 - 0.87 39 (14.1%) 17 (10.7%) 0.61 0.30 - 1.24
Trend test p-value 0.0006 0.1584 0.3142 0.7041 0.1882 0.0966 0.0241 0.1338
alcohol (g/day) 0.8773
none 2879 (60.5%) 1868 (63.8%) 509 (36.6%) 357 (41.0%) 353 (63.0%) 204 (66.4%) 154 (67.2%) 86 (68.3%) 882 (78.8%) 605 (80.5%) 310 (60.3%) 206 (64.6%) 461 (70.3%) 289 (73.9%) 210 (72.9%) 121 (74.2%)
<=14 1432 (30.1%) 843 (28.8%) 0.95 0.85 - 1.07 580 (41.7%) 352 (40.5%) 0.88 0.72 - 1.08 169 (30.2%) 85 (27.7%) 0.81 0.57 - 1.16 57 (24.9%) 36 (28.6%) 1.36 0.78 - 2.39 208 (18.6%) 133 (17.7%) 1 0.77 - 1.30 175 (34.0%) 102 (32.0%) 0.88 0.62 - 1.24 176 (26.8%) 97 (24.8%) 0.99 0.71 - 1.37 67 (23.3%) 38 (23.3%) 1.03 0.61 - 1.72
>14 445 (9.4%) 217 (7.4%) 0.80** 0.65 - 0.97 301 (21.7%) 161 (18.5%) 0.79* 0.61 - 1.03 38 (6.8%) 18 (5.9%) 0.9 0.48 - 1.68 18 (7.9%) 4 (3.2%) 0.53 0.15 - 1.83 29 (2.6%) 14 (1.9%) 0.77 0.39 - 1.52 29 (5.6%) 11 (3.4%) 0.63 0.29 - 1.36 19 (2.9%) 5 (1.3%) 0.55 0.18 - 1.63 11 (3.8%) 4 (2.5%) 0.52 0.14 - 1.98
Trend test p-value 0.0399 0.0699 0.3635 0.968 0.6676 0.2254 0.5373 0.5906
Coffee: (Cups/day) 0.6665
none 1529 (32.1%) 1042 (35.6%) 430 (30.9%) 311 (35.7%) 244 (43.6%) 144 (46.9%) 78 (34.1%) 55 (43.7%) 299 (26.7%) 212 (28.2%) 150 (29.2%) 98 (30.7%) 234 (35.7%) 160 (40.9%) 94 (32.6%) 62 (38.0%)
>=1 2110 (44.4%) 1320 (45.1%) 0.95 0.85 - 1.06 543 (39.1%) 345 (39.7%) 0.87 0.70 - 1.07 232 (41.4%) 126 (41.0%) 1.08 0.77 - 1.53 107 (46.7%) 59 (46.8%) 0.67 0.39 - 1.14 548 (49.0%) 383 (50.9%) 1.01 0.80 - 1.27 236 (45.9%) 148 (46.4%) 1.05 0.74 - 1.49 299 (45.6%) 180 (46.0%) 0.95 0.69 - 1.30 145 (50.3%) 79 (48.5%) 1.04 0.64 - 1.67
>1/<=4 914 (19.2%) 484 (16.5%) 0.84** 0.73 - 0.97 316 (22.7%) 175 (20.1%) 0.78** 0.61 - 1.00 70 (12.5%) 36 (11.7%) 0.91 0.54 - 1.51 36 (15.7%) 9 (7.1%) 0.47* 0.19 - 1.15 235 (21.0%) 141 (18.8%) 0.95 0.71 - 1.27 106 (20.6%) 64 (20.1%) 1.1 0.71 - 1.70 108 (16.5%) 43 (11.0%) 0.72 0.45 - 1.14 43 (14.9%) 16 (9.8%) 0.64 0.32 - 1.30
>4 203 (4.3%) 82 (2.8%) 0.67*** 0.51 - 0.89 101 (7.3%) 39 (4.5%) 0.58** 0.39 - 0.88 14 (2.5%) 1 (0.3%) 0.13* 0.02 - 1.01 8 (3.5%) 3 (2.4%) 0.55 0.13 - 2.36 37 (3.3%) 16 (2.1%) 0.75 0.39 - 1.42 22 (4.3%) 9 (2.8%) 0.69 0.28 - 1.73 15 (2.3%) 8 (2.0%) 1.18 0.44 - 3.11 6 (2.1%) 6 (3.7%) 2.33 0.64 - 8.49
Trend test p-value 0.0015 0.0035 0.285 0.0648 0.5097 0.9614 0.3629 0.841
BMI (kg/m2) 0.0199
<25 2286 (48.8%) 1313 (45.4%) 781 (56.4%) 460 (52.9%) 118 (22.2%) 52 (17.9%) 63 (27.6%) 31 (25.0%) 786 (71.5%) 482 (64.7%) 169 (33.0%) 103 (32.3%) 202 (31.1%) 109 (28.1%) 167 (60.1%) 76 (48.4%)
25-<30 1459 (31.2%) 1039 (35.9%) 1.30*** 1.16 - 1.46 391 (28.3%) 271 (31.2%) 1.16 0.95 - 1.43 185 (34.8%) 137 (47.2%) 1.65** 1.08 - 2.52 74 (32.5%) 55 (44.4%) 1.56 0.85 - 2.86 244 (22.2%) 219 (29.4%) 1.51*** 1.21 - 1.89 194 (37.9%) 138 (43.3%) 1.23 0.87 - 1.75 287 (44.2%) 168 (43.3%) 0.93 0.66 - 1.32 84 (30.2%) 51 (32.5%) 1.29 0.79 - 2.10
30+ 937 (20.0%) 540 (18.7%) 1.05 0.91 - 1.22 212 (15.3%) 138 (15.9%) 1.03 0.80 - 1.33 228 (42.9%) 101 (34.8%) 0.94 0.61 - 1.43 91 (39.9%) 38 (30.6%) 0.82 0.42 - 1.59 70 (6.4%) 44 (5.9%) 1.13 0.74 - 1.70 149 (29.1%) 78 (24.5%) 0.81 0.55 - 1.21 160 (24.7%) 111 (28.6%) 1.23 0.82 - 1.83 27 (9.7%) 30 (19.1%) 2.50*** 1.27 - 4.93
Trend test p-value 0.0762 0.4984 0.2941 0.5335 0.007 0.3685 0.3343 0.0088
MODEL 2
Average number of cigarettes per day 0.7849
Never 2693 (58.3%) 1781 (62.9%) 642 (46.7%) 421 (49.0%) 245 (45.3%) 158 (53.0%) 105 (47.1%) 72 (59.0%) 782 (70.6%) 544 (74.1%) 303 (60.6%) 200 (64.9%) 416 (69.7%) 265 (75.5%) 200 (71.9%) 121 (76.1%)
< 8 cigarettes 518 (11.2%) 277 (9.8%) 0.83** 0.71 - 0.98 121 (8.8%) 73 (8.5%) 0.95 0.68 - 1.32 85 (15.7%) 39 (13.1%) 0.65* 0.40 - 1.06 16 (7.2%) 6 (4.9%) 0.6 0.21 - 1.69 65 (5.9%) 43 (5.9%) 0.95 0.62 - 1.44 93 (18.6%) 46 (14.9%) 0.78 0.52 - 1.16 109 (18.3%) 59 (16.8%) 0.85 0.59 - 1.23 29 (10.4%) 11 (6.9%) 0.57 0.26 - 1.23
>= 8 cigarettes 1409 (30.5%) 774 (27.3%) 0.90* 0.80 - 1.01 611 (44.5%) 366 (42.6%) 1.04 0.86 - 1.26 211 (39.0%) 101 (33.9%) 0.73* 0.51 - 1.03 102 (45.7%) 44 (36.1%) 0.9 0.53 - 1.51 260 (23.5%) 147 (20.0%) 0.86 0.67 - 1.10 104 (20.8%) 62 (20.1%) 0.97 0.65 - 1.43 72 (12.1%) 27 (7.7%) 0.61** 0.37 - 1.00 49 (17.6%) 27 (17.0%) 0.75 0.42 - 1.34
Trend test p-value 0.0427 0.6874 0.0674 0.683 0.2201 0.6337 0.0413 0.236
alcohol (g/day) 0.9455
none 2879 (60.5%) 1868 (63.8%) 509 (36.6%) 357 (41.0%) 353 (63.0%) 204 (66.4%) 154 (67.2%) 86 (68.3%) 882 (78.8%) 605 (80.5%) 310 (60.3%) 206 (64.6%) 461 (70.3%) 289 (73.9%) 210 (72.9%) 121 (74.2%)
<=14 1432 (30.1%) 843 (28.8%) 0.94 0.84 - 1.06 580 (41.7%) 352 (40.5%) 0.9 0.73 - 1.10 169 (30.2%) 85 (27.7%) 0.83 0.59 - 1.18 57 (24.9%) 36 (28.6%) 1.29 0.74 - 2.23 208 (18.6%) 133 (17.7%) 0.99 0.76 - 1.28 175 (34.0%) 102 (32.0%) 0.88 0.62 - 1.24 176 (26.8%) 97 (24.8%) 0.96 0.70 - 1.33 67 (23.3%) 38 (23.3%) 1.04 0.62 - 1.74
>14 445 (9.4%) 217 (7.4%) 0.78** 0.64 - 0.96 301 (21.7%) 161 (18.5%) 0.77** 0.59 - 1.00 38 (6.8%) 18 (5.9%) 0.97 0.52 - 1.80 18 (7.9%) 4 (3.2%) 0.5 0.15 - 1.71 29 (2.6%) 14 (1.9%) 0.76 0.38 - 1.50 29 (5.6%) 11 (3.4%) 0.66 0.30 - 1.44 19 (2.9%) 5 (1.3%) 0.62 0.21 - 1.84 11 (3.8%) 4 (2.5%) 0.52 0.14 - 1.96
Trend test p-value 0.0256 0.0494 0.4969 0.8857 0.5966 0.2564 0.5372 0.5992
Coffee: (Cups/day) 0.6445
none 1529 (32.1%) 1042 (35.6%) 430 (30.9%) 311 (35.7%) 244 (43.6%) 144 (46.9%) 78 (34.1%) 55 (43.7%) 299 (26.7%) 212 (28.2%) 150 (29.2%) 98 (30.7%) 234 (35.7%) 160 (40.9%) 94 (32.6%) 62 (38.0%)
>=1 2110 (44.4%) 1320 (45.1%) 0.95 0.85 - 1.06 543 (39.1%) 345 (39.7%) 0.88 0.71 - 1.08 232 (41.4%) 126 (41.0%) 1.14 0.81 - 1.62 107 (46.7%) 59 (46.8%) 0.68 0.40 - 1.16 548 (49.0%) 383 (50.9%) 0.99 0.79 - 1.25 236 (45.9%) 148 (46.4%) 1.05 0.74 - 1.49 299 (45.6%) 180 (46.0%) 0.93 0.68 - 1.27 145 (50.3%) 79 (48.5%) 1.02 0.63 - 1.65
>1/<=4 914 (19.2%) 484 (16.5%) 0.83** 0.72 - 0.96 316 (22.7%) 175 (20.1%) 0.78** 0.62 - 1.00 70 (12.5%) 36 (11.7%) 0.99 0.59 - 1.65 36 (15.7%) 9 (7.1%) 0.43* 0.18 - 1.03 235 (21.0%) 141 (18.8%) 0.92 0.69 - 1.24 106 (20.6%) 64 (20.1%) 1.04 0.67 - 1.61 108 (16.5%) 43 (11.0%) 0.71 0.45 - 1.13 43 (14.9%) 16 (9.8%) 0.62 0.31 - 1.24
>4 203 (4.3%) 82 (2.8%) 0.65*** 0.49 - 0.86 101 (7.3%) 39 (4.5%) 0.56*** 0.37 - 0.84 14 (2.5%) 1 (0.3%) 0.14* 0.02 - 1.12 8 (3.5%) 3 (2.4%) 0.52 0.12 - 2.24 37 (3.3%) 16 (2.1%) 0.73 0.38 - 1.39 22 (4.3%) 9 (2.8%) 0.62 0.25 - 1.50 15 (2.3%) 8 (2.0%) 1.1 0.42 - 2.88 6 (2.1%) 6 (3.7%) 2.25 0.62 - 8.21
Trend test p-value 0.0006 0.0024 0.4935 0.045 0.3954 0.7036 0.3012 0.7425
BMI (kg/m2) 0.0237
<25 2286 (48.8%) 1313 (45.4%) 781 (56.4%) 460 (52.9%) 118 (22.2%) 52 (17.9%) 63 (27.6%) 31 (25.0%) 786 (71.5%) 482 (64.7%) 169 (33.0%) 103 (32.3%) 202 (31.1%) 109 (28.1%) 167 (60.1%) 76 (48.4%)
25-<30 1459 (31.2%) 1039 (35.9%) 1.31*** 1.17 - 1.47 391 (28.3%) 271 (31.2%) 1.17 0.95 - 1.43 185 (34.8%) 137 (47.2%) 1.60** 1.05 - 2.44 74 (32.5%) 55 (44.4%) 1.54 0.85 - 2.82 244 (22.2%) 219 (29.4%) 1.51*** 1.21 - 1.89 194 (37.9%) 138 (43.3%) 1.21 0.86 - 1.70 287 (44.2%) 168 (43.3%) 1.03 0.73 - 1.47 84 (30.2%) 51 (32.5%) 1.28 0.79 - 2.10
30+ 937 (20.0%) 540 (18.7%) 1.06 0.92 - 1.22 212 (15.3%) 138 (15.9%) 1.04 0.81 - 1.34 228 (42.9%) 101 (34.8%) 0.89 0.58 - 1.35 91 (39.9%) 38 (30.6%) 0.87 0.46 - 1.65 70 (6.4%) 44 (5.9%) 1.12 0.74 - 1.69 149 (29.1%) 78 (24.5%) 0.79 0.54 - 1.18 160 (24.7%) 111 (28.6%) 1.32 0.89 - 1.95 27 (9.7%) 30 (19.1%) 2.55*** 1.29 - 5.06
Trend test p-value 0.0672 0.4314 0.1787 0.6368 0.0072 0.3127 0.1772 0.0081
MODEL 3
Packs of Cigarette per year 0.3871
Never 2693 (58.9%) 1781 (63.4%) 642 (47.0%) 421 (49.2%) 245 (46.5%) 158 (53.7%) 105 (47.3%) 72 (60.0%) 782 (70.8%) 544 (74.6%) 303 (61.8%) 200 (65.6%) 416 (70.9%) 265 (76.8%) 200 (72.5%) 121 (76.1%)
< 12 938 (20.5%) 557 (19.8%) 0.94 0.82 - 1.06 278 (20.3%) 205 (23.9%) 1.23* 0.97 - 1.54 150 (28.5%) 75 (25.5%) 0.73 0.50 - 1.07 43 (19.4%) 20 (16.7%) 0.84 0.44 - 1.63 163 (14.8%) 89 (12.2%) 0.79 0.58 - 1.07 128 (26.1%) 77 (25.2%) 0.93 0.66 - 1.32 129 (22.0%) 68 (19.7%) 0.83 0.58 - 1.19 47 (17.0%) 23 (14.5%) 0.65 0.35 - 1.20
>= 12 942 (20.6%) 470 (16.7%) 0.81*** 0.70 - 0.93 447 (32.7%) 230 (26.9%) 0.89 0.72 - 1.10 132 (25.0%) 61 (20.7%) 0.73 0.49 - 1.10 74 (33.3%) 28 (23.3%) 0.77 0.43 - 1.40 159 (14.4%) 96 (13.2%) 0.93 0.69 - 1.25 59 (12.0%) 28 (9.2%) 0.74 0.43 - 1.26 42 (7.2%) 12 (3.5%) 0.44** 0.22 - 0.87 29 (10.5%) 15 (9.4%) 0.79 0.38 - 1.64
Trend test p-value 0.0031 0.4197 0.0967 0.3865 0.3493 0.2833 0.0183 0.2733
alcohol (g/day) 0.9354
none 2879 (60.5%) 1868 (63.8%) 509 (36.6%) 357 (41.0%) 353 (63.0%) 204 (66.4%) 154 (67.2%) 86 (68.3%) 882 (78.8%) 605 (80.5%) 310 (60.3%) 206 (64.6%) 461 (70.3%) 289 (73.9%) 210 (72.9%) 121 (74.2%)
<=14 1432 (30.1%) 843 (28.8%) 0.96 0.85 - 1.07 580 (41.7%) 352 (40.5%) 0.9 0.74 - 1.11 169 (30.2%) 85 (27.7%) 0.82 0.58 - 1.17 57 (24.9%) 36 (28.6%) 1.37 0.78 - 2.39 208 (18.6%) 133 (17.7%) 1 0.78 - 1.30 175 (34.0%) 102 (32.0%) 0.89 0.63 - 1.27 176 (26.8%) 97 (24.8%) 1 0.72 - 1.40 67 (23.3%) 38 (23.3%) 1.02 0.61 - 1.71
>14 445 (9.4%) 217 (7.4%) 0.79** 0.65 - 0.96 301 (21.7%) 161 (18.5%) 0.77* 0.60 - 1.00 38 (6.8%) 18 (5.9%) 0.94 0.51 - 1.76 18 (7.9%) 4 (3.2%) 0.5 0.15 - 1.72 29 (2.6%) 14 (1.9%) 0.75 0.38 - 1.50 29 (5.6%) 11 (3.4%) 0.65 0.30 - 1.42 19 (2.9%) 5 (1.3%) 0.57 0.19 - 1.71 11 (3.8%) 4 (2.5%) 0.52 0.14 - 1.95
Trend test p-value 0.0361 0.0558 0.4477 0.9732 0.6604 0.2797 0.6218 0.5724
Coffee: (Cups/day) 0.714
none 1529 (32.1%) 1042 (35.6%) 430 (30.9%) 311 (35.7%) 244 (43.6%) 144 (46.9%) 78 (34.1%) 55 (43.7%) 299 (26.7%) 212 (28.2%) 150 (29.2%) 98 (30.7%) 234 (35.7%) 160 (40.9%) 94 (32.6%) 62 (38.0%)
>=1 2110 (44.4%) 1320 (45.1%) 0.95 0.84 - 1.06 543 (39.1%) 345 (39.7%) 0.87 0.70 - 1.07 232 (41.4%) 126 (41.0%) 1.12 0.79 - 1.59 107 (46.7%) 59 (46.8%) 0.66 0.39 - 1.13 548 (49.0%) 383 (50.9%) 1 0.80 - 1.26 236 (45.9%) 148 (46.4%) 1.07 0.75 - 1.52 299 (45.6%) 180 (46.0%) 0.93 0.68 - 1.28 145 (50.3%) 79 (48.5%) 1.01 0.63 - 1.64
>1/<=4 914 (19.2%) 484 (16.5%) 0.84** 0.73 - 0.98 316 (22.7%) 175 (20.1%) 0.79* 0.62 - 1.00 70 (12.5%) 36 (11.7%) 0.98 0.59 - 1.65 36 (15.7%) 9 (7.1%) 0.47 0.19 - 1.16 235 (21.0%) 141 (18.8%) 0.93 0.70 - 1.25 106 (20.6%) 64 (20.1%) 1.08 0.70 - 1.67 108 (16.5%) 43 (11.0%) 0.75 0.47 - 1.20 43 (14.9%) 16 (9.8%) 0.61 0.30 - 1.23
>4 203 (4.3%) 82 (2.8%) 0.67*** 0.50 - 0.89 101 (7.3%) 39 (4.5%) 0.58*** 0.38 - 0.87 14 (2.5%) 1 (0.3%) 0.14* 0.02 - 1.15 8 (3.5%) 3 (2.4%) 0.55 0.13 - 2.37 37 (3.3%) 16 (2.1%) 0.72 0.38 - 1.38 22 (4.3%) 9 (2.8%) 0.66 0.26 - 1.63 15 (2.3%) 8 (2.0%) 1.13 0.43 - 2.99 6 (2.1%) 6 (3.7%) 2.17 0.60 - 7.91
Trend test p-value 0.0016 0.0034 0.5048 0.0649 0.4195 0.8662 0.4108 0.7154
BMI (kg/m2) 0.0209
<25 2286 (48.8%) 1313 (45.4%) 781 (56.4%) 460 (52.9%) 118 (22.2%) 52 (17.9%) 63 (27.6%) 31 (25.0%) 786 (71.5%) 482 (64.7%) 169 (33.0%) 103 (32.3%) 202 (31.1%) 109 (28.1%) 167 (60.1%) 76 (48.4%)
25-<30 1459 (31.2%) 1039 (35.9%) 1.31*** 1.17 - 1.47 391 (28.3%) 271 (31.2%) 1.18 0.96 - 1.44 185 (34.8%) 137 (47.2%) 1.62** 1.06 - 2.48 74 (32.5%) 55 (44.4%) 1.57 0.85 - 2.88 244 (22.2%) 219 (29.4%) 1.51*** 1.21 - 1.88 194 (37.9%) 138 (43.3%) 1.21 0.85 - 1.71 287 (44.2%) 168 (43.3%) 0.95 0.66 - 1.36 84 (30.2%) 51 (32.5%) 1.28 0.78 - 2.08
30+ 937 (20.0%) 540 (18.7%) 1.05 0.91 - 1.22 212 (15.3%) 138 (15.9%) 1.03 0.80 - 1.32 228 (42.9%) 101 (34.8%) 0.91 0.59 - 1.39 91 (39.9%) 38 (30.6%) 0.88 0.46 - 1.71 70 (6.4%) 44 (5.9%) 1.15 0.76 - 1.75 149 (29.1%) 78 (24.5%) 0.79 0.53 - 1.19 160 (24.7%) 111 (28.6%) 1.28 0.85 - 1.92 27 (9.7%) 30 (19.1%) 2.56*** 1.29 - 5.07
Trend test p-value 0.0772 0.493 0.2311 0.6857 0.0062 0.3206 0.2475 0.0083
*** p<0.01, ** p<0.05, * p<0.1
Page | 45

4.2.3. Multivariate models of reproductive variables and POP risk
Table 12 shows the association between key reproductive factors and risk of POP. Current
estrogen use was positively associated with risk of POP with odds ratio for current estrogen use
increasing to 1.72 (95%CI: 1.29-2.29) compared to univariate analyses (OR = 1.34, 95%CI:
1.12-1.61). This positive association was only observed among Japanese without heterogeneity
tested across racial/ethnic groups (p=0.504). Progesterone use was positively associated with
POP for all women combined, but the association was only found for foreign-born Latinos.
Previous progesterone users among Latinos were 3.70 times to get POP (95%CI: 1.74-7.88), and
current progesterone users among Latinos were 3.26 times to be diagnosed of POP (95%CI:
1.20-8.82). Parity was still a risk factor for POP with the risk of POP increasing for women who
had more kids (trend p<0.0001), with a trend test was statistically significant for all racial/ethnic
groups. Overall, estimates of association in this model were similar to the univariate model.
Trend test showed that longer duration of estrogen use could result in more risk of POP for all
women combined (trend p=0.022). No trend tests were significant for any racial/ethnic groups
with the test of heterogeneity that did not reach significance (p=0.148).

Page | 46

Table 12. Multivariate models of estrogen use for Prolapse across ethnic groups

MODEL 1 Total White Black Hawaiian Japanese L-us born L-foreign born Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 4756 2928 1390 870 560 307 229 126 1119 752 514 319 656 391
Estrogen Use 0.504
No 2055 (51.9%) 996 (39.8%) 535 (41.8%) 252 (31.0%) 300 (62.8%) 132 (50.0%) 127 (63.8%) 50 (43.9%) 501 (50.8%) 249 (36.6%) 256 (54.9%) 122 (41.4%) 336 (61.2%) 191 (56.8%)
Yes, previously 676 (17.1%) 407 (16.3%) 1.14 0.86 - 1.50 223 (17.4%) 124 (15.3%) 1.06 0.64 - 1.76 97 (20.3%) 65 (24.6%) 1.52 0.66 - 3.49 29 (14.6%) 19 (16.7%) 1.69 0.40 - 7.19 126 (12.8%) 74 (10.9%) 0.93 0.48 - 1.82 87 (18.7%) 42 (14.2%) 1.01 0.43 - 2.36 114 (20.8%) 83 (24.7%) 1.06 0.57 - 1.96
Yes, currently 1226 (31.0%) 1099 (43.9%) 1.72*** 1.29 - 2.29 521 (40.7%) 436 (53.7%) 1.54* 0.93 - 2.57 81 (16.9%) 67 (25.4%) 2.59* 0.94 - 7.09 43 (21.6%) 45 (39.5%) 4.35* 0.85 - 22.18 359 (36.4%) 358 (52.6%) 2.06** 1.12 - 3.78 123 (26.4%) 131 (44.4%) 2.04* 0.88 - 4.70 99 (18.0%) 62 (18.5%) 0.69 0.31 - 1.51
Trend test p-value 0.0001 0.0426 0.0571 0.0624 0.0058 0.061 0.4202
Menopausal status 0.9182
Pre-Menopausal 300 (8.1%) 160 (6.8%) 100 (8.2%) 48 (6.3%) 45 (10.2%) 17 (6.7%) 15 (8.1%) 6 (5.7%) 75 (8.2%) 48 (7.5%) 32 (7.4%) 20 (7.4%) 33 (6.2%) 21 (6.3%)
Natural Menopause 2258 (60.6%) 1320 (55.7%) 0.67 0.41 - 1.11 715 (58.8%) 412 (53.9%) 0.65 0.28 - 1.50 207 (46.7%) 123 (48.2%) 0.63 0.11 - 3.70 107 (57.8%) 62 (59.0%) 0.99 0.08 - 11.72 628 (68.3%) 376 (58.8%) 0.48 0.14 - 1.60 247 (57.4%) 134 (49.3%) 1.65 0.29 - 9.44 354 (66.5%) 213 (64.2%) 0.7 0.22 - 2.21
Surgical Menopause 1167 (31.3%) 888 (37.5%) 0.81 0.48 - 1.38 401 (33.0%) 305 (39.9%) 0.8 0.33 - 1.93 191 (43.1%) 115 (45.1%) 0.5 0.08 - 3.17 63 (34.1%) 37 (35.2%) 0.8 0.04 - 15.44 216 (23.5%) 215 (33.6%) 0.53 0.15 - 1.93 151 (35.1%) 118 (43.4%) 2.36 0.42 - 13.26 145 (27.3%) 98 (29.5%) 0.98 0.28 - 3.46
Trend test p-value 0.3416 0.5377 0.4044 0.752 0.9611 0.1846 0.3891
Progesterone Use 0.2396
No 1663 (64.1%) 1087 (59.3%) 490 (55.2%) 344 (54.3%) 227 (82.5%) 139 (77.2%) 80 (69.6%) 39 (52.0%) 356 (56.3%) 257 (53.3%) 212 (70.7%) 137 (64.0%) 298 (77.6%) 171 (68.7%)
Yes, previously 368 (14.2%) 321 (17.5%) 1.42*** 1.11 - 1.81 159 (17.9%) 114 (18.0%) 1.01 0.69 - 1.48 29 (10.5%) 26 (14.4%) 1.23 0.48 - 3.15 16 (13.9%) 19 (25.3%) 2.84 0.73 - 11.02 73 (11.6%) 78 (16.2%) 1.4 0.82 - 2.41 42 (14.0%) 40 (18.7%) 1.72 0.79 - 3.78 49 (12.8%) 44 (17.7%) 3.70*** 1.74 - 7.88
Yes, currently 562 (21.7%) 426 (23.2%) 1.19 0.91 - 1.56 238 (26.8%) 176 (27.8%) 1.14 0.74 - 1.74 19 (6.9%) 15 (8.3%) 0.66 0.20 - 2.18 19 (16.5%) 17 (22.7%) 0.8 0.18 - 3.52 203 (32.1%) 147 (30.5%) 0.96 0.55 - 1.68 46 (15.3%) 37 (17.3%) 1.31 0.56 - 3.09 37 (9.6%) 34 (13.7%) 3.26** 1.20 - 8.82
Trend test p-value 0.0704 0.5905 0.6867 0.7058 0.9105 0.3395 0.0006
Parity 0.6007
0 645 (13.8%) 131 (4.5%) 229 (16.6%) 43 (5.0%) 69 (12.7%) 22 (7.4%) 17 (7.6%) 2 (1.6%) 173 (15.6%) 35 (4.7%) 58 (11.5%) 12 (3.8%) 64 (10.0%) 14 (3.7%)
1 539 (11.5%) 267 (9.2%) 2.69*** 1.80 - 4.02 164 (11.9%) 82 (9.5%) 2.63*** 1.44 - 4.80 94 (17.3%) 45 (15.1%) 2.69 0.74 - 9.75 14 (6.2%) 5 (4.0%) 127 (11.4%) 74 (9.9%) 3.24*** 1.43 - 7.37 38 (7.5%) 21 (6.6%) 3.35 0.69 - 16.38 67 (10.5%) 28 (7.4%) 1.86 0.54 - 6.33
2 1022 (21.8%) 680 (23.5%) 3.18*** 2.24 - 4.52 355 (25.8%) 233 (27.0%) 2.94*** 1.74 - 4.98 98 (18.0%) 70 (23.4%) 4.69** 1.35 - 16.28 34 (15.1%) 16 (12.8%) 320 (28.8%) 233 (31.3%) 2.95*** 1.49 - 5.87 73 (14.5%) 54 (17.1%) 7.60*** 2.07 - 27.97 82 (12.9%) 36 (9.5%) 2.38 0.78 - 7.30
3+ 2475 (52.9%) 1812 (62.7%) 4.11*** 2.93 - 5.76 629 (45.7%) 506 (58.6%) 4.27*** 2.55 - 7.13 283 (52.0%) 162 (54.2%) 4.23** 1.35 - 13.32 160 (71.1%) 102 (81.6%) 490 (44.1%) 403 (54.1%) 3.83*** 1.92 - 7.63 336 (66.5%) 229 (72.5%) 4.19** 1.33 - 13.18 424 (66.6%) 301 (79.4%) 5.04*** 1.91 - 13.30
Trend test p-value <0.0001 <0.0001 0.0116 0.0004 0.0357 <0.0001
MODEL 2
Total duration of estrogen use 0.148
Never 2055 (49.0%) 996 (37.7%) 535 (40.3%) 252 (30.1%) 300 (60.6%) 132 (47.5%) 127 (61.1%) 50 (41.3%) 501 (48.8%) 249 (35.4%) 256 (53.9%) 122 (40.7%) 336 (61.2%) 191 (57.4%)
< 4 years 794 (18.9%) 525 (19.8%) 1.36** 1.04 - 1.78 241 (18.2%) 143 (17.1%) 1.12 0.67 - 1.88 103 (20.8%) 60 (21.6%) 1.64 0.70 - 3.86 36 (17.3%) 28 (23.1%) 2.94 0.67 - 12.91 158 (15.4%) 113 (16.1%) 1.69* 0.91 - 3.13 87 (18.3%) 60 (20.0%) 1.43 0.65 - 3.17 121 (22.0%) 83 (24.9%) 0.93 0.49 - 1.75
>= 4 years 1343 (32.0%) 1124 (42.5%) 1.43** 1.08 - 1.89 551 (41.5%) 442 (52.8%) 1.31 0.79 - 2.17 92 (18.6%) 86 (30.9%) 2.23* 0.87 - 5.74 45 (21.6%) 43 (35.5%) 2.04 0.48 - 8.68 367 (35.8%) 341 (48.5%) 1.51 0.83 - 2.75 132 (27.8%) 118 (39.3%) 1.63 0.71 - 3.78 92 (16.8%) 59 (17.7%) 0.93 0.44 - 1.98
Trend Test p-value 0.022 0.2228 0.0923 0.3826 0.3688 0.2645 0.8385
Menopausal status 0.1705
Pre-Menopausal 300 (8.1%) 160 (6.8%) 100 (8.2%) 48 (6.3%) 45 (10.2%) 17 (6.7%) 15 (8.1%) 6 (5.7%) 75 (8.2%) 48 (7.5%) 32 (7.4%) 20 (7.4%) 33 (6.2%) 21 (6.3%)
Natural Menopause 2258 (60.6%) 1320 (55.7%) 0.69 0.41 - 1.14 715 (58.8%) 412 (53.9%) 0.76 0.32 - 1.81 207 (46.7%) 123 (48.2%) 0.77 0.14 - 4.30 107 (57.8%) 62 (59.0%) 0.92 0.07 - 12.03 628 (68.3%) 376 (58.8%) 0.43 0.13 - 1.42 247 (57.4%) 134 (49.3%) 1.21 0.21 - 7.06 354 (66.5%) 213 (64.2%) 0.6 0.18 - 1.98
Surgical Menopause 1167 (31.3%) 888 (37.5%) 0.88 0.52 - 1.51 401 (33.0%) 305 (39.9%) 0.99 0.40 - 2.43 191 (43.1%) 115 (45.1%) 0.6 0.10 - 3.56 63 (34.1%) 37 (35.2%) 1.11 0.06 - 19.73 216 (23.5%) 215 (33.6%) 0.57 0.16 - 2.03 151 (35.1%) 118 (43.4%) 2.02 0.35 - 11.67 145 (27.3%) 98 (29.5%) 0.74 0.20 - 2.69
Trend Test p-value 0.1297 0.2639 0.4279 0.813 0.6055 0.1279 0.757
Progesterone Use 0.0395
No 1663 (64.1%) 1087 (59.3%) 490 (55.2%) 344 (54.3%) 227 (82.5%) 139 (77.2%) 80 (69.6%) 39 (52.0%) 356 (56.3%) 257 (53.3%) 212 (70.7%) 137 (64.0%) 298 (77.6%) 171 (68.7%)
Yes, previously 368 (14.2%) 321 (17.5%) 1.35** 1.05 - 1.72 159 (17.9%) 114 (18.0%) 0.99 0.68 - 1.45 29 (10.5%) 26 (14.4%) 1.25 0.48 - 3.25 16 (13.9%) 19 (25.3%) 2.33 0.64 - 8.55 73 (11.6%) 78 (16.2%) 1.24 0.73 - 2.09 42 (14.0%) 40 (18.7%) 1.46 0.67 - 3.21 49 (12.8%) 44 (17.7%) 3.62*** 1.68 - 7.78
Yes, currently 562 (21.7%) 426 (23.2%) 1.36** 1.05 - 1.76 238 (26.8%) 176 (27.8%) 1.27 0.85 - 1.90 19 (6.9%) 15 (8.3%) 0.81 0.27 - 2.45 19 (16.5%) 17 (22.7%) 1.47 0.37 - 5.88 203 (32.1%) 147 (30.5%) 1.26 0.74 - 2.16 46 (15.3%) 37 (17.3%) 1.64 0.73 - 3.70 37 (9.6%) 34 (13.7%) 2.43* 1.00 - 5.90
Trend Test p-value 0.0116 0.2691 0.858 0.3678 0.3711 0.1901 0.0049
Parity 0.1207
0 645 (13.8%) 131 (4.5%) 229 (16.6%) 43 (5.0%) 69 (12.7%) 22 (7.4%) 17 (7.6%) 2 (1.6%) 173 (15.6%) 35 (4.7%) 58 (11.5%) 12 (3.8%) 64 (10.0%) 14 (3.7%)
1 539 (11.5%) 267 (9.2%) 2.73*** 1.82 - 4.09 164 (11.9%) 82 (9.5%) 2.60*** 1.42 - 4.75 94 (17.3%) 45 (15.1%) 2.46 0.69 - 8.74 14 (6.2%) 5 (4.0%) 127 (11.4%) 74 (9.9%) 3.57*** 1.58 - 8.08 38 (7.5%) 21 (6.6%) 2.68 0.52 - 13.75 67 (10.5%) 28 (7.4%) 2.33 0.63 - 8.63
2 1022 (21.8%) 680 (23.5%) 3.21*** 2.25 - 4.56 355 (25.8%) 233 (27.0%) 2.97*** 1.75 - 5.03 98 (18.0%) 70 (23.4%) 4.04** 1.19 - 13.71 34 (15.1%) 16 (12.8%) 320 (28.8%) 233 (31.3%) 2.98*** 1.51 - 5.89 73 (14.5%) 54 (17.1%) 7.75*** 2.16 - 27.75 82 (12.9%) 36 (9.5%) 2.45 0.75 - 8.02
3+ 2475 (52.9%) 1812 (62.7%) 4.13*** 2.95 - 5.80 629 (45.7%) 506 (58.6%) 4.27*** 2.55 - 7.15 283 (52.0%) 162 (54.2%) 3.65** 1.16 - 11.46 160 (71.1%) 102 (81.6%) 490 (44.1%) 403 (54.1%) 3.89*** 1.96 - 7.72 336 (66.5%) 229 (72.5%) 4.39*** 1.42 - 13.51 424 (66.6%) 301 (79.4%) 5.11*** 1.85 - 14.11
Trend Test p-value <0.0001 <0.0001 0.0269 0.0005 0.014 <0.0001
*** p<0.01, ** p<0.05, * p<0.1
Page | 47

4.2.4. Multivariate models of factors related to diet and lifestyle and POP risk.
A model including all factors related to diet and lifestyle was used to measure the relationship of
these modifiable risk factors and risk of POP (Table 13). There was a statistically significant
association between BMI and POP. Women with BMI between 25 kg/m
2
and 30 kg/m
2
were
1.30 times to get POP compared to women with BMI less than 25 kg/m
2
(95%CI: 1.16-1.46).
However, increasing BMI may not result in increasing risk of POP (trend p=0.0693). The
relationship between BMI and POP only significantly existed among African-American and
Japanese Americans with significant heterogeneity across racial/ethnic groups (p=0.0346). The
inverse association between smoking and POP was also shown in this model. The likelihood of
getting POP reduced by 20% if women smoked no less than 12 packs of cigarette per year
compared to those who never smoked (OR=0.80, 96%CI: 0.70-0.92). Increasing smoking related
to be less likely to get POP (trend p=0.0023). Trend test was significant for foreign-born Latinos
with the test of heterogeneity insignificant (p=0.4343). Alcohol also seemed to be inversely
associated with POP in this model. Women who drank alcohol more than 14 g/day were 0.79
times to be diagnosed of POP compared to those who never drank alcohol (95%CI: 0.65-0.96).
However, the effect was only significant for Whites. Trend test was significant for all women
combined, but the inverse dose-response trend only existed among Whites. Regular coffee was
only inversely associated with risk of POP among Whites, and women who drank regular coffee
more than 240 g/day were 0.79 times to get POP compared to those who drank less than 240
g/day (95%CI: 0.66-0.94) in Whites. The association between decaffeinated coffee and POP was
inconsistent among different ethnic groups. Red meat excluding processed red meat, processed
Page | 48

red meat, total vegetables, total fruits and juice, vitamin D and physical activity were also
considered in this model, but no more than 10% change occurred for the estimates.
Page | 49

Table 13. Multivariate models of factors related to diet and lifestyle for Prolapse across ethnic groups
Total White Black Hawaiian Japanese L-us born L-foreign born Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 4756 2928 1390 870 560 307 229 126 1119 752 514 319 656 391
Calories (Kcal/day) 0.4038
427-<1324.27 1135 (23.9%) 761 (26.0%) 347 (25.0%) 222 (25.5%) 177 (31.6%) 113 (36.8%) 38 (16.6%) 23 (18.3%) 277 (24.8%) 183 (24.3%) 109 (21.2%) 92 (28.8%) 116 (17.7%) 92 (23.5%)
1324.27-<1749.475 1163 (24.5%) 721 (24.6%) 0.96 0.84 - 1.11 385 (27.7%) 250 (28.7%) 1.15 0.90 - 1.47 124 (22.1%) 66 (21.5%) 0.86 0.56 - 1.33 45 (19.7%) 21 (16.7%) 0.69 0.30 - 1.59 313 (28.0%) 216 (28.7%) 1.02 0.78 - 1.34 106 (20.6%) 73 (22.9%) 0.81 0.51 - 1.27 124 (18.9%) 62 (15.9%) 0.58** 0.36 - 0.93
1749.475-<2345.409 1235 (26.0%) 664 (22.7%) 0.82*** 0.71 - 0.95 393 (28.3%) 230 (26.4%) 1.04 0.81 - 1.34 121 (21.6%) 44 (14.3%) 0.58** 0.36 - 0.93 54 (23.6%) 25 (19.8%) 0.68 0.31 - 1.51 324 (29.0%) 191 (25.4%) 0.81 0.61 - 1.06 128 (24.9%) 59 (18.5%) 0.54** 0.33 - 0.87 155 (23.6%) 79 (20.2%) 0.7 0.45 - 1.09
2345.409-7742 1223 (25.7%) 782 (26.7%) 1.01 0.88 - 1.16 265 (19.1%) 168 (19.3%) 1.09 0.83 - 1.42 138 (24.6%) 84 (27.4%) 1.08 0.71 - 1.64 92 (40.2%) 57 (45.2%) 0.95 0.49 - 1.86 205 (18.3%) 162 (21.5%) 1.12 0.83 - 1.51 171 (33.3%) 95 (29.8%) 0.72 0.47 - 1.09 261 (39.8%) 158 (40.4%) 0.71* 0.48 - 1.05
Trend Test p-value 0.5648 0.714 0.8234 0.8616 0.9787 0.0743 0.2541
BMI (kg/m2) 0.0346
<25 2286 (48.8%) 1313 (45.4%) 781 (56.4%) 460 (52.9%) 118 (22.2%) 52 (17.9%) 63 (27.6%) 31 (25.0%) 786 (71.5%) 482 (64.7%) 169 (33.0%) 103 (32.3%) 202 (31.1%) 109 (28.1%)
25-<30 1459 (31.2%) 1039 (35.9%) 1.30*** 1.16 - 1.46 391 (28.3%) 271 (31.2%) 1.18 0.96 - 1.45 185 (34.8%) 137 (47.2%) 1.55** 1.01 - 2.38 74 (32.5%) 55 (44.4%) 1.5 0.80 - 2.80 244 (22.2%) 219 (29.4%) 1.50*** 1.20 - 1.88 194 (37.9%) 138 (43.3%) 1.21 0.85 - 1.73 287 (44.2%) 168 (43.3%) 0.98 0.68 - 1.40
30+ 937 (20.0%) 540 (18.7%) 1.06 0.92 - 1.22 212 (15.3%) 138 (15.9%) 1.02 0.79 - 1.32 228 (42.9%) 101 (34.8%) 0.91 0.59 - 1.40 91 (39.9%) 38 (30.6%) 0.8 0.40 - 1.60 70 (6.4%) 44 (5.9%) 1.14 0.75 - 1.73 149 (29.1%) 78 (24.5%) 0.82 0.54 - 1.24 160 (24.7%) 111 (28.6%) 1.37 0.90 - 2.06
Trend Test p-value 0.0693 0.503 0.2679 0.5033 0.0086 0.4279 0.152
Packs of Cigarette per year 0.4343
Never 2693 (58.9%) 1781 (63.4%) 642 (47.0%) 421 (49.2%) 245 (46.5%) 158 (53.7%) 105 (47.3%) 72 (60.0%) 782 (70.8%) 544 (74.6%) 303 (61.8%) 200 (65.6%) 416 (70.9%) 265 (76.8%)
< 12 938 (20.5%) 557 (19.8%) 0.93 0.82 - 1.06 278 (20.3%) 205 (23.9%) 1.21* 0.96 - 1.53 150 (28.5%) 75 (25.5%) 0.75 0.51 - 1.10 43 (19.4%) 20 (16.7%) 0.81 0.42 - 1.57 163 (14.8%) 89 (12.2%) 0.81 0.60 - 1.11 128 (26.1%) 77 (25.2%) 0.92 0.64 - 1.31 129 (22.0%) 68 (19.7%) 0.83 0.58 - 1.19
>= 12 942 (20.6%) 470 (16.7%) 0.80*** 0.70 - 0.92 447 (32.7%) 230 (26.9%) 0.88 0.71 - 1.10 132 (25.0%) 61 (20.7%) 0.71* 0.47 - 1.07 74 (33.3%) 28 (23.3%) 0.72 0.39 - 1.31 159 (14.4%) 96 (13.2%) 0.95 0.70 - 1.28 59 (12.0%) 28 (9.2%) 0.7 0.41 - 1.21 42 (7.2%) 12 (3.5%) 0.44** 0.22 - 0.89
Trend Test p-value 0.0023 0.3871 0.0723 0.265 0.4679 0.2202 0.0205
alcohol (g/day) 0.9324
none 2879 (60.5%) 1868 (63.8%) 509 (36.6%) 357 (41.0%) 353 (63.0%) 204 (66.4%) 154 (67.2%) 86 (68.3%) 882 (78.8%) 605 (80.5%) 310 (60.3%) 206 (64.6%) 461 (70.3%) 289 (73.9%)
<=14 1432 (30.1%) 843 (28.8%) 0.96 0.85 - 1.08 580 (41.7%) 352 (40.5%) 0.89 0.73 - 1.10 169 (30.2%) 85 (27.7%) 0.82 0.58 - 1.17 57 (24.9%) 36 (28.6%) 1.27 0.72 - 2.24 208 (18.6%) 133 (17.7%) 1.01 0.78 - 1.31 175 (34.0%) 102 (32.0%) 0.87 0.60 - 1.25 176 (26.8%) 97 (24.8%) 1.01 0.72 - 1.41
>14 445 (9.4%) 217 (7.4%) 0.79** 0.65 - 0.96 301 (21.7%) 161 (18.5%) 0.76** 0.58 - 0.99 38 (6.8%) 18 (5.9%) 0.95 0.50 - 1.81 18 (7.9%) 4 (3.2%) 0.46 0.13 - 1.59 29 (2.6%) 14 (1.9%) 0.75 0.38 - 1.50 29 (5.6%) 11 (3.4%) 0.67 0.30 - 1.46 19 (2.9%) 5 (1.3%) 0.63 0.21 - 1.90
Trend Test p-value 0.041 0.0387 0.4562 0.7557 0.7101 0.2505 0.7032
Regular coffee (g/day) 0.8486
0-<240 2324 (48.9%) 1537 (52.5%) 619 (44.5%) 432 (49.7%) 345 (61.6%) 202 (65.8%) 120 (52.4%) 74 (58.7%) 499 (44.6%) 349 (46.4%) 239 (46.5%) 149 (46.7%) 356 (54.3%) 240 (61.4%)
240-<961 2432 (51.1%) 1391 (47.5%) 0.89** 0.80 - 0.99 771 (55.5%) 438 (50.3%) 0.79*** 0.66 - 0.94 215 (38.4%) 105 (34.2%) 0.98 0.68 - 1.42 109 (47.6%) 52 (41.3%) 0.94 0.56 - 1.58 620 (55.4%) 403 (53.6%) 0.88 0.72 - 1.08 275 (53.5%) 170 (53.3%) 1.25 0.90 - 1.74 300 (45.7%) 151 (38.6%) 0.86 0.64 - 1.16
Decaffeinated Coffee (g/day) 0.7418
0-<33.95 3573 (75.1%) 2184 (74.6%) 1061 (76.3%)653 (75.1%) 430 (76.8%) 231 (75.2%) 174 (76.0%) 100 (79.4%) 845 (75.5%) 582 (77.4%) 394 (76.7%) 229 (71.8%) 466 (71.0%) 282 (72.1%)
33.95-<600 923 (19.4%) 610 (20.8%) 1.09 0.96 - 1.24 218 (15.7%) 165 (19.0%) 1.16 0.92 - 1.48 109 (19.5%) 65 (21.2%) 1.2 0.80 - 1.80 49 (21.4%) 24 (19.0%) 0.81 0.43 - 1.52 236 (21.1%) 147 (19.5%) 0.91 0.70 - 1.16 89 (17.3%) 71 (22.3%) 1.68** 1.13 - 2.51 149 (22.7%) 91 (23.3%) 1.06 0.75 - 1.51
600-961 260 (5.5%) 134 (4.6%) 0.81* 0.64 - 1.02 111 (8.0%) 52 (6.0%) 0.70* 0.49 - 1.01 21 (3.8%) 11 (3.6%) 1.16 0.53 - 2.57 6 (2.6%) 2 (1.6%) 0.4 0.07 - 2.29 38 (3.4%) 23 (3.1%) 0.79 0.46 - 1.37 31 (6.0%) 19 (6.0%) 1.17 0.60 - 2.28 41 (6.2%) 18 (4.6%) 0.98 0.51 - 1.88
Trend Test p-value 0.6628 0.3818 0.3979 0.2477 0.2768 0.0668 0.8629
Black Tea (g/day) 0.1099
0-<33.94 3483 (73.2%) 2191 (74.8%) 929 (66.8%) 576 (66.2%) 428 (76.4%) 251 (81.8%) 169 (73.8%) 84 (66.7%) 836 (74.7%) 575 (76.5%) 372 (72.4%) 248 (77.7%) 546 (83.2%) 336 (85.9%)
33.94-<240 809 (17.0%) 475 (16.2%) 0.93 0.81 - 1.06 250 (18.0%) 182 (20.9%) 1.16 0.92 - 1.46 96 (17.1%) 41 (13.4%) 0.79 0.50 - 1.25 39 (17.0%) 28 (22.2%) 1.31 0.73 - 2.36 190 (17.0%) 117 (15.6%) 0.86 0.66 - 1.13 101 (19.6%) 45 (14.1%) 0.67* 0.44 - 1.03 73 (11.1%) 38 (9.7%) 0.86 0.53 - 1.41
240-<961 464 (9.8%) 262 (8.9%) 0.85* 0.72 - 1.01 211 (15.2%) 112 (12.9%) 0.77* 0.59 - 1.00 36 (6.4%) 15 (4.9%) 0.76 0.35 - 1.62 21 (9.2%) 14 (11.1%) 1.76 0.78 - 3.97 93 (8.3%) 60 (8.0%) 0.97 0.67 - 1.40 41 (8.0%) 26 (8.2%) 0.75 0.43 - 1.33 37 (5.6%) 17 (4.3%) 0.66 0.34 - 1.28
Trend Test p-value 0.0458 0.2121 0.2375 0.1269 0.5161 0.0976 0.1834
*** p<0.01, ** p<0.05, * p<0.1
Page | 50

4.2.5. Multivariate models of all variables for POP risk
Table 14 shows the results of comprehensive model for POP. Estrogen use was still statistically
significantly associated with the risk of POP. However, only the association between current
estrogen use and POP was statistically significant. Current estrogen user was 2.09 times to get
POP compared to women who never took estrogen (95%CI: 1.53-2.87). The positive association
was also statistically significant among African-American, Hawaiians, Japanese, and Latinos
born in US with the test of heterogeneity that did not reach statistical significance (p=0.6324).
No association between progesterone use and risk of POP was found for all women combined or
for any racial/ethnic groups. Besides, parity is still a risk factor for POP. Women who never had
a child were 72% less likely to get POP compared to women who had one or more children
(OR=0.28; 95%CI: 0.20-0.40). The inverse association was found among Whites, Japanese, all
Latinos with no heterogeneity tested across racial/ethnic groups (p=0.7881). Among Latinos
born in US, women who had children were 6.67 times to get POP, and among foreign-born
Latinos, the likelihood of POP also increased dramatically for women who had children
compared to those who never gave birth to babies.
BMI was found to be positively associated with POP with women with BMI between 25
kg/m
2
and 30 kg/m
2
having 1.62 times to get POP compared to women with BMI less than 25
kg/m
2
(95%CI: 1.31-2.00), while the association between BMI more than 30 kg/m
2
and risk of
POP was not significant. The positive association between BMI and risk of POP existed among
Whites and African-American. The dose-response trend was observed for all women combined,
and also significant among Whites and African-American, also marginally significant for
Hawaiians with no heterogeneity across racial/ethnic groups (p=0.642).
Page | 51

The inverse association between smoking and POP was still present, but only significant
for Latinos born in US. Women smoking less than 12 packs of cigarette per year were 0.80 times
to get POP compared to those who never smoked, and no significant association was found for
those who smoked equal to or more than 12 packs of cigarette per year. Trend test was not
significant for all women combined, but was significant for Hawaiians and foreign-born Latinos
with no heterogeneity observed across racial/ethnic groups (p=0.6394). We also considered the
effects of red meat excluding processed red meat, processed red meat, total vegetables, and total
fruits and juice, but no more than 10% change occurred in the estimates. For Hawaiians, the
model was not adjusted for nulliparity, progesterone use, and alcohol because of small sample
size or no within group variances.

Page | 52

Table 14. Multivariate models of all variables for Prolapse across ethnic groups
Total White Black Hawaiian Japanese L-us born L-foreign born Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 4756 2928 1390 870 560 307 229 126 1119 752 514 319 656 391
Estrogen Use 0.6324
No 2055 (51.9%) 996 (39.8%) 535 (41.8%) 252 (31.0%) 300 (62.8%) 132 (50.0%) 127 (63.8%) 50 (43.9%) 501 (50.8%) 249 (36.6%) 256 (54.9%) 122 (41.4%) 336 (61.2%) 191 (56.8%)
Yes, previously 676 (17.1%) 407 (16.3%) 1.22 0.89 - 1.66 223 (17.4%) 124 (15.3%) 0.89 0.51 - 1.56 97 (20.3%) 65 (24.6%) 2.82* 0.93 - 8.58 29 (14.6%) 19 (16.7%) 3.95** 1.32 - 11.79126 (12.8%) 74 (10.9%) 0.99 0.47 - 2.10 87 (18.7%) 42 (14.2%) 2.26 0.65 - 7.79 114 (20.8%) 83 (24.7%) 1.39 0.57 - 3.43
Yes, currently 1226 (31.0%) 1099 (43.9%) 2.09*** 1.53 - 2.87 521 (40.7%) 436 (53.7%) 1.41 0.81 - 2.47 81 (16.9%) 67 (25.4%) 6.73*** 1.63 - 27.79 43 (21.6%) 45 (39.5%) 2.32** 1.00 - 5.38 359 (36.4%) 358 (52.6%) 2.42** 1.23 - 4.76 123 (26.4%) 131 (44.4%) 3.67** 1.13 - 11.96 99 (18.0%) 62 (18.5%) 1.97 0.72 - 5.42
Trend Test p-value <0.0001 0.0811 0.0052 0.005 0.0024 0.0251 0.1826
Menopausal status 0.9844
Pre-Menopausal 300 (8.1%) 160 (6.8%) 100 (8.2%) 48 (6.3%) 45 (10.2%) 17 (6.7%) 15 (8.1%) 6 (5.7%) 75 (8.2%) 48 (7.5%) 32 (7.4%) 20 (7.4%) 33 (6.2%) 21 (6.3%)
Natural Menopause 2258 (60.6%) 1320 (55.7%) 0.73 0.42 - 1.28 715 (58.8%) 412 (53.9%) 0.76 0.28 - 2.09 207 (46.7%) 123 (48.2%) 0.31 0.04 - 2.43 107 (57.8%) 62 (59.0%) 0.57 0.11 - 3.01 628 (68.3%) 376 (58.8%) 0.56 0.15 - 2.07 247 (57.4%) 134 (49.3%) 0.77 0.10 - 6.22 354 (66.5%) 213 (64.2%) 0.77 0.18 - 3.20
Surgical Menopause 1167 (31.3%) 888 (37.5%) 0.77 0.43 - 1.40 401 (33.0%) 305 (39.9%) 0.88 0.31 - 2.53 191 (43.1%) 115 (45.1%) 0.22 0.02 - 2.02 63 (34.1%) 37 (35.2%) 0.29 0.05 - 1.75 216 (23.5%) 215 (33.6%) 0.6 0.15 - 2.46 151 (35.1%) 118 (43.4%) 0.99 0.13 - 7.47 145 (27.3%) 98 (29.5%) 0.74 0.14 - 3.75
Trend Test p-value 0.9529 0.6274 0.2529 0.012 0.9412 0.7168 0.7912
Progesterone Use 0.5688
No 1663 (64.1%) 1087 (59.3%) 490 (55.2%) 344 (54.3%) 227 (82.5%) 139 (77.2%) 80 (69.6%) 39 (52.0%) 356 (56.3%) 257 (53.3%) 212 (70.7%) 137 (64.0%) 298 (77.6%) 171 (68.7%)
Yes, previously 368 (14.2%) 321 (17.5%) 1.30* 0.99 - 1.69 159 (17.9%) 114 (18.0%) 1.1 0.73 - 1.66 29 (10.5%) 26 (14.4%) 1.77 0.57 - 5.55 16 (13.9%) 19 (25.3%) 73 (11.6%) 78 (16.2%) 1.39 0.78 - 2.49 42 (14.0%) 40 (18.7%) 0.85 0.29 - 2.43 49 (12.8%) 44 (17.7%) 2.49* 0.86 - 7.23
Yes, currently 562 (21.7%) 426 (23.2%) 1.06 0.79 - 1.43 238 (26.8%) 176 (27.8%) 1.21 0.75 - 1.94 19 (6.9%) 15 (8.3%) 0.37 0.06 - 2.08 19 (16.5%) 17 (22.7%) 203 (32.1%) 147 (30.5%) 0.93 0.50 - 1.72 46 (15.3%) 37 (17.3%) 1.22 0.37 - 3.98 37 (9.6%) 34 (13.7%) 2.34 0.61 - 8.95
Trend Test p-value 0.4441 0.4247 0.6362 0.9784 0.8285 0.0644
Nulliparity 0.7881
no (have 1 or more kids) 3519 (86.4%) 2437 (95.3%) 1078 (83.6%)779 (95.1%) 429 (87.7%) 252 (93.0%) 197 (94.3%) 114 (98.3%) 857 (84.9%) 662 (95.1%) 420 (88.4%) 289 (96.0%) 538 (89.4%) 341 (96.6%)
yes 555 (13.6%) 119 (4.7%) 0.28*** 0.20 - 0.40 212 (16.4%) 40 (4.9%) 0.29*** 0.17 - 0.50 60 (12.3%) 19 (7.0%) 0.24** 0.06 - 0.93 12 (5.7%) 2 (1.7%) 152 (15.1%) 34 (4.9%) 0.29*** 0.14 - 0.59 55 (11.6%) 12 (4.0%) 0.15*** 0.04 - 0.58 64 (10.6%) 12 (3.4%) 0.18** 0.04 - 0.78
Density for Vitamin D (IU/1000 kcal/day) 0.8929
0.44-38.02 1155 (24.3%) 615 (21.0%) 238 (17.1%) 128 (14.7%) 135 (24.1%) 58 (18.9%) 41 (17.9%) 15 (11.9%) 333 (29.8%) 205 (27.3%) 146 (28.4%) 88 (27.6%) 176 (26.8%) 95 (24.4%)
38.02-<60.85 1176 (24.7%) 695 (23.7%) 1.09 0.84 - 1.43 297 (21.4%) 167 (19.2%) 1.01 0.62 - 1.63 144 (25.7%) 77 (25.1%) 0.99 0.35 - 2.82 60 (26.2%) 32 (25.4%) 1.66 0.48 - 5.71 309 (27.6%) 206 (27.4%) 1.2 0.74 - 1.94 104 (20.2%) 81 (25.4%) 3.46** 1.22 - 9.83 186 (28.4%) 91 (23.3%) 0.54 0.21 - 1.38
60.85-<91.87 1198 (25.2%) 791 (27.0%) 1.12 0.87 - 1.44 347 (25.0%) 247 (28.4%) 0.95 0.60 - 1.50 139 (24.8%) 95 (30.9%) 1.09 0.39 - 3.00 68 (29.7%) 44 (34.9%) 2.04 0.66 - 6.34 274 (24.5%) 200 (26.6%) 1.37 0.83 - 2.26 138 (26.8%) 72 (22.6%) 1.84 0.67 - 5.08 155 (23.6%) 97 (24.9%) 0.72 0.32 - 1.65
91.87-515 1227 (25.8%) 826 (28.2%) 1.1 0.85 - 1.42 508 (36.5%) 328 (37.7%) 1.09 0.71 - 1.68 142 (25.4%) 77 (25.1%) 1.27 0.47 - 3.46 60 (26.2%) 35 (27.8%) 1.31 0.37 - 4.60 203 (18.1%) 141 (18.8%) 0.98 0.56 - 1.69 126 (24.5%) 78 (24.5%) 2.07 0.79 - 5.45 139 (21.2%) 107 (27.4%) 0.69 0.27 - 1.80
Trend Test p-value 0.4678 0.6828 0.6208 0.0186 0.7696 0.3004 0.5573
Calories (Kcal/day) 0.2598
427-<1324.27 1135 (23.9%) 761 (26.0%) 347 (25.0%) 222 (25.5%) 177 (31.6%) 113 (36.8%) 38 (16.6%) 23 (18.3%) 277 (24.8%) 183 (24.3%) 109 (21.2%) 92 (28.8%) 116 (17.7%) 92 (23.5%)
1324.27-<1749.475 1163 (24.5%) 721 (24.6%) 0.97 0.75 - 1.26 385 (27.7%) 250 (28.7%) 1.24 0.83 - 1.84 124 (22.1%) 66 (21.5%) 0.48 0.15 - 1.50 45 (19.7%) 21 (16.7%) 0.94 0.27 - 3.20 313 (28.0%) 216 (28.7%) 1.1 0.65 - 1.87 106 (20.6%) 73 (22.9%) 0.42 0.14 - 1.25 124 (18.9%) 62 (15.9%) 0.5 0.17 - 1.43
1749.475-<2345.409 1235 (26.0%) 664 (22.7%) 0.86 0.67 - 1.11 393 (28.3%) 230 (26.4%) 1.11 0.74 - 1.66 121 (21.6%) 44 (14.3%) 0.55 0.20 - 1.53 54 (23.6%) 25 (19.8%) 0.91 0.30 - 2.71 324 (29.0%) 191 (25.4%) 0.76 0.46 - 1.27 128 (24.9%) 59 (18.5%) 0.44 0.15 - 1.28 155 (23.6%) 79 (20.2%) 0.92 0.34 - 2.49
2345.409-7742 1223 (25.7%) 782 (26.7%) 0.99 0.77 - 1.28 265 (19.1%) 168 (19.3%) 1.2 0.78 - 1.84 138 (24.6%) 84 (27.4%) 0.56 0.22 - 1.44 92 (40.2%) 57 (45.2%) 1.64 0.59 - 4.61 205 (18.3%) 162 (21.5%) 1.03 0.59 - 1.81 171 (33.3%) 95 (29.8%) 0.59 0.22 - 1.56 261 (39.8%) 158 (40.4%) 0.59 0.23 - 1.47
Trend Test p-value 0.7334 0.5102 0.2176 0.26 0.5733 0.4835 0.4454
BMI (kg/m2) 0.642
<25 2286 (48.8%) 1313 (45.4%) 781 (56.4%) 460 (52.9%) 118 (22.2%) 52 (17.9%) 63 (27.6%) 31 (25.0%) 786 (71.5%) 482 (64.7%) 169 (33.0%) 103 (32.3%) 202 (31.1%) 109 (28.1%)
25-<30 1459 (31.2%) 1039 (35.9%) 1.62*** 1.31 - 2.00 391 (28.3%) 271 (31.2%) 2.20*** 1.54 - 3.15 185 (34.8%) 137 (47.2%) 2.25 0.82 - 6.16 74 (32.5%) 55 (44.4%) 2.18 0.85 - 5.58 244 (22.2%) 219 (29.4%) 1.48* 0.97 - 2.25 194 (37.9%) 138 (43.3%) 1.51 0.66 - 3.45 287 (44.2%) 168 (43.3%) 1.49 0.64 - 3.44
30+ 937 (20.0%) 540 (18.7%) 1.26* 0.97 - 1.65 212 (15.3%) 138 (15.9%) 1.32 0.87 - 1.99 228 (42.9%) 101 (34.8%) 3.22** 1.13 - 9.23 91 (39.9%) 38 (30.6%) 1.06 0.43 - 2.63 70 (6.4%) 44 (5.9%) 1.47 0.59 - 3.64 149 (29.1%) 78 (24.5%) 0.69 0.26 - 1.83 160 (24.7%) 111 (28.6%) 1.91 0.76 - 4.76
Trend Test p-value 0.0054 0.0108 0.0274 0.0638 0.0716 0.6268 0.1646
Packs of Cigarette per year 0.6394
Never 2693 (58.9%) 1781 (63.4%) 642 (47.0%) 421 (49.2%) 245 (46.5%) 158 (53.7%) 105 (47.3%) 72 (60.0%) 782 (70.8%) 544 (74.6%) 303 (61.8%) 200 (65.6%) 416 (70.9%) 265 (76.8%)
< 12 938 (20.5%) 557 (19.8%) 0.80* 0.63 - 1.00 278 (20.3%) 205 (23.9%) 1.03 0.72 - 1.48 150 (28.5%) 75 (25.5%) 1.02 0.37 - 2.78 43 (19.4%) 20 (16.7%) 0.53 0.20 - 1.41 163 (14.8%) 89 (12.2%) 0.82 0.48 - 1.40 128 (26.1%) 77 (25.2%) 0.42** 0.18 - 0.99 129 (22.0%) 68 (19.7%) 0.67 0.32 - 1.41
>= 12 942 (20.6%) 470 (16.7%) 0.85 0.67 - 1.09 447 (32.7%) 230 (26.9%) 0.96 0.67 - 1.36 132 (25.0%) 61 (20.7%) 0.57 0.20 - 1.66 74 (33.3%) 28 (23.3%) 0.52 0.21 - 1.27 159 (14.4%) 96 (13.2%) 1.16 0.67 - 2.00 59 (12.0%) 28 (9.2%) 0.66 0.20 - 2.20 42 (7.2%) 12 (3.5%) 0.28* 0.08 - 1.03
Trend Test p-value 0.1062 0.8396 0.3293 0.0493 0.8154 0.1428 0.0415
alcohol (g/day) 0.7793
none 2879 (60.5%) 1868 (63.8%) 509 (36.6%) 357 (41.0%) 353 (63.0%) 204 (66.4%) 154 (67.2%) 86 (68.3%) 882 (78.8%) 605 (80.5%) 310 (60.3%) 206 (64.6%) 461 (70.3%) 289 (73.9%)
<=14 1432 (30.1%) 843 (28.8%) 0.91 0.74 - 1.12 580 (41.7%) 352 (40.5%) 0.8 0.57 - 1.11 169 (30.2%) 85 (27.7%) 0.83 0.37 - 1.85 57 (24.9%) 36 (28.6%) 208 (18.6%) 133 (17.7%) 0.94 0.57 - 1.54 175 (34.0%) 102 (32.0%) 1.07 0.49 - 2.35 176 (26.8%) 97 (24.8%) 0.98 0.50 - 1.91
>14 445 (9.4%) 217 (7.4%) 0.8 0.58 - 1.11 301 (21.7%) 161 (18.5%) 0.74 0.49 - 1.12 38 (6.8%) 18 (5.9%) 0.73 0.17 - 3.04 18 (7.9%) 4 (3.2%) 29 (2.6%) 14 (1.9%) 0.98 0.34 - 2.88 29 (5.6%) 11 (3.4%) 0.82 0.18 - 3.79 19 (2.9%) 5 (1.3%) 0.25 0.01 - 4.31
Trend Test p-value 0.1619 0.1263 0.569 0.8359 0.9476 0.6633
Coffee: (Cups/day) 0.9274
none 1529 (32.1%) 1042 (35.6%) 430 (30.9%) 311 (35.7%) 244 (43.6%) 144 (46.9%) 78 (34.1%) 55 (43.7%) 299 (26.7%) 212 (28.2%) 150 (29.2%) 98 (30.7%) 234 (35.7%) 160 (40.9%)
>=1 2110 (44.4%) 1320 (45.1%) 1.01 0.81 - 1.24 543 (39.1%) 345 (39.7%) 0.88 0.62 - 1.25 232 (41.4%) 126 (41.0%) 1.22 0.57 - 2.61 107 (46.7%) 59 (46.8%) 0.51* 0.23 - 1.12 548 (49.0%) 383 (50.9%) 0.86 0.56 - 1.32 236 (45.9%) 148 (46.4%) 1.9 0.71 - 5.10 299 (45.6%) 180 (46.0%) 1.26 0.63 - 2.50
>1/<=4 914 (19.2%) 484 (16.5%) 0.93 0.71 - 1.20 316 (22.7%) 175 (20.1%) 0.74 0.49 - 1.12 70 (12.5%) 36 (11.7%) 0.42 0.12 - 1.43 36 (15.7%) 9 (7.1%) 0.28* 0.06 - 1.26 235 (21.0%) 141 (18.8%) 0.99 0.58 - 1.71 106 (20.6%) 64 (20.1%) 1.68 0.56 - 4.98 108 (16.5%) 43 (11.0%) 1.05 0.38 - 2.89
>4 203 (4.3%) 82 (2.8%) 0.72 0.44 - 1.18 101 (7.3%) 39 (4.5%) 0.68 0.34 - 1.37 14 (2.5%) 1 (0.3%) 1.31 0.05 - 34.66 8 (3.5%) 3 (2.4%) 0.37 0.05 - 2.63 37 (3.3%) 16 (2.1%) 1 0.26 - 3.86 22 (4.3%) 9 (2.8%) 1.07 0.16 - 7.22 15 (2.3%) 8 (2.0%) 0.75 0.15 - 3.70
Trend Test p-value 0.2773 0.1 0.4346 0.2714 0.9421 0.6834 0.982
0.6895
none 2599 (58.4%) 1656 (60.5%) 704 (53.1%) 420 (51.0%) 330 (64.2%) 200 (69.9%) 107 (49.1%) 58 (47.5%) 697 (65.0%) 488 (67.3%) 275 (57.1%) 182 (60.9%) 331 (59.3%) 217 (66.0%)
<= 0.11 761 (17.1%) 446 (16.3%) 0.87 0.67 - 1.12 223 (16.8%) 149 (18.1%) 1.07 0.72 - 1.58 83 (16.1%) 40 (14.0%) 1.13 0.38 - 3.37 34 (15.6%) 18 (14.8%) 1.96 0.72 - 5.36 170 (15.8%) 106 (14.6%) 0.66 0.36 - 1.20 90 (18.7%) 57 (19.1%) 0.40* 0.15 - 1.04 94 (16.8%) 47 (14.3%) 0.8 0.33 - 1.97
> 0.11 - <=0.36 508 (11.4%) 311 (11.4%) 0.98 0.73 - 1.31 154 (11.6%) 103 (12.5%) 1.34 0.84 - 2.15 43 (8.4%) 23 (8.0%) 1.52 0.38 - 6.12 32 (14.7%) 18 (14.8%) 3.41** 1.03 - 11.29125 (11.6%) 82 (11.3%) 0.83 0.47 - 1.47 50 (10.4%) 32 (10.7%) 0.5 0.14 - 1.81 70 (12.5%) 34 (10.3%) 0.66 0.25 - 1.75
>0.36 582 (13.1%) 323 (11.8%) 0.92 0.71 - 1.20 246 (18.5%) 152 (18.4%) 1.19 0.81 - 1.76 58 (11.3%) 23 (8.0%) 1.32 0.40 - 4.30 45 (20.6%) 28 (23.0%) 1.81 0.70 - 4.71 81 (7.5%) 49 (6.8%) 0.48** 0.23 - 1.00 67 (13.9%) 28 (9.4%) 0.67 0.24 - 1.88 63 (11.3%) 31 (9.4%) 0.7 0.26 - 1.90
Trend Test p-value 0.5259 0.2571 0.474 0.1383 0.0409 0.1959 0.3124
*** p<0.01, ** p<0.05, * p<0.1
Vigorous activity (vigorous work and sports) hours per day
Page | 53

4.2.6. Summary of findings for POP
Table 15 also summarized the relationship between reproductive, lifestyle, dietary factors and
risk of POP.

Page | 54

Table 15. Summary for the association between reproductive, lifestyle, dietary factors and risk of POP
Total White Black Hawaiian Japanese L-us born L-foreign born
Reproductive factors
Estrogen Use
Progesterone use
Menopausal status Positive and sig
Nulliparity Positive but not-sig
no association
Lifestyle Negtive but not-sig
Smoking Negtive and sig
Alcohol
Coffee
Vitamin D
BMI
Physical activity
Diet
Red meat excluding processed red meat
Processed red meat
Total vegetables
Total fruits and juice
Page | 55

4.3. Risk factors for FI
Among 667 FI cases, 209 (31.33%) were White, 111 (16.64%) were African-American, 40
(6.00%) were Hawaiian, 205 (30.73%) were Japanese Americans, 50 (7.50%) were Latinos born
in US, 25 (3.75%) were foreign-born Latinos, and 27 (4.05%) were from other racial/ethnic
group. 1072 FI controls were comprised of 327 (30.50%) White, 196 (18.28%) African-
American, 70 (6.53%) Hawaiian, 313 (29.20%) Japanese American, 78 (7.28%) Latinos born in
US, 40 (3.73%) foreign-born Latinos, and 48 (4.48%) from other racial/ethnic group. Since the
population of Latinos was too small, Latinos – us born and Latinos – foreign born were
combined.

4.3.1. Univariate analyses for FI
Frequency of cases and controls for each factor and univariate analyses are shown in Table 16.
Parity was not a statistically significant risk factor for FI for all women combined. However,
women with 1 child were 5.94 times to get FI compared to those who never had children
(95%CI: 1.25-28.26) among Latinos, but having additional children did not show statistically
significant associations and there was no dose-response. No trend test was significant either for
all women combined or for any racial/ethnic group. Previous progesterone users were 1.54 times
more likely to be diagnosed with FI compared to those who never used progesterone (95%CI: 1-
2.36). However, no significant association between current progesterone use and FI was found.
The positive association between progesterone use and risk of FI only existed for all women
combined, but not for any racial/ethnic group. No trend test was significant. Current estrogen use
was also positively associated with FI, and women who currently used estrogen were 1.72 times
Page | 56

more likely to get FI compared to those who never used estrogen (95%CI: 1.33-2.22). No
association between previous estrogen use and FI was identified. The positive association existed
among Japanese and Latinos. Longer period of estrogen use related to the higher probability of
FI (trend p<0.0001). The trend test was significant among Whites, Japanese and Latinos with
statistically significant heterogeneity across racial/ethnic groups (p=0.0039). Current estrogen
users were 2.78 times to get FI compared to those who never took estrogen among Latinos
(95%CI: 1.3-5.93).
Women with history of asthma or allergy were 1.46 times more likely to get FI compared
to those who did not have a history (95%CI: 1.19-1.79). The association was significant for
White and Latinos with a test of heterogeneity that did not reach statistical significance
(p=0.1891). No associations between smoking and FI were discovered when smoking status,
total number of years smoked, average number of cigarettes per day and packs of cigarette per
year were used for all women combined. However, higher level of smoking was positively
associated with FI among African-American. Women who smoked equal to or more than 12
packs of cigarette per year were 2.05 times to get FI compared to those who never smoked
(95%CI: 1.09-3.87) among African-American.
Women who drank 1 cup of coffee per day were less likely to get FI with 22% reduction
of risk. However, no significant associations were found for more consumption of coffee. No
inverse association between coffee and FI was found. Also, no relationships between regular
coffee, decaffeinated coffee and risk of FI were identified. No positive association between BMI
and risk of FI was found for all women combined, but women with BMI over 30 kg/m
2
were
7.64 times to get FI compared to those with BMI less than 25 kg/m
2
(95%CI: 1.49-39.23) among
Latinos with no heterogeneity across racial/ethnic groups was observed.
Page | 57

No positive association between vitamin D and risk of FI was found for all women
combined, but women taking over 91.87 IU/1000 kcal/day were 2.51 times to get FI compared to
those who took less than 38.02 IU/1000 kcal/day among Latinos (95%CI: 1-6.27). A trend test
was not statistically significant for all women combined, but a trend existed among Latinos with
no heterogeneity tested (p=0.1194). Women who ate more than 219.78 g/day of vegetables were
0.69 times less likely to get FI compared to those who ate less than 119.37 g/day (95%CI: 0.52-
0.93) for all women combined, but no inverse association was found for any racial/ethnic groups.
The inverse dose-response trend was statistically significant for all women combined, but the
trend only existed for women from other racial/ethnic groups with no heterogeneity observed
(p=0.8969). In addition, there was an inverse association between fruits and juice among Whites
and African-American, but no association for all women combined.

Page | 58

Table 16. Univariate analyses to compare risk factors between women with FI and controls across ethnic groups

total White Black Hawaiian Japanese Latinos Other Interaction p-value
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 1072 667 327 209 196 111 70 40 313 205 118 75 48 27
Area 0.5731
Hawaiian 575 (53.6%) 358 (53.7%) 232 (70.9%) 138 (66.0%) 2 (1.0%) 2 (1.8%) 69 (99%) 40 (100%) 236 (75.4%) 161 (78.5%) 8 (6.8%) 5 (6.7%) 28 (58%) 12 (44%)
Los Angeles 497 (46.4%) 309 (46.3%) 1.05 0.8-1.36 95 (29.1%) 71 (34.0%) 1.2 0.8-1.79 194 (99.0%) 109 (98.2%) 0.5 0.07-3.55 1 (1%) 0 (0%) 77 (24.6%) 44 (21.5%) 0.86 0.57-1.29 110 (93.2%) 70 (93.3%) 1.12 0.36-3.47 20 (42%) 15 (56%) 1.91 0.67-5.45
Place of Birth 0.6684
USA 906 (84.8%) 583 (87.5%) 274 (84.3%) 186 (89.4%) 192 (98.5%) 109 (98.2%) 70 (100%) 40 (100%) 276 (88.2%) 190 (92.7%) 77 (65.3%) 49 (65.3%) 17 (35%) 9 (33%)
Outside of USA 163 (15.2%) 83 (12.5%) 0.69 0.48-1 51 (15.7%) 22 (10.6%) 0.61 0.36-1.03 3 (1.5%) 2 (1.8%) 1.15 0.19-7.03 37 (11.8%) 15 (7.3%) 0.6 0.31-1.15 41 (34.7%) 26 (34.7%) 2 0.13-31.98 31 (65%) 18 (67%) 1.19 0.43-3.28
Years in the United States, Categorical c 0.1947
<=15 years 24 (2.3%) 9 (1.4%) 2 (0.6%) 3 (1.5%) 1 (0.6%) 0 (0.0%) 1 (0.3%) 1 (0.5%) 9 (8.1%) 4 (5.6%) 11 (23%) 1 (4%)
16-25 years 42 (4.0%) 21 (3.2%) 1.36 0.53-3.49 16 (5.0%) 3 (1.5%) 0.13 0.01-1.15 1 (0.6%) 0 (0.0%) / / / / 8 (2.6%) 5 (2.4%) 0.5 0.03-9.98 11 (9.9%) 8 (11.3%) 1.94 0.39-9.74 6 (12%) 5 (19%) 8.37* 0.82-85.44
>=26 years 973 (93.6%) 621 (95.4%) 1.65 0.75-3.66 305 (94.4%) 198 (97.1%) 0.43 0.07-2.66 175 (98.9%) 105 (100.0%) / / 69 (100%) 39 (100%) / / 302 (97.1%) 199 (97.1%) 0.5 0.03-7.99 91 (82.0%) 59 (83.1%) 1.38 0.39-4.83 31 (65%) 21 (78%) 6.04* 0.74-49.52
Trend Test p-value 0.1705 0.5329 0.5769 0.7304 0.0968
Year of Cohort Entry 0.1849
1993 421 (39.3%) 227 (34.0%) 103 (31.5%) 65 (31.1%) 139 (70.9%) 76 (68.5%) 18 (26%) 11 (28%) 94 (30.0%) 44 (21.5%) 53 (44.9%) 25 (33.3%) 14 (29%) 6 (22%)
1994 507 (47.3%) 369 (55.3%) 1.28** 1.02-1.62 200 (61.2%) 128 (61.2%) 0.94 0.64-1.38 23 (11.7%) 16 (14.4%) 1.13 0.56-2.29 39 (56%) 27 (68%) 1.19 0.5-2.84 168 (53.7%) 136 (66.3%) 1.67** 1.08-2.58 52 (44.1%) 45 (60.0%) 1.95* 0.95-4.03 25 (52%) 17 (63%) 1.39 0.35-5.56
1995 118 (11.0%) 53 (7.9%) 0.78 0.53-1.15 17 (5.2%) 10 (4.8%) 0.9 0.39-2.09 31 (15.8%) 18 (16.2%) 1.08 0.53-2.23 11 (16%) 1 (2%) 0.14* 0.02-1.23 50 (16.0%) 24 (11.7%) 0.93 0.5-1.72 1 (0.8%) 0 (0.0%) 8 (17%) 0 (0%)
>=1996 26 (2.4%) 18 (2.7%) 1.39 0.72-2.69 7 (2.1%) 6 (2.9%) 1.33 0.43-4.11 3 (1.5%) 1 (0.9%) 0.58 0.06-5.8 2 (3%) 1 (2%) 1.16 0.09-14.28 1 (0.3%) 1 (0.5%) 1.29 0.08-21.29 12 (10.2%) 5 (6.7%) 1.02 0.28-3.73 1 (2%) 4 (15%) 7.47* 0.72-77.88
Trend Test p-value 0.7168 0.9637 0.9335 0.2948 0.6903 0.6214 0.4644
Age at Birth of First Child 0.3716
<19 years old 56 (7.2%) 39 (7.8%) 9 (3.6%) 9 (5.8%) 25 (18.7%) 19 (22.9%) 6 (10%) 2 (6%) 1 (0.4%) 1 (0.6%) 15 (16%) 8 (12%)
19 - 25 years old 518 (66.5%) 309 (61.6%) 0.89 0.55-1.46 183 (74.1%) 108 (69.2%) 0.46 0.16-1.3 93 (69.4%) 52 (62.7%) 0.82 0.37-1.79 51 (82%) 24 (73%) 2.89 0.29-28.66 129 (52.7%) 82 (50.0%) 0.77 0.05-12.72 62 (68%) 43 (65%) 0.28 -0.69-1.25
26 - 32 years old 151 (19.4%) 118 (23.5%) 1.03 0.59-1.8 45 (18.2%) 27 (17.3%) 0.45 0.14-1.45 14 (10.4%) 9 (10.8%) 1.07 0.35-3.23 3 (5%) 4 (12%) 6.67 0.36-123.95 81 (33.1%) 67 (40.9%) 0.84 0.05-14.06 8 (9%) 11 (17%) 0.6 -0.84-2.04
>33 years old 54 (6.9%) 36 (7.2%) 0.95 0.48-1.86 10 (4.0%) 12 (7.7%) 1.02 0.25-4.25 2 (1.5%) 3 (3.6%) 1.02 0.13-8.04 2 (3%) 3 (9%) 5.69 0.36-89.61 34 (13.9%) 14 (8.5%) 0.45 0.03-7.92 6 (7%) 4 (6%) 0.37 -1.3-2.05
Trend Test p-value 0.7727 0.7880 0.9894 0.1279 0.3607 0.5066
0.2542
< 40 years old 114 (71.7%) 91 (74.0%) 32 (59%) 30 (67%) 38 (81%) 20 (87%) 7 (70%) 7 (88%) 18 (64%) 17 (68%) 19 (95%) 17 (77%)
>= 40 years old 45 (28.3%) 32 (26.0%) 0.83 0.25-2.73 22 (41%) 15 (33%) 1 0.2-4.95 9 (19%) 3 (13%) 1 0.06-15.99 3 (30%) 1 (12%) / / 10 (36%) 8 (32%) / / 1 (5%) 5 (23%) / /
Nulliparity 0.1516
no 804 (86.3%) 518 (89.3%) 253 (84.1%) 160 (83.3%) 145 (85.3%) 87 (91.6%) 64 (97%) 33 (94%) 248 (85.8%) 171 (91.4%) 94 (88.7%) 67 (94.4%)
yes 128 (13.7%) 62 (10.7%) 0.77 0.55-1.08 48 (15.9%) 32 (16.7%) 1.18 0.7-2 25 (14.7%) 8 (8.4%) 0.48 0.19-1.23 2 (3%) 2 (6%) 1.69 0.23-12.23 41 (14.2%) 16 (8.6%) 0.6 0.32-1.11 12 (11.3%) 4 (5.6%) 0.37 0.1-1.41
Number of children 0.3072
0 142 (13.4%) 74 (11.3%) 52 (16.1%) 34 (16.4%) 28 (14.4%) 12 (11.1%) 2 (3%) 2 (5%) 44 (14.2%) 19 (9.4%) 14 (12.4%) 5 (6.8%) 2 (4%) 2 (7%)
1 124 (11.7%) 78 (11.9%) 1.25 0.83-1.88 41 (12.7%) 19 (9.2%) 0.64 0.31-1.32 36 (18.6%) 23 (21.3%) 1.38 0.57-3.37 6 (9%) 4 (11%) 1.18 0.11-12.39 29 (9.4%) 20 (9.9%) 1.76 0.78-3.98 5 (4.4%) 10 (13.7%) 5.94** 1.25-28.26 7 (15%) 2 (7%) 0.42 0.02-7.48
2 249 (23.6%) 156 (23.8%) 1.23 0.86-1.75 83 (25.8%) 48 (23.2%) 0.83 0.46-1.5 36 (18.6%) 19 (17.6%) 1.29 0.51-3.25 4 (6%) 3 (8%) 0.86 0.06-11.56 96 (31.0%) 65 (32.2%) 1.6 0.86-2.97 14 (12.4%) 14 (19.2%) 3.04 0.75-12.36 16 (33%) 7 (26%) 0.35 0.04-3.39
3 232 (21.9%) 151 (23.1%) 1.17 0.81-1.69 65 (20.2%) 46 (22.2%) 1.05 0.57-1.94 29 (14.9%) 15 (13.9%) 1.01 0.38-2.72 18 (26%) 5 (13%) 0.38 0.04-3.52 91 (29.4%) 56 (27.7%) 1.23 0.65-2.36 20 (17.7%) 18 (24.7%) 2.58 0.66-10.12 9 (19%) 11 (41%) 1.27 0.12-13.3
4 149 (14.1%) 92 (14.0%) 1.19 0.8-1.76 47 (14.6%) 34 (16.4%) 0.98 0.52-1.85 29 (14.9%) 11 (10.2%) 0.79 0.28-2.21 20 (29%) 12 (32%) 0.71 0.08-6.21 31 (10.0%) 26 (12.9%) 1.79 0.84-3.84 18 (15.9%) 6 (8.2%) 1.09 0.25-4.77 4 (8%) 3 (11%) 1.1 0.05-24.02
5 69 (6.5%) 48 (7.3%) 1.4 0.87-2.25 20 (6.2%) 14 (6.8%) 1.1 0.47-2.53 11 (5.7%) 9 (8.3%) 1.81 0.59-5.61 5 (7%) 6 (16%) 1.62 0.15-17.17 12 (3.9%) 13 (6.4%) 2.17 0.84-5.58 16 (14.2%) 6 (8.2%) 1.38 0.3-6.35 5 (10%) 0 (0%)
6 39 (3.7%) 19 (2.9%) 0.97 0.52-1.83 8 (2.5%) 8 (3.9%) 1.36 0.47-3.96 11 (5.7%) 6 (5.6%) 1.21 0.32-4.56 8 (11%) 0 (0%) 4 (1.3%) 1 (0.5%) 0.61 0.06-5.94 7 (6.2%) 3 (4.1%) 1.67 0.27-10.4 1 (2%) 1 (4%) 1.81 0.06-52.78
7 or more 53 (5.0%) 37 (5.6%) 1.48 0.87-2.51 6 (1.9%) 4 (1.9%) 0.92 0.23-3.58 14 (7.2%) 13 (12.0%) 2.03 0.72-5.75 7 (10%) 6 (16%) 1.36 0.11-17.01 3 (1.0%) 2 (1.0%) 1.56 0.23-10.49 19 (16.8%) 11 (15.1%) 1.87 0.44-7.96 4 (8%) 1 (4%) 0.23 0.01-4.53
Trend Test p-value 0.3229 0.3856 0.3273 0.8847 0.3640 0.3435 0.7936
Progesterone Use 0.8241
No 381 (63.3%) 250 (59.7%) 125 (59.2%) 79 (54.1%) 82 (83%) 52 (83%) 25 (60%) 10 (48%) 110 (57.3%) 76 (55.9%) 39 (67%) 33 (62%)
Yes, previously 75 (12.5%) 71 (16.9%) 1.54** 1-2.36 33 (15.6%) 31 (21.2%) 1.91* 0.97-3.76 5 (5%) 5 (8%) 2.51 0.59-10.77 8 (19%) 8 (38%) 1.68 0.46-6.2 22 (11.5%) 16 (11.8%) 0.98 0.44-2.2 7 (12%) 11 (21%) 1.39 0.36-5.34
Yes, currently 146 (24.3%) 98 (23.4%) 1.13 0.78-1.64 53 (25.1%) 36 (24.7%) 0.97 0.5-1.88 12 (12%) 6 (10%) 0.73 0.17-3.11 9 (21%) 3 (14%) 0.64 0.1-3.98 60 (31.2%) 44 (32.4%) 1.41 0.79-2.53 12 (21%) 9 (17%) 0.97 0.34-2.77
Trend Test p-value 0.3494 0.7267 0.9564 1.0000 0.2478 0.9646
Estrogen Use 0.3539
No 438 (47.9%) 219 (38.5%) 117 (39.3%) 57 (30.2%) 98 (59.0%) 53 (57.6%) 36 (55%) 16 (47%) 129 (45.4%) 68 (36.8%) 58 (58.0%) 25 (36.2%)
Yes, previously 182 (19.9%) 86 (15.1%) 0.88 0.64-1.23 65 (21.8%) 34 (18.0%) 0.98 0.56-1.71 37 (22.3%) 16 (17.4%) 0.79 0.38-1.63 7 (11%) 5 (15%) 1.59 0.37-6.87 56 (19.7%) 19 (10.3%) 0.52* 0.27-1.02 17 (17.0%) 12 (17.4%) 1.73 0.69-4.33
Yes, currently 294 (32.2%) 264 (46.4%) 1.72*** 1.33-2.22 116 (38.9%) 98 (51.9%) 1.50* 0.98-2.3 31 (18.7%) 23 (25.0%) 1.33 0.65-2.75 23 (35%) 13 (38%) 1.31 0.48-3.56 99 (34.9%) 98 (53.0%) 1.97*** 1.26-3.1 25 (25.0%) 32 (46.4%) 2.78*** 1.3-5.93
Trend Test p-value <0.0001 0.0454 0.5410 0.6132 0.0022 0.0063
Total Duration of Estrogen Use 0.0039
0.5 years 124 (23.8%) 62 (15.9%) 42 (21.8%) 17 (12.1%) 18 (24%) 11 (23%) 5 (16%) 5 (25%) 38 (23.9%) 18 (14.1%) 16 (37%) 10 (22%) 5 (%) 1 (%)
1.5 years 86 (16.5%) 51 (13.0%) 1.53 0.83-2.79 23 (11.9%) 18 (12.8%) 1.76 0.66-4.73 14 (19%) 6 (13%) 0.97 0.18-5.15 8 (25%) 4 (20%) 0.44 0.03-5.67 27 (17.0%) 13 (10.2%) 3.65 0.93-14.41 6 (14%) 7 (16%) 0.4 0.03-4.7 8 (%) 3 (%)
4 years 98 (18.8%) 52 (13.3%) 1.2 0.64-2.23 35 (18.1%) 9 (6.4%) 0.48 0.15-1.51 14 (19%) 9 (19%) 2.13 0.36-12.56 8 (25%) 4 (20%) 0.71 0.07-7.03 31 (19.5%) 24 (18.8%) 5.58 1.37-22.76 7 (16%) 5 (11%) 0.27 0.02-4.33 3 (%) 1 (%)
>4 years 213 (40.9%) 226 (57.8%) 2.61 1.58-4.33 93 (48.2%) 97 (68.8%) 1.97 0.91-4.26 29 (39%) 21 (45%) 3.06 0.64-14.59 11 (34%) 7 (35%) 0.21 0.03-1.49 63 (39.6%) 73 (57.0%) 8.45 2.29-31.18 14 (33%) 23 (51%) 7.3 0.86-62.2 3 (%) 5 (%)
Trend Test p-value <0.0001 0.0451 0.0869 0.0900 0.0009 0.0050
Total Duration of Progesterone Use
0.5 years 60 (26.1%) 42 (23.3%) 22 (25%) 15 (21%) 3 (14%) 4 (33%) 6 (38%) 4 (33%) 19 (24%) 10 (17%) 8 (44%) 9 (43%) 2 (25%) 0 (0%)
1.5 years 45 (19.6%) 40 (22.2%) 1.49 0.56-3.98 12 (14%) 18 (26%) 1.13 0.24-5.45 5 (24%) 1 (8%) 4 (25%) 3 (25%) 18 (22%) 12 (20%) 2.64 0.5-13.99 3 (17%) 4 (19%) 1 0.01-68.99 3 (38%) 2 (33%) /
4 years 52 (22.6%) 32 (17.8%) 0.98 0.35-2.71 18 (21%) 10 (14%) 0.58 0.12-2.71 8 (38%) 4 (33%) 3 (19%) 2 (17%) 19 (24%) 12 (20%) 2.47 0.31-19.66 3 (17%) 2 (10%) 1 0.04-24.55 1 (12%) 2 (33%)
>4 years 73 (31.7%) 66 (36.7%) 1.12 0.42-3.01 35 (40%) 27 (39%) 0.66 0.16-2.63 5 (24%) 3 (25%) 3 (19%) 3 (25%) 24 (30%) 25 (42%) 4.72 0.56-40.11 4 (22%) 6 (29%) 1 0.04-24.55 2 (25%) 2 (33%)
Trend Test p-value 0.8344 0.3551 0.2220 1.0000
Menopausal status 0.558
Pre-Menopausal 72 (8.5%) 32 (6.1%) 30 (10.6%) 14 (7.8%) 8 (5.2%) 3 (3.5%) 10 (18%) 2 (6%) 21 (8.0%) 10 (6.1%) 3 (3%) 3 (5%)
Natural Menopause 495 (58.2%) 278 (52.7%) 1.08 0.61 - 1.89 165 (58.3%) 84 (46.9%) 0.74 0.28 - 1.96 67 (43.2%) 40 (46.5%) 1.99 0.45 - 8.70 27 (47%) 15 (47%) 3.01 0.23 - 39.20 175 (67.0%) 106 (64.2%) 1.22 0.45 - 3.30 61 (64%) 33 (50%) 0.51 0.10 - 2.58
Surgical Menopause 284 (33.4%) 218 (41.3%) 1.48 0.83 - 2.63 88 (31.1%) 81 (45.3%) 1.34 0.52 - 3.44 80 (51.6%) 43 (50.0%) 1.67 0.39 - 7.17 20 (35%) 15 (47%) 3.52 0.33 - 37.65 65 (24.9%) 49 (29.7%) 1.58 0.54 - 4.58 31 (33%) 30 (45%) 0.86 0.16 - 4.73
Trend test p-value 0.0142 0.0288 0.9362 0.3406 0.2601 0.2784
History of Asthma or Allergy 0.1891
no 729 (68.0%) 397 (59.5%) 217 (66.4%) 114 (54.5%) 128 (65.3%) 76 (68.5%) 45 (64%) 20 (50%) 213 (68.1%) 130 (63.4%) 91 (77.1%) 43 (57.3%) 35 (73%) 14 (52%)
yes 343 (32.0%) 270 (40.5%) 1.46*** 1.19-1.79 110 (33.6%) 95 (45.5%) 1.60** 1.11-2.31 68 (34.7%) 35 (31.5%) 0.93 0.57-1.52 25 (36%) 20 (50%) 1.99 0.85-4.65 100 (31.9%) 75 (36.6%) 1.27 0.87-1.85 27 (22.9%) 32 (42.7%) 2.33** 1.22-4.44 13 (27%) 13 (48%) 2.39* 0.91-6.28
Smoking status 0.9426
No 607 (57.5%) 374 (56.7%) 146 (45.1%) 101 (48.6%) 101 (52.3%) 48 (44.0%) 39 (56%) 22 (56%) 215 (69.6%) 136 (67.3%) 71 (63.4%) 48 (64.0%) 35 (73%) 19 (70%)
Yes and quit smoking 307 (29.1%) 207 (31.4%) 1.16 0.92-1.45 122 (37.7%) 84 (40.4%) 1.03 0.71-1.5 59 (30.6%) 39 (35.8%) 1.42 0.83-2.44 18 (26%) 8 (21%) 0.93 0.35-2.48 70 (22.7%) 52 (25.7%) 1.28 0.83-1.97 26 (23.2%) 17 (22.7%) 1.08 0.51-2.26 12 (25%) 7 (26%) 1.03 0.33-3.26
Yes and currently smoking 142 (13.4%) 79 (12.0%) 0.96 0.71-1.31 56 (17.3%) 23 (11.1%) 0.67 0.4-1.15 33 (17.1%) 22 (20.2%) 1.31 0.69-2.49 13 (19%) 9 (23%) 1.34 0.48-3.79 24 (7.8%) 14 (6.9%) 0.98 0.49-1.97 15 (13.4%) 10 (13.3%) 1.05 0.44-2.51 1 (2%) 1 (4%) 2.01 0.12-32.71
Trend Test p-value 0.7400 0.2576 0.2833 0.6297 0.5728 0.8660 0.7481
Age that period stopped due to (surgery) hysterectomy but no oophorectomy
Page | 59

Total number of years smoked 0.7306
Never 607 (58.1%) 374 (57.3%) 146 (45.2%) 101 (48.8%) 101 (53.7%) 48 (44.9%) 39 (57%) 22 (56%) 215 (70.0%) 136 (68.0%) 71 (64.5%) 48 (64.9%) 35 (73%) 19 (73%)
<25 years 203 (19.4%) 130 (19.9%) 1.07 0.82 - 1.40 83 (25.7%) 42 (20.3%) 0.77 0.49 - 1.19 39 (20.7%) 27 (25.2%) 1.31 0.69 - 2.49 15 (22%) 7 (18%) 1 0.31 - 3.21 38 (12.4%) 35 (17.5%) 1.67* 0.98 - 2.87 20 (18.2%) 14 (18.9%) 1.06 0.47 - 2.41 8 (17%) 5 (19%) 1.03 0.31 - 3.40
>=25 years 235 (22.5%) 149 (22.8%) 1.1 0.86 - 1.41 94 (29.1%) 64 (30.9%) 1.03 0.69 - 1.54 48 (25.5%) 32 (29.9%) 1.51 0.86 - 2.67 15 (22%) 10 (26%) 1.27 0.49 - 3.29 54 (17.6%) 29 (14.5%) 0.88 0.52 - 1.48 19 (17.3%) 12 (16.2%) 1.04 0.46 - 2.36 5 (10%) 2 (8%) 0.51 0.05 - 4.76
Trend test p-value 0.413 0.9864 0.1394 0.6276 0.9017 0.8963 0.6646
Average number of cigarettes per day 0.3689
Never 607 (57.9%) 374 (57.0%) 146 (45.1%) 101 (48.8%) 101 (53.4%) 48 (44.9%) 39 (57%) 22 (56%) 215 (69.8%) 136 (67.3%) 71 (64.0%) 48 (64.9%) 35 (73%) 19 (70%)
<8 cigarettes 101 (9.6%) 60 (9.1%) 1.03 0.73 - 1.45 30 (9.3%) 14 (6.8%) 0.74 0.38 - 1.43 26 (13.8%) 11 (10.3%) 0.85 0.38 - 1.88 5 (7%) 1 (3%) 0.46 0.05 - 4.21 17 (5.5%) 18 (8.9%) 1.82* 0.91 - 3.64 16 (14.4%) 11 (14.9%) 1.14 0.50 - 2.59 7 (15%) 5 (19%) 1.26 0.36 - 4.40
>=8 cigarettes 341 (32.5%) 222 (33.8%) 1.13 0.90 - 1.40 148 (45.7%) 92 (44.4%) 0.94 0.65 - 1.34 62 (32.8%) 48 (44.9%) 1.74** 1.02 - 2.95 25 (36%) 16 (41%) 1.26 0.54 - 2.97 76 (24.7%) 48 (23.8%) 1.08 0.70 - 1.66 24 (21.6%) 15 (20.3%) 0.93 0.44 - 1.97 6 (12%) 3 (11%) 0.86 0.16 - 4.63
Trend test p-value 0.2996 0.714 0.0418 0.5577 0.5868 0.9267 1
Packs of Cigarette per year 0.4478
Never 607 (58.3%) 374 (57.5%) 146 (45.2%) 101 (49.0%) 101 (54.3%) 48 (45.3%) 39 (57%) 22 (56%) 215 (70.3%) 136 (68.0%) 71 (64.5%) 48 (64.9%) 35 (73%) 19 (73%)
<12 210 (20.2%) 127 (19.5%) 1.03 0.80 - 1.34 69 (21.4%) 35 (17.0%) 0.78 0.49 - 1.25 52 (28.0%) 28 (26.4%) 1.12 0.62 - 2.03 10 (14%) 4 (10%) 0.88 0.23 - 3.36 43 (14.1%) 39 (19.5%) 1.59* 0.97 - 2.60 27 (24.5%) 16 (21.6%) 0.89 0.44 - 1.81 9 (19%) 5 (19%) 0.95 0.29 - 3.19
>=12 225 (21.6%) 150 (23.0%) 1.16 0.90 - 1.49 108 (33.4%) 70 (34.0%) 0.98 0.66 - 1.45 33 (17.7%) 30 (28.3%) 2.05** 1.09 - 3.87 20 (29%) 13 (33%) 1.26 0.52 - 3.06 48 (15.7%) 25 (12.5%) 0.84 0.48 - 1.49 12 (10.9%) 10 (13.5%) 1.47 0.57 - 3.77 4 (8%) 2 (8%) 0.66 0.07 - 6.57
Trend test p-value 0.2825 0.8277 0.0323 0.5964 0.8786 0.6132 0.7633
alcohol (g/day) 0.3930
none 660 (61.6%) 407 (61.0%) 116 (35.5%) 87 (41.6%) 136 (69.4%) 67 (60.4%) 49 (70%) 27 (68%) 250 (79.9%) 164 (80.0%) 71 (60.2%) 42 (56.0%) 38 (79%) 20 (74%)
<=14 316 (29.5%) 191 (28.6%) 1.01 0.8-1.27 144 (44.0%) 78 (37.3%) 0.75 0.51-1.11 50 (25.5%) 34 (30.6%) 1.39 0.82-2.35 17 (24%) 11 (28%) 1.27 0.51-3.2 56 (17.9%) 36 (17.6%) 1 0.63-1.59 41 (34.7%) 25 (33.3%) 1.07 0.58-1.98 8 (17%) 7 (26%) 2.51 0.6-10.6
>14 96 (9.0%) 69 (10.3%) 1.11 0.78-1.59 67 (20.5%) 44 (21.1%) 0.83 0.52-1.33 10 (5.1%) 10 (9.0%) 2.07 0.8-5.32 4 (6%) 2 (5%) 0.83 0.15-4.71 7 (2.2%) 5 (2.4%) 1.3 0.38-4.4 6 (5.1%) 8 (10.7%) 2.19 0.66-7.26 2 (4%) 0 (0%)
Trend Test p-value 0.5561 0.7661 0.1601 0.8282 0.6813 0.1958 0.1859
Coffee: (Cups/day) 0.2132
none 342 (31.9%) 248 (37.2%) 92 (28.1%) 68 (32.5%) 88 (44.9%) 56 (50.5%) 25 (36%) 22 (55%) 99 (31.6%) 69 (33.7%) 22 (18.6%) 23 (30.7%) 16 (33%) 10 (37%)
>=1 493 (46.0%) 284 (42.6%) 0.78** 0.62-0.98 142 (43.4%) 88 (42.1%) 0.8 0.52-1.24 83 (42.3%) 40 (36.0%) 0.77 0.47-1.25 31 (44%) 14 (35%) 0.54 0.22-1.34 150 (47.9%) 97 (47.3%) 0.96 0.64-1.45 68 (57.6%) 34 (45.3%) 0.48* 0.22-1.01 19 (40%) 11 (41%) 1.17 0.33-4.13
>1/<=4 197 (18.4%) 113 (16.9%) 0.8 0.6-1.07 75 (22.9%) 43 (20.6%) 0.78 0.48-1.27 24 (12.2%) 13 (11.7%) 0.87 0.41-1.85 10 (14%) 4 (10%) 0.53 0.16-1.81 55 (17.6%) 33 (16.1%) 0.88 0.51-1.52 21 (17.8%) 16 (21.3%) 0.79 0.3-2.03 12 (25%) 4 (15%) 0.56 0.12-2.51
>4 40 (3.7%) 22 (3.3%) 0.81 0.47-1.41 18 (5.5%) 10 (4.8%) 0.85 0.37-1.97 1 (0.5%) 2 (1.8%) 3.43 0.3-38.62 4 (6%) 0 (0%) 9 (2.9%) 6 (2.9%) 1.06 0.36-3.1 7 (5.9%) 2 (2.7%) 0.25 0.04-1.42 1 (2%) 2 (7%) 3.62 0.27-49.25
Trend Test p-value 0.0932 0.3706 0.6815 0.0536 0.7695 0.2522 1.0000
Regular coffee (g/day) 0.5483
0-<240 526 (49.1%) 334 (50.1%) 143 (43.7%) 89 (42.6%) 124 (63.3%) 74 (66.7%) 38 (54%) 28 (70%) 156 (49.8%) 95 (46.3%) 44 (37.3%) 34 (45.3%) 21 (44%) 14 (52%)
240-<961 546 (50.9%) 333 (49.9%) 0.95 0.78-1.16 184 (56.3%) 120 (57.4%) 1.05 0.74-1.5 72 (36.7%) 37 (33.3%) 0.81 0.5-1.32 32 (46%) 12 (30%) 0.52 0.22-1.23 157 (50.2%) 110 (53.7%) 1.17 0.82-1.66 74 (62.7%) 41 (54.7%) 0.76 0.42-1.36 27 (56%) 13 (48%) 0.71 0.24-2.08
Decaffeinated Coffee (g/day) 0.7529
0-<33.95 815 (76.0%) 499 (74.8%) 250 (76.5%) 165 (78.9%) 145 (74.0%) 82 (73.9%) 59 (84%) 33 (82%) 228 (72.8%) 143 (69.8%) 95 (80.5%) 57 (76.0%) 38 (79%) 19 (70%)
33.95-<600 203 (18.9%) 139 (20.8%) 1.08 0.85-1.39 51 (15.6%) 35 (16.7%) 0.93 0.57-1.54 44 (22.4%) 25 (22.5%) 1.01 0.58-1.76 10 (14%) 7 (18%) 1.2 0.44-3.28 68 (21.7%) 51 (24.9%) 1.15 0.76-1.74 22 (18.6%) 15 (20.0%) 1.08 0.5-2.32 8 (17%) 6 (22%) 1.91 0.49-7.42
600-961 54 (5.0%) 29 (4.3%) 0.85 0.53-1.37 26 (8.0%) 9 (4.3%) 0.54 0.25-1.18 7 (3.6%) 4 (3.6%) 0.85 0.21-3.47 1 (1%) 0 (0%) 17 (5.4%) 11 (5.4%) 1.04 0.48-2.28 1 (0.8%) 3 (4.0%) 4.37 0.44-43.1 2 (4%) 2 (7%) 1.69 0.23-12.23
Trend Test p-value 0.8656 0.1373 0.8878 0.9408 0.6549 0.2799 0.3611
Black Tea (g/day) 0.8558
0-<33.94 732 (68.3%) 484 (72.6%) 200 (61.2%) 131 (62.7%) 142 (72.4%) 92 (82.9%) 45 (64%) 30 (75%) 227 (72.5%) 153 (74.6%) 79 (66.9%) 58 (77.3%) 39 (81%) 20 (74%)
33.94-<240 217 (20.2%) 117 (17.5%) 0.81 0.63-1.05 74 (22.6%) 49 (23.4%) 1.04 0.68-1.6 40 (20.4%) 13 (11.7%) 0.51* 0.26-1.02 21 (30%) 7 (18%) 0.55 0.22-1.37 53 (16.9%) 33 (16.1%) 0.87 0.53-1.44 25 (21.2%) 12 (16.0%) 0.68 0.31-1.5 4 (8%) 3 (11%) 1.22 0.27-5.57
240-<961 123 (11.5%) 66 (9.9%) 0.79 0.57-1.09 53 (16.2%) 29 (13.9%) 0.85 0.52-1.41 14 (7.1%) 6 (5.4%) 0.71 0.26-1.9 4 (6%) 3 (8%) 0.97 0.2-4.61 33 (10.5%) 19 (9.3%) 0.87 0.48-1.59 14 (11.9%) 5 (6.7%) 0.37* 0.12-1.18 5 (10%) 4 (15%) 1.43 0.34-5.94
Trend Test p-value 0.0845 0.5760 0.1579 0.5549 0.5871 0.0574 0.5850
0.4955
none 587 (58.7%) 370 (58.6%) 155 (49.8%) 102 (50.7%) 124 (71.3%) 70 (68.0%) 25 (37%) 14 (38%) 191 (64.3%) 119 (61.3%) 63 (60.0%) 49 (70.0%) 29 (64%) 16 (62%)
<= 0.11 161 (16.1%) 115 (18.2%) 1.12 0.84 - 1.49 58 (18.6%) 40 (19.9%) 1.02 0.62 - 1.67 26 (14.9%) 19 (18.4%) 1.43 0.71 - 2.88 9 (13%) 11 (30%) 2.04 0.65 - 6.39 48 (16.2%) 32 (16.5%) 0.93 0.55 - 1.59 15 (14.3%) 10 (14.3%) 1.08 0.41 - 2.85 5 (11%) 3 (12%) 1.02 0.22 - 4.74
> 0.11 - <=0.36 109 (10.9%) 77 (12.2%) 1.14 0.82 - 1.58 40 (12.9%) 36 (17.9%) 1.33 0.78 - 2.26 14 (8.0%) 7 (6.8%) 1.03 0.38 - 2.80 13 (19%) 4 (11%) 0.44 0.11 - 1.81 27 (9.1%) 22 (11.3%) 1.31 0.73 - 2.37 13 (12.4%) 3 (4.3%) 0.33 0.09 - 1.25 2 (4%) 5 (19%) 4.27* 0.80 - 22.79
>0.36 143 (14.3%) 69 (10.9%) 0.76 0.55 - 1.07 58 (18.6%) 23 (11.4%) 0.64 0.36 - 1.14 10 (5.7%) 7 (6.8%) 1.29 0.44 - 3.84 21 (31%) 8 (22%) 0.72 0.26 - 2.04 31 (10.4%) 21 (10.8%) 0.97 0.52 - 1.84 14 (13.3%) 8 (11.4%) 0.67 0.24 - 1.86 9 (20%) 2 (8%) 0.39 0.07 - 2.08
Trend test p-value 0.3738 0.3929 0.555 0.2576 0.7123 0.2341 0.8234
BMI (kg/m2) 0.1994
<25 502 (47.9%) 333 (50.8%) 170 (52.1%) 113 (54.6%) 41 (22.4%) 34 (32.7%) 18 (26%) 11 (28%) 209 (67.6%) 142 (70.0%) 38 (32.5%) 24 (32.0%) 26 (58%) 9 (33%)
25-<30 321 (30.6%) 194 (29.6%) 0.95 0.75-1.2 84 (25.8%) 58 (28.0%) 1.06 0.71-1.57 68 (37.2%) 32 (30.8%) 0.56* 0.3-1.06 27 (39%) 14 (36%) 0.94 0.36-2.47 80 (25.9%) 50 (24.6%) 0.97 0.63-1.5 46 (39.3%) 31 (41.3%) 1.04 0.52-2.08 16 (36%) 9 (33%) 1.4 0.49-4.01
30+ 226 (21.5%) 128 (19.5%) 0.89 0.67-1.17 72 (22.1%) 36 (17.4%) 0.78 0.49-1.24 74 (40.4%) 38 (36.5%) 0.61 0.32-1.16 24 (35%) 14 (36%) 0.94 0.35-2.49 20 (6.5%) 11 (5.4%) 0.89 0.39-2.01 33 (28.2%) 20 (26.7%) 0.83 0.36-1.91 3 (7%) 9 (33%) 7.64** 1.49-39.23
Trend Test p-value 0.3908 0.3730 0.1858 0.9042 0.7811 0.6838 0.0096
Calories (Kcal/day) 0.6235
427-<1324.27 289 (27.0%) 177 (26.5%) 86 (26.3%) 61 (29.2%) 79 (40.3%) 37 (33.3%) 12 (17%) 5 (12%) 81 (25.9%) 45 (22.0%) 22 (18.6%) 24 (32.0%) 9 (19%) 5 (19%)
1324.27-<1749.475 259 (24.2%) 164 (24.6%) 0.99 0.75-1.3 91 (27.8%) 55 (26.3%) 0.78 0.48-1.28 35 (17.9%) 24 (21.6%) 1.5 0.76-2.96 12 (17%) 3 (8%) 0.61 0.12-3.08 89 (28.4%) 60 (29.3%) 1.09 0.66-1.8 23 (19.5%) 16 (21.3%) 0.67 0.27-1.67 9 (19%) 6 (22%) 1.1 0.28-4.36
1749.475-<2345.409 251 (23.4%) 152 (22.8%) 0.91 0.69-1.2 86 (26.3%) 50 (23.9%) 0.73 0.45-1.2 27 (13.8%) 21 (18.9%) 1.5 0.77-2.93 14 (20%) 9 (22%) 1.49 0.34-6.62 81 (25.9%) 53 (25.9%) 1.04 0.63-1.72 28 (23.7%) 15 (20.0%) 0.53 0.22-1.24 15 (31%) 4 (15%) 0.49 0.11-2.29
2345.409-7742 273 (25.5%) 174 (26.1%) 1.06 0.81-1.39 64 (19.6%) 43 (20.6%) 0.93 0.56-1.54 55 (28.1%) 29 (26.1%) 1.24 0.68-2.26 32 (46%) 23 (57%) 1.53 0.5-4.68 62 (19.8%) 47 (22.9%) 1.34 0.8-2.24 45 (38.1%) 20 (26.7%) 0.45* 0.2-1.02 15 (31%) 12 (44%) 1.41 0.42-4.79
Trend Test p-value 0.6768 0.8059 0.6300 0.2276 0.2925 0.0520 0.4968
0.6582
0-<12.91 292 (27.2%) 196 (29.4%) 98 (30.0%) 79 (37.8%) 65 (33.2%) 35 (31.5%) 8 (11%) 2 (5%) 88 (28.1%) 51 (24.9%) 22 (18.6%) 22 (29.3%) 11 (23%) 7 (26%)
12.91-<24.95 266 (24.8%) 141 (21.1%) 0.82 0.62-1.08 88 (26.9%) 42 (20.1%) 0.64* 0.4-1.03 40 (20.4%) 25 (22.5%) 1.18 0.61-2.29 20 (29%) 7 (18%) 1.36 0.23-7.95 86 (27.5%) 50 (24.4%) 1.03 0.63-1.68 22 (18.6%) 14 (18.7%) 0.56 0.22-1.44 10 (21%) 3 (11%) 0.54 0.11-2.71
24.95-<42.98 272 (25.4%) 165 (24.7%) 0.91 0.7-1.19 83 (25.4%) 48 (23.0%) 0.72 0.45-1.15 44 (22.4%) 29 (26.1%) 1.31 0.72-2.38 18 (26%) 9 (22%) 1.45 0.26-7.97 81 (25.9%) 59 (28.8%) 1.22 0.74-2.01 33 (28.0%) 15 (20.0%) 0.49 0.21-1.15 13 (27%) 5 (19%) 0.6 0.14-2.61
42.98-499 242 (22.6%) 165 (24.7%) 1.11 0.84-1.46 58 (17.7%) 40 (19.1%) 0.91 0.55-1.51 47 (24.0%) 22 (19.8%) 0.93 0.48-1.79 24 (34%) 22 (55%) 3.44 0.64-18.36 58 (18.5%) 45 (22.0%) 1.43 0.84-2.44 41 (34.7%) 24 (32.0%) 0.62 0.28-1.39 14 (29%) 12 (44%) 1.4 0.43-4.58
Trend Test p-value 0.2389 0.8752 0.8446 0.0232 0.1417 0.4442 0.2827
Processed red meat (g/day) 0.0194
0-<3.96 254 (23.7%) 166 (24.9%) 107 (32.7%) 61 (29.2%) 39 (19.9%) 30 (27.0%) 13 (19%) 2 (5%) 69 (22.0%) 44 (21.5%) 18 (15.3%) 24 (32.0%) 8 (17%) 5 (19%)
3.96-<8.96 296 (27.6%) 171 (25.6%) 0.91 0.69-1.19 87 (26.6%) 59 (28.2%) 1.25 0.8-1.95 60 (30.6%) 29 (26.1%) 0.63 0.34-1.19 9 (13%) 7 (18%) 5.92* 0.87-40.48 94 (30.0%) 48 (23.4%) 0.78 0.46-1.33 32 (27.1%) 22 (29.3%) 0.48* 0.21-1.12 14 (29%) 6 (22%) 0.71 0.15-3.31
8.96-<17.18 258 (24.1%) 173 (25.9%) 1.04 0.78-1.38 68 (20.8%) 58 (27.8%) 1.44 0.9-2.32 49 (25.0%) 20 (18.0%) 0.50* 0.24-1.05 15 (21%) 11 (28%) 4.04* 0.85-19.27 92 (29.4%) 62 (30.2%) 1.08 0.63-1.85 23 (19.5%) 16 (21.3%) 0.55 0.22-1.38 11 (23%) 6 (22%) 0.92 0.21-3.99
17.18-222 264 (24.6%) 157 (23.5%) 0.94 0.71-1.25 65 (19.9%) 31 (14.8%) 0.83 0.49-1.41 48 (24.5%) 32 (28.8%) 0.92 0.47-1.79 33 (47%) 20 (50%) 4.83* 0.88-26.48 58 (18.5%) 51 (24.9%) 1.36 0.79-2.33 45 (38.1%) 13 (17.3%) 0.22*** 0.09-0.55 15 (31%) 10 (37%) 1.08 0.3-3.83
Trend Test p-value 0.8980 0.4903 0.7778 0.3040 0.0876 0.0012 0.6739
0.1194
0.44-38.02 241 (22.5%) 137 (20.5%) 44 (13.5%) 37 (17.7%) 49 (25.0%) 29 (26.1%) 14 (20%) 6 (15%) 96 (30.7%) 51 (24.9%) 29 (24.6%) 10 (13.3%) 9 (19%) 4 (15%)
38.02-<60.85 281 (26.2%) 172 (25.8%) 1.09 0.82-1.45 70 (21.4%) 51 (24.4%) 0.88 0.49-1.59 63 (32.1%) 21 (18.9%) 0.55* 0.27-1.11 22 (31%) 15 (38%) 1.88 0.48-7.32 79 (25.2%) 62 (30.2%) 1.52* 0.95-2.42 32 (27.1%) 17 (22.7%) 1.37 0.55-3.41 15 (31%) 6 (22%) 0.92 0.21-4.08
60.85-<91.87 285 (26.6%) 167 (25.0%) 0.99 0.74-1.32 106 (32.4%) 44 (21.1%) 0.47** 0.27-0.84 44 (22.4%) 28 (25.2%) 1.03 0.53-2 15 (21%) 11 (28%) 1.83 0.44-7.67 82 (26.2%) 56 (27.3%) 1.21 0.75-1.97 28 (23.7%) 21 (28.0%) 2 0.81-4.94 10 (21%) 7 (26%) 1.29 0.3-5.6
91.87-515 265 (24.7%) 191 (28.6%) 1.27 0.95-1.7 107 (32.7%) 77 (36.8%) 0.88 0.51-1.51 40 (20.4%) 33 (29.7%) 1.4 0.71-2.74 19 (27%) 8 (20%) 1.14 0.29-4.49 56 (17.9%) 36 (17.6%) 1.17 0.68-2.02 29 (24.6%) 27 (36.0%) 2.51** 1-6.27 14 (29%) 10 (37%) 1.53 0.35-6.76
Trend Test p-value 0.1265 0.8165 0.1028 0.7382 0.7804 0.0288 0.4083
Total Vegetables (g/day) 0.8969
0.15-<119.37 255 (23.8%) 167 (25.0%) 77 (23.5%) 47 (22.5%) 53 (27.0%) 36 (32.4%) 17 (24%) 9 (22%) 70 (22.4%) 46 (22.4%) 27 (22.9%) 20 (26.7%) 11 (23%) 9 (33%)
119.37-<162.63 267 (24.9%) 184 (27.6%) 1.04 0.79-1.37 77 (23.5%) 62 (29.7%) 1.33 0.8-2.22 47 (24.0%) 31 (27.9%) 1 0.53-1.92 20 (29%) 12 (30%) 1.1 0.38-3.18 77 (24.6%) 51 (24.9%) 1.03 0.6-1.77 34 (28.8%) 19 (25.3%) 0.65 0.28-1.5 12 (25%) 9 (33%) 0.94 0.28-3.13
162.63-<219.78 257 (24.0%) 175 (26.2%) 0.99 0.74-1.32 85 (26.0%) 54 (25.8%) 1.02 0.6-1.73 48 (24.5%) 26 (23.4%) 0.75 0.4-1.4 14 (20%) 8 (20%) 1.12 0.37-3.43 67 (21.4%) 60 (29.3%) 1.4 0.79-2.47 33 (28.0%) 22 (29.3%) 0.81 0.35-1.89 10 (21%) 5 (19%) 0.56 0.13-2.43
219.78-1131 293 (27.3%) 141 (21.1%) 0.69** 0.52-0.93 88 (26.9%) 46 (22.0%) 0.79 0.46-1.35 48 (24.5%) 18 (16.2%) 0.56 0.28-1.14 19 (27%) 11 (28%) 0.9 0.3-2.68 99 (31.6%) 48 (23.4%) 0.78 0.45-1.33 24 (20.3%) 14 (18.7%) 0.8 0.32-2.02 15 (31%) 4 (15%) 0.25* 0.06-1.13
Trend Test p-value 0.0055 0.1609 0.0653 0.8172 0.2458 0.7645 0.0423
Total Fruits and Juice (g/day) 0.2070
0-<101.18 260 (24.3%) 173 (25.9%) 78 (23.9%) 53 (25.4%) 40 (20.4%) 31 (27.9%) 22 (31%) 14 (35%) 72 (23.0%) 47 (22.9%) 33 (28.0%) 19 (25.3%) 15 (31%) 9 (33%)
101.18-<175.79 271 (25.3%) 156 (23.4%) 0.8 0.6-1.06 81 (24.8%) 52 (24.9%) 0.82 0.49-1.4 49 (25.0%) 16 (14.4%) 0.44** 0.21-0.9 21 (30%) 9 (22%) 0.6 0.2-1.82 72 (23.0%) 53 (25.9%) 1.04 0.62-1.73 38 (32.2%) 21 (28.0%) 0.92 0.42-2 10 (21%) 5 (19%) 0.8 0.17-3.7
175.79-<272.92 274 (25.6%) 158 (23.7%) 0.79 0.59-1.06 92 (28.1%) 40 (19.1%) 0.54** 0.31-0.96 49 (25.0%) 28 (25.2%) 0.79 0.41-1.52 14 (20%) 7 (18%) 0.72 0.21-2.48 80 (25.6%) 61 (29.8%) 1.08 0.65-1.78 27 (22.9%) 13 (17.3%) 0.73 0.29-1.87 12 (25%) 9 (33%) 1.24 0.33-4.67
272.92-1219 267 (24.9%) 180 (27.0%) 0.93 0.7-1.23 76 (23.2%) 64 (30.6%) 1.13 0.67-1.9 58 (29.6%) 36 (32.4%) 0.79 0.42-1.47 13 (19%) 10 (25%) 0.91 0.25-3.27 89 (28.4%) 44 (21.5%) 0.61* 0.35-1.07 20 (16.9%) 22 (29.3%) 1.67 0.71-3.91 11 (23%) 4 (15%) 0.71 0.19-2.66
Trend Test p-value 0.8782 0.4336 0.9801 0.9890 0.0760 0.1942 0.6649
*** p<0.01, ** p<0.05, * p<0.1
Vigorous activity (vigorous work and sports) hours per day
Red meat excluding processed red meat (g/day)
Density for Vitamin D (IU/1000 kcal/day)
Page | 60

4.3.2. Multivariate models of smoking for FI risk
The same models including different types of smoking variables as we used above were used to
measure the relationship between smoking and risk of FI (Table 17). There was no significant
association between smoking and risk of FI. However, in the model 3, smoking was positively
associated with risk of FI among African-American. Women who smoked equal to or more than
12 packs of cigarette per year were 2.23 times to get FI compared to those who never smoked
(95%CI: 1.10-4.49) among African-American. Trend test was only significant for African-
American in model 3 (p=0.0294). The probability of FI reduced by 24% for women who drank 1
cup of coffee (OR=0.76; 95%CI: 0.60-0.97), and 2 or 3 cups of coffee lead to 27% decrease in FI
(OR=0.73; 95%CI: 0.54-0.99). Increasing consumption of coffee seemed to decrease risk of FI,
but the trend was only statistically significant for Hawaiians (trend p=0.0204), and the test of
heterogeneity was insignificant (p=0.0942). The relationships between coffee and FI in model 1
were consistent with model 2 and model 3.

Page | 61

Table 17. Multivariate models of smoking for FI across ethnic groups

total White Black Hawaiian Japanese Latinos Other Interaction p
MODEL 1 Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 1072 667 327 209 196 111 70 40 313 205 118 75 48 27
Total number of years smoked 0.7699
Never 607 (58.1%) 374 (57.3%) 146 (45.2%) 101 (48.8%) 101 (53.7%) 48 (44.9%) 39 (57%) 22 (56%) 215 (70.0%) 136 (68.0%) 71 (64.5%) 48 (64.9%) 35 (73%) 19 (73%)
< 25 years 203 (19.4%) 130 (19.9%) 1.09 0.83 - 1.43 83 (25.7%) 42 (20.3%) 0.79 0.50 - 1.24 39 (20.7%) 27 (25.2%) 1.35 0.67 - 2.75 15 (22%) 7 (18%) 0.84 0.23 - 3.10 38 (12.4%) 35 (17.5%) 1.68* 0.97 - 2.89 20 (18.2%) 14 (18.9%) 1.07 0.44 - 2.58 8 (17%) 5 (19%) 0.91 0.22 - 3.75
>= 25 years 235 (22.5%) 149 (22.8%) 1.15 0.89 - 1.50 94 (29.1%) 64 (30.9%) 1.1 0.72 - 1.67 48 (25.5%) 32 (29.9%) 1.59 0.84 - 3.03 15 (22%) 10 (26%) 1.36 0.48 - 3.83 54 (17.6%) 29 (14.5%) 0.87 0.51 - 1.49 19 (17.3%) 12 (16.2%) 1.32 0.52 - 3.36 5 (10%) 2 (8%) 0.81 0.07 - 9.43
Trend test p-value 0.2631 0.7644 0.137 0.5954 0.921 0.5739 0.8435
alcohol (g/day) 0.5905
none 660 (61.6%) 407 (61.0%) 116 (35.5%) 87 (41.6%) 136 (69.4%) 67 (60.4%) 49 (70%) 27 (68%) 250 (79.9%) 164 (80.0%) 71 (60.2%) 42 (56.0%) 38 (79%) 20 (74%)
<=14 316 (29.5%) 191 (28.6%) 1.04 0.82 - 1.32 144 (44.0%) 78 (37.3%) 0.79 0.52 - 1.20 50 (25.5%) 34 (30.6%) 1.42 0.78 - 2.56 17 (24%) 11 (28%) 1.87 0.58 - 6.05 56 (17.9%) 36 (17.6%) 0.99 0.61 - 1.59 41 (34.7%) 25 (33.3%) 1.13 0.57 - 2.21 8 (17%) 7 (26%) 2.22 0.44 - 11.24
>14 96 (9.0%) 69 (10.3%) 1.1 0.75 - 1.62 67 (20.5%) 44 (21.1%) 0.84 0.50 - 1.40 10 (5.1%) 10 (9.0%) 1.76 0.58 - 5.36 4 (6%) 2 (5%) 1.7 0.20 - 14.67 7 (2.2%) 5 (2.4%) 1.13 0.30 - 4.22 6 (5.1%) 8 (10.7%) 2.34 0.58 - 9.42 2 (4%) 0 (0%)
Trend test p-value 0.5994 0.4071 0.1803 0.3735 0.9553 0.3437
Coffee: (Cups/day) 0.0942
none 342 (31.9%) 248 (37.2%) 92 (28.1%) 68 (32.5%) 88 (44.9%) 56 (50.5%) 25 (36%) 22 (55%) 99 (31.6%) 69 (33.7%) 22 (18.6%) 23 (30.7%) 16 (33%) 10 (37%)
>=1 493 (46.0%) 284 (42.6%) 0.76** 0.60 - 0.97 142 (43.4%) 88 (42.1%) 0.82 0.52 - 1.29 83 (42.3%) 40 (36.0%) 0.69 0.39 - 1.24 31 (44%) 14 (35%) 0.47 0.16 - 1.39 150 (47.9%) 97 (47.3%) 0.95 0.62 - 1.46 68 (57.6%) 34 (45.3%) 0.37** 0.16 - 0.86 19 (40%) 11 (41%) 0.87 0.19 - 3.96
>1/<=4 197 (18.4%) 113 (16.9%) 0.73** 0.54 - 0.99 75 (22.9%) 43 (20.6%) 0.77 0.46 - 1.29 24 (12.2%) 13 (11.7%) 0.55 0.22 - 1.40 10 (14%) 4 (10%) 0.33 0.07 - 1.52 55 (17.6%) 33 (16.1%) 0.95 0.54 - 1.69 21 (17.8%) 16 (21.3%) 0.61 0.22 - 1.74 12 (25%) 4 (15%) 0.46 0.08 - 2.58
>4 40 (3.7%) 22 (3.3%) 0.79 0.44 - 1.41 18 (5.5%) 10 (4.8%) 0.81 0.32 - 2.03 1 (0.5%) 2 (1.8%) 1.81 0.15 - 22.43 4 (6%) 0 (0%) 9 (2.9%) 6 (2.9%) 1.3 0.42 - 4.01 7 (5.9%) 2 (2.7%) 0.18* 0.03 - 1.16 1 (2%) 2 (7%)
Trend test p-value 0.0408 0.3593 0.2278 0.0204 0.9431 0.126 0.6948
BMI (kg/m2) 0.1929
<25 502 (47.9%) 333 (50.8%) 170 (52.1%) 113 (54.6%) 41 (22.4%) 34 (32.7%) 18 (26%) 11 (28%) 209 (67.6%) 142 (70.0%) 38 (32.5%) 24 (32.0%) 26 (58%) 9 (33%)
25-<30 321 (30.6%) 194 (29.6%) 1.01 0.79 - 1.29 84 (25.8%) 58 (28.0%) 1.01 0.67 - 1.53 68 (37.2%) 32 (30.8%) 0.71 0.36 - 1.43 27 (39%) 14 (36%) 1.48 0.42 - 5.23 80 (25.9%) 50 (24.6%) 0.97 0.62 - 1.53 46 (39.3%) 31 (41.3%) 2.04* 0.88 - 4.75 16 (36%) 9 (33%) 1.24 0.37 - 4.21
30+ 226 (21.5%) 128 (19.5%) 0.93 0.70 - 1.24 72 (22.1%) 36 (17.4%) 0.73 0.45 - 1.19 74 (40.4%) 38 (36.5%) 0.77 0.39 - 1.54 24 (35%) 14 (36%) 0.9 0.29 - 2.78 20 (6.5%) 11 (5.4%) 0.89 0.38 - 2.07 33 (28.2%) 20 (26.7%) 1.26 0.51 - 3.11 3 (7%) 9 (33%) 6.49** 1.17 - 35.89
Trend test p-value 0.6813 0.2741 0.5288 0.7037 0.7961 0.5559 0.0363
MODEL 2
Average number of cigarettes per day 0.4237
Never 607 (57.9%) 374 (57.0%) 146 (45.1%) 101 (48.8%) 101 (53.4%) 48 (44.9%) 39 (57%) 22 (56%) 215 (69.8%) 136 (67.3%) 71 (64.0%) 48 (64.9%) 35 (73%) 19 (70%)
< 8 cigarettes 101 (9.6%) 60 (9.1%) 1.08 0.76 - 1.54 30 (9.3%) 14 (6.8%) 0.74 0.38 - 1.45 26 (13.8%) 11 (10.3%) 0.94 0.37 - 2.41 5 (7%) 1 (3%) 0.27 0.02 - 3.04 17 (5.5%) 18 (8.9%) 1.81* 0.90 - 3.66 16 (14.4%) 11 (14.9%) 1.29 0.53 - 3.14 7 (15%) 5 (19%) 1.34 0.30 - 5.94
>= 8 cigarettes 341 (32.5%) 222 (33.8%) 1.16 0.93 - 1.46 148 (45.7%) 92 (44.4%) 0.99 0.68 - 1.45 62 (32.8%) 48 (44.9%) 1.75* 0.98 - 3.14 25 (36%) 16 (41%) 1.35 0.53 - 3.46 76 (24.7%) 48 (23.8%) 1.08 0.69 - 1.68 24 (21.6%) 15 (20.3%) 0.98 0.42 - 2.25 6 (12%) 3 (11%) 0.99 0.14 - 6.96
Trend test p-value 0.1898 0.9718 0.0565 0.5224 0.5944 0.9191 0.8771
alcohol (g/day) 0.4826
none 660 (61.6%) 407 (61.0%) 116 (35.5%) 87 (41.6%) 136 (69.4%) 67 (60.4%) 49 (70%) 27 (68%) 250 (79.9%) 164 (80.0%) 71 (60.2%) 42 (56.0%) 38 (79%) 20 (74%)
<=14 316 (29.5%) 191 (28.6%) 1.05 0.82 - 1.33 144 (44.0%) 78 (37.3%) 0.79 0.52 - 1.20 50 (25.5%) 34 (30.6%) 1.48 0.82 - 2.69 17 (24%) 11 (28%) 1.9 0.58 - 6.28 56 (17.9%) 36 (17.6%) 0.96 0.59 - 1.55 41 (34.7%) 25 (33.3%) 1.07 0.54 - 2.10 8 (17%) 7 (26%) 2.17 0.43 - 10.92
>14 96 (9.0%) 69 (10.3%) 1.07 0.73 - 1.55 67 (20.5%) 44 (21.1%) 0.79 0.47 - 1.31 10 (5.1%) 10 (9.0%) 1.99 0.67 - 5.94 4 (6%) 2 (5%) 1.42 0.17 - 11.94 7 (2.2%) 5 (2.4%) 1.28 0.37 - 4.38 6 (5.1%) 8 (10.7%) 2.53 0.63 - 10.15 2 (4%) 0 (0%)
Trend test p-value 0.676 0.3022 0.1135 0.446 0.9294 0.3472 0.9458
Coffee: (Cups/day) 0.1718
none 342 (31.9%) 248 (37.2%) 92 (28.1%) 68 (32.5%) 88 (44.9%) 56 (50.5%) 25 (36%) 22 (55%) 99 (31.6%) 69 (33.7%) 22 (18.6%) 23 (30.7%) 16 (33%) 10 (37%)
>=1 493 (46.0%) 284 (42.6%) 0.78** 0.61 - 0.98 142 (43.4%) 88 (42.1%) 0.86 0.55 - 1.35 83 (42.3%) 40 (36.0%) 0.72 0.40 - 1.29 31 (44%) 14 (35%) 0.47 0.16 - 1.37 150 (47.9%) 97 (47.3%) 0.92 0.60 - 1.41 68 (57.6%) 34 (45.3%) 0.38** 0.16 - 0.86 19 (40%) 11 (41%) 0.85 0.18 - 3.96
>1/<=4 197 (18.4%) 113 (16.9%) 0.72** 0.53 - 0.98 75 (22.9%) 43 (20.6%) 0.76 0.46 - 1.27 24 (12.2%) 13 (11.7%) 0.53 0.21 - 1.35 10 (14%) 4 (10%) 0.29 0.06 - 1.36 55 (17.6%) 33 (16.1%) 0.86 0.49 - 1.51 21 (17.8%) 16 (21.3%) 0.7 0.25 - 1.95 12 (25%) 4 (15%) 0.43 0.08 - 2.39
>4 40 (3.7%) 22 (3.3%) 0.75 0.43 - 1.34 18 (5.5%) 10 (4.8%) 0.91 0.36 - 2.25 1 (0.5%) 2 (1.8%) 1.65 0.13 - 20.27 4 (6%) 0 (0%) 9 (2.9%) 6 (2.9%) 0.98 0.33 - 2.91 7 (5.9%) 2 (2.7%) 0.21* 0.03 - 1.27 1 (2%) 2 (7%) 1.44 0.05 - 37.82
Trend test p-value 0.0281 0.3902 0.2144 0.0138 0.6537 0.1841 0.5003
BMI (kg/m2) 0.2164
<25 502 (47.9%) 333 (50.8%) 170 (52.1%) 113 (54.6%) 41 (22.4%) 34 (32.7%) 18 (26%) 11 (28%) 209 (67.6%) 142 (70.0%) 38 (32.5%) 24 (32.0%) 26 (58%) 9 (33%)
25-<30 321 (30.6%) 194 (29.6%) 1.01 0.79 - 1.28 84 (25.8%) 58 (28.0%) 1.04 0.68 - 1.57 68 (37.2%) 32 (30.8%) 0.71 0.35 - 1.43 27 (39%) 14 (36%) 1.37 0.39 - 4.83 80 (25.9%) 50 (24.6%) 0.96 0.62 - 1.51 46 (39.3%) 31 (41.3%) 1.87 0.82 - 4.27 16 (36%) 9 (33%) 0.94 0.28 - 3.23
30+ 226 (21.5%) 128 (19.5%) 0.93 0.69 - 1.24 72 (22.1%) 36 (17.4%) 0.73 0.45 - 1.19 74 (40.4%) 38 (36.5%) 0.82 0.41 - 1.66 24 (35%) 14 (36%) 0.78 0.25 - 2.47 20 (6.5%) 11 (5.4%) 0.88 0.38 - 2.04 33 (28.2%) 20 (26.7%) 1.21 0.49 - 2.97 3 (7%) 9 (33%) 6.07** 1.07 - 34.44
Trend test p-value 0.6526 0.2823 0.6609 0.5308 0.7618 0.5973 0.0642
MODEL 3
Packs of Cigarette per year 0.4167
Never 607 (58.3%) 374 (57.5%) 146 (45.2%) 101 (49.0%) 101 (54.3%) 48 (45.3%) 39 (57%) 22 (56%) 215 (70.3%) 136 (68.0%) 71 (64.5%) 48 (64.9%) 35 (73%) 19 (73%)
< 12 210 (20.2%) 127 (19.5%) 1.06 0.82 - 1.38 69 (21.4%) 35 (17.0%) 0.8 0.50 - 1.29 52 (28.0%) 28 (26.4%) 1.16 0.61 - 2.23 10 (14%) 4 (10%) 0.62 0.14 - 2.71 43 (14.1%) 39 (19.5%) 1.58* 0.96 - 2.62 27 (24.5%) 16 (21.6%) 1.02 0.47 - 2.21 9 (19%) 5 (19%) 0.91 0.22 - 3.75
>= 12 225 (21.6%) 150 (23.0%) 1.21 0.93 - 1.58 108 (33.4%) 70 (34.0%) 1.05 0.69 - 1.58 33 (17.7%) 30 (28.3%) 2.23** 1.10 - 4.49 20 (29%) 13 (33%) 1.41 0.53 - 3.75 48 (15.7%) 25 (12.5%) 0.85 0.47 - 1.53 12 (10.9%) 10 (13.5%) 1.6 0.57 - 4.54 4 (8%) 2 (8%) 0.81 0.07 - 9.43
Trend test p-value 0.1643 0.907 0.0294 0.5033 0.872 0.4553 0.8435
alcohol (g/day) 0.5819
none 660 (61.6%) 407 (61.0%) 116 (35.5%) 87 (41.6%) 136 (69.4%) 67 (60.4%) 49 (70%) 27 (68%) 250 (79.9%) 164 (80.0%) 71 (60.2%) 42 (56.0%) 38 (79%) 20 (74%)
<=14 316 (29.5%) 191 (28.6%) 1.04 0.82 - 1.32 144 (44.0%) 78 (37.3%) 0.81 0.53 - 1.22 50 (25.5%) 34 (30.6%) 1.4 0.77 - 2.55 17 (24%) 11 (28%) 1.82 0.56 - 5.96 56 (17.9%) 36 (17.6%) 0.95 0.58 - 1.54 41 (34.7%) 25 (33.3%) 1.11 0.56 - 2.18 8 (17%) 7 (26%) 2.22 0.44 - 11.24
>14 96 (9.0%) 69 (10.3%) 1.07 0.73 - 1.57 67 (20.5%) 44 (21.1%) 0.83 0.50 - 1.39 10 (5.1%) 10 (9.0%) 1.71 0.55 - 5.31 4 (6%) 2 (5%) 1.57 0.18 - 13.43 7 (2.2%) 5 (2.4%) 1.07 0.29 - 3.99 6 (5.1%) 8 (10.7%) 2.12 0.51 - 8.75 2 (4%) 0 (0%)
Trend test p-value 0.6877 0.4126 0.2075 0.4224 0.9036 0.4212
Coffee: (Cups/day) 0.0899
none 342 (31.9%) 248 (37.2%) 92 (28.1%) 68 (32.5%) 88 (44.9%) 56 (50.5%) 25 (36%) 22 (55%) 99 (31.6%) 69 (33.7%) 22 (18.6%) 23 (30.7%) 16 (33%) 10 (37%)
>=1 493 (46.0%) 284 (42.6%) 0.78** 0.61 - 0.99 142 (43.4%) 88 (42.1%) 0.84 0.53 - 1.33 83 (42.3%) 40 (36.0%) 0.73 0.40 - 1.31 31 (44%) 14 (35%) 0.5 0.17 - 1.47 150 (47.9%) 97 (47.3%) 0.93 0.60 - 1.42 68 (57.6%) 34 (45.3%) 0.37** 0.16 - 0.86 19 (40%) 11 (41%) 0.87 0.19 - 3.96
>1/<=4 197 (18.4%) 113 (16.9%) 0.74* 0.54 - 1.00 75 (22.9%) 43 (20.6%) 0.77 0.46 - 1.28 24 (12.2%) 13 (11.7%) 0.57 0.22 - 1.49 10 (14%) 4 (10%) 0.3 0.06 - 1.44 55 (17.6%) 33 (16.1%) 0.92 0.52 - 1.64 21 (17.8%) 16 (21.3%) 0.6 0.21 - 1.71 12 (25%) 4 (15%) 0.46 0.08 - 2.58
>4 40 (3.7%) 22 (3.3%) 0.79 0.44 - 1.41 18 (5.5%) 10 (4.8%) 0.87 0.35 - 2.16 1 (0.5%) 2 (1.8%) 1.76 0.14 - 21.52 4 (6%) 0 (0%) 9 (2.9%) 6 (2.9%) 1.21 0.40 - 3.70 7 (5.9%) 2 (2.7%) 0.18* 0.03 - 1.11 1 (2%) 2 (7%)
Trend test p-value 0.0479 0.3862 0.2939 0.0153 0.9425 0.1109 0.6948
BMI (kg/m2) 0.1871
<25 502 (47.9%) 333 (50.8%) 170 (52.1%) 113 (54.6%) 41 (22.4%) 34 (32.7%) 18 (26%) 11 (28%) 209 (67.6%) 142 (70.0%) 38 (32.5%) 24 (32.0%) 26 (58%) 9 (33%)
25-<30 321 (30.6%) 194 (29.6%) 1.01 0.79 - 1.29 84 (25.8%) 58 (28.0%) 1.03 0.68 - 1.57 68 (37.2%) 32 (30.8%) 0.69 0.34 - 1.40 27 (39%) 14 (36%) 1.35 0.38 - 4.75 80 (25.9%) 50 (24.6%) 0.98 0.63 - 1.55 46 (39.3%) 31 (41.3%) 1.96 0.84 - 4.58 16 (36%) 9 (33%) 1.24 0.37 - 4.21
30+ 226 (21.5%) 128 (19.5%) 0.93 0.69 - 1.24 72 (22.1%) 36 (17.4%) 0.73 0.45 - 1.19 74 (40.4%) 38 (36.5%) 0.77 0.38 - 1.54 24 (35%) 14 (36%) 0.81 0.26 - 2.56 20 (6.5%) 11 (5.4%) 0.87 0.37 - 2.03 33 (28.2%) 20 (26.7%) 1.21 0.49 - 3.02 3 (7%) 9 (33%) 6.49** 1.17 - 35.89
Trend test p-value 0.673 0.2811 0.5147 0.5802 0.7872 0.6192 0.0363
*** p<0.01, ** p<0.05, * p<0.1
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4.3.3. Multivariate models of reproductive variables and FI risk
The same models with variables including estrogen use, menopausal status, progesterone use,
and parity were used to evaluate their role in FI risk (Table 18). Previous estrogen users were
0.43 times less likely of getting FI compared to women who never took estrogen (95%CI: 0.23-
0.80), but the inverse association only existed among Japanese with no heterogeneity across
racial/ethnic groups (p=0.3379). Previous progesterone users were 2.32 times to get FI compared
to those who never took progesterone (95%CI: 1.35-3.98), while current progesterone use was
not associated with FI. The positive association only existed among Whites where previous
estrogen users were 2.69-fold increase in risk of FI. No positive association between parity and
FI was revealed for all women combined, but Latino women who had 2 children showed a higher
risk of getting FI compared to women who never had kids.
The model considering duration of estrogen use showed similar results, but no significant
association between estrogen use and FI was found.

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Table 18. Multivariate models of estrogen use for FI across ethnic groups

Table 18. Multivariate models of estrogen use for FI across ethnic groups
MODEL 1 total White Black Hawaiian Japanese Latinos Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 1072 667 327 209 196 111 70 40 313 205 118 75
Estrogen Use 0.3379
No 438 (47.9%) 219 (38.5%) 117 (39.3%) 57 (30.2%) 98 (59.0%) 53 (57.6%) 36 (55%) 16 (47%) 129 (45.4%) 68 (36.8%) 58 (58.0%) 25 (36.2%)
Yes, previously 182 (19.9%) 86 (15.1%) 0.43*** 0.23 - 0.80 65 (21.8%) 34 (18.0%) 0.51 0.15 - 1.74 37 (22.3%) 16 (17.4%) 0.51 0.14 - 1.93 7 (11%) 5 (15%) 56 (19.7%) 19 (10.3%) 0.26** 0.07 - 0.93 17 (17.0%) 12 (17.4%) 0.02* 0.00 - 1.61
Yes, currently 294 (32.2%) 264 (46.4%) 1.16 0.63 - 2.16 116 (38.9%) 98 (51.9%) 0.86 0.26 - 2.89 31 (18.7%) 23 (25.0%) 0.99 0.25 - 4.02 23 (35%) 13 (38%) 0.93 0.04 - 19.85 99 (34.9%) 98 (53.0%) 1.55 0.44 - 5.44 25 (25.0%) 32 (46.4%) 0.19 0.01 - 6.38
Trend test p-value 0.1361 0.7877 0.9375 0.1554 0.5942
Menopausal status 0.4131
Pre-Menopausal 72 (8.5%) 32 (6.1%) 30 (10.6%) 14 (7.8%) 8 (5.2%) 3 (3.5%) 10 (18%) 2 (6%) 21 (8.0%) 10 (6.1%) 3 (3%) 3 (5%)
Natural Menopause 495 (58.2%) 278 (52.7%) 0.72 0.20 - 2.57 165 (58.3%) 84 (46.9%) 0.32 0.03 - 2.90 67 (43.2%) 40 (46.5%) / / 27 (47%) 15 (47%) / / 175 (67.0%) 106 (64.2%) 0.89 0.08 - 10.36 61 (64%) 33 (50%) / /
Surgical Menopause 284 (33.4%) 218 (41.3%) 0.95 0.25 - 3.60 88 (31.1%) 81 (45.3%) 0.78 0.08 - 7.84 80 (51.6%) 43 (50.0%) / / 20 (35%) 15 (47%) / / 65 (24.9%) 49 (29.7%) 1.01 0.07 - 13.79 31 (33%) 30 (45%) / /
Trend test p-value 0.3728 0.1456 0.8335
Progesterone Use 0.7685
No 381 (63.3%) 250 (59.7%) 125 (59.2%) 79 (54.1%) 82 (83%) 52 (83%) 25 (60%) 10 (48%) 110 (57.3%) 76 (55.9%) 39 (67%) 33 (62%)
Yes, previously 75 (12.5%) 71 (16.9%) 2.32*** 1.35 - 3.98 33 (15.6%) 31 (21.2%) 2.69** 1.14 - 6.31 5 (5%) 5 (8%) 4.14 0.74 - 23.26 8 (19%) 8 (38%) 0.39 0.03 - 5.52 22 (11.5%) 16 (11.8%) 1.78 0.60 - 5.32 7 (12%) 11 (21%) 3.72 0.26 - 53.69
Yes, currently 146 (24.3%) 98 (23.4%) 0.89 0.49 - 1.62 53 (25.1%) 36 (24.7%) 1.4 0.48 - 4.07 12 (12%) 6 (10%) 0.44 0.06 - 3.27 9 (21%) 3 (14%) 0.58 0.04 - 7.72 60 (31.2%) 44 (32.4%) 0.79 0.25 - 2.52 12 (21%) 9 (17%) 3.13 0.12 - 83.80
Trend test p-value 0.5796 0.1975 0.8823 0.5892 0.8851 0.3288
Parity 0.1588
0 142 (13.4%) 74 (11.3%) 52 (16.1%) 34 (16.4%) 28 (14.4%) 12 (11.1%) 2 (3%) 2 (5%) 44 (14.2%) 19 (9.4%) 14 (12.4%) 5 (6.8%)
1 124 (11.7%) 78 (11.9%) 1.44 0.68 - 3.05 41 (12.7%) 19 (9.2%) 0.26* 0.07 - 1.05 36 (18.6%) 23 (21.3%) 3.31 0.39 - 28.36 6 (9%) 4 (11%) / / 29 (9.4%) 20 (9.9%) 2.56 0.61 - 10.76 5 (4.4%) 10 (13.7%) 2.39 0.02 - 316.91
2 249 (23.6%) 156 (23.8%) 1.11 0.60 - 2.08 83 (25.8%) 48 (23.2%) 0.36* 0.11 - 1.11 36 (18.6%) 19 (17.6%) 1.12 0.14 - 8.82 4 (6%) 3 (8%) / / 96 (31.0%) 65 (32.2%) 1.32 0.46 - 3.74 14 (12.4%) 14 (19.2%) 57.00** 1.34 - 2,418.35
3+ 542 (51.3%) 347 (53.0%) 1.08 0.62 - 1.89 146 (45.3%) 106 (51.2%) 0.49 0.18 - 1.32 94 (48.5%) 54 (50.0%) 1.67 0.26 - 10.73 58 (83%) 29 (76%) / / 141 (45.5%) 98 (48.5%) 1.07 0.42 - 2.78 80 (70.8%) 44 (60.3%) 6.27 0.29 - 134.41
Trend test p-value 0.8763 0.5725 0.9872 0.8068 0.3966
MODEL 2
Total duration of estrogen use 0.077
Never 438 (45.7%) 219 (35.9%) 117 (37.7%) 57 (28.8%) 98 (56.6%) 53 (53.0%) 36 (53%) 16 (44%) 129 (44.8%) 68 (34.7%) 58 (57.4%) 25 (35.7%)
< 4 years 210 (21.9%) 113 (18.5%) 0.56* 0.31 - 1.01 65 (21.0%) 35 (17.7%) 0.7 0.21 - 2.35 32 (18.5%) 17 (17.0%) 0.45 0.11 - 1.79 13 (19%) 9 (25%) 2.18 0.11 - 42.26 65 (22.6%) 31 (15.8%) 0.32* 0.09 - 1.12 22 (21.8%) 17 (24.3%) 0.01* 0.00 - 1.45
>= 4 years 311 (32.4%) 278 (45.6%) 0.97 0.52 - 1.79 128 (41.3%) 106 (53.5%) 0.64 0.19 - 2.14 43 (24.9%) 30 (30.0%) 1.07 0.27 - 4.25 19 (28%) 11 (31%) 0.77 0.01 - 42.96 94 (32.6%) 97 (49.5%) 1.36 0.40 - 4.59 21 (20.8%) 28 (40.0%) 0.23 0.00 - 10.91
Trend Test p-value 0.5128 0.5093 0.8292 0.828 0.126 0.6252
Menopausal status 0.2569
Pre-Menopausal 72 (8.5%) 32 (6.1%) 30 (10.6%) 14 (7.8%) 8 (5.2%) 3 (3.5%) 10 (18%) 2 (6%) 21 (8.0%) 10 (6.1%) 3 (3%) 3 (5%)
Natural Menopause 495 (58.2%) 278 (52.7%) 0.73 0.20 - 2.60 165 (58.3%) 84 (46.9%) 0.29 0.03 - 2.66 67 (43.2%) 40 (46.5%) / / 27 (47%) 15 (47%) / / 175 (67.0%) 106 (64.2%) 0.97 0.08 - 11.81 61 (64%) 33 (50%) / /
Surgical Menopause 284 (33.4%) 218 (41.3%) 1.03 0.27 - 3.90 88 (31.1%) 81 (45.3%) 0.95 0.09 - 9.78 80 (51.6%) 43 (50.0%) / / 20 (35%) 15 (47%) / / 65 (24.9%) 49 (29.7%) 1.38 0.10 - 19.49 31 (33%) 30 (45%) / /
Trend Test p-value 0.2438 0.0364 0.4963
Progesterone Use 0.4117
No 381 (63.3%) 250 (59.7%) 125 (59.2%) 79 (54.1%) 82 (83%) 52 (83%) 25 (60%) 10 (48%) 110 (57.3%) 76 (55.9%) 39 (67%) 33 (62%)
Yes, previously 75 (12.5%) 71 (16.9%) 1.99*** 1.18 - 3.37 33 (15.6%) 31 (21.2%) 2.59** 1.11 - 6.02 5 (5%) 5 (8%) 4.22 0.73 - 24.58 8 (19%) 8 (38%) 0.87 0.08 - 9.56 22 (11.5%) 16 (11.8%) 1.89 0.65 - 5.49 7 (12%) 11 (21%) 2.36 0.11 - 48.65
Yes, currently 146 (24.3%) 98 (23.4%) 1.18 0.67 - 2.07 53 (25.1%) 36 (24.7%) 2.09 0.72 - 6.08 12 (12%) 6 (10%) 0.47 0.07 - 3.27 9 (21%) 3 (14%) 0.82 0.06 - 11.79 60 (31.2%) 44 (32.4%) 1.66 0.61 - 4.57 12 (21%) 9 (17%) 6.5 0.16 - 260.39
Trend Test p-value 0.2863 0.0779 0.8693 0.8756 0.2781 0.2599
Parity 0.1374
0 142 (13.4%) 74 (11.3%) 52 (16.1%) 34 (16.4%) 28 (14.4%) 12 (11.1%) 2 (3%) 2 (5%) 44 (14.2%) 19 (9.4%) 14 (12.4%) 5 (6.8%)
1 124 (11.7%) 78 (11.9%) 1.62 0.78 - 3.36 41 (12.7%) 19 (9.2%) 0.26* 0.07 - 1.04 36 (18.6%) 23 (21.3%) 3.42 0.42 - 28.12 6 (9%) 4 (11%) / / 29 (9.4%) 20 (9.9%) 3.09 0.77 - 12.44 5 (4.4%) 10 (13.7%) 3.95 0.01 - 1,505.42
2 249 (23.6%) 156 (23.8%) 1.19 0.64 - 2.21 83 (25.8%) 48 (23.2%) 0.36* 0.12 - 1.12 36 (18.6%) 19 (17.6%) 0.96 0.12 - 7.84 4 (6%) 3 (8%) / / 96 (31.0%) 65 (32.2%) 1.39 0.47 - 4.14 14 (12.4%) 14 (19.2%) 268.18** 1.39 - 51,568.24
3+ 542 (51.3%) 347 (53.0%) 1.14 0.66 - 1.99 146 (45.3%) 106 (51.2%) 0.53 0.20 - 1.41 94 (48.5%) 54 (50.0%) 1.59 0.24 - 10.35 58 (83%) 29 (76%) / / 141 (45.5%) 98 (48.5%) 1.19 0.45 - 3.14 80 (70.8%) 44 (60.3%) 14.44 0.39 - 539.02
Trend Test p-value 0.9192 0.7307 0.8978 0.8951 0.3159
*** p<0.01, ** p<0.05, * p<0.1; missing data are due to small sample sizes
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4.3.4. Multivariate models of factors related to diet and lifestyle and FI risk.
The same model including all factors related to diet and lifestyle was used to measure the
relationship of these modifiable risk factors and risk of FI (Table 19). Women who ate
vegetables more than 219.78 g/day were 0.70 times to get FI, and the increasing vegetable intake
was related to decrease of FI risk (trend p=0.0291). Even though similar trends were observed
for most racial/ethnic groups, no significant associations were observed for either, an no
significant trends. Among Latino women, high intake of fruits and juices were inversely
associated with FI, with intake of fruit and juice over 100 g/day showing an OR of 0.26 (95%CI:
0.07-0.89), but there was no dose-response and significant trend. Vitamin D intake only showed
an association among Latinos, where it showed a positive association with FI risk. Women who
took vitamin D more than 60 IU/1000 kcal/day were about 3.70 times to get FI compared to
those taking less than 38 IU/1000 kcal/day, and the trend test was statistically significant
(p=0.004).
Smoking was positively associated with risk of FI, but was only statistically significant
among African-American. Among them, women smoking more than 12 packs of cigarette per
year were 2.36 times more likely to get FI compared to those who never smoked (95%CI: 1.05-
5.31), with significant trend test (p = 0.0483). No association was found for other racial/ethnic
groups; however, the test of heterogeneity was not statistically significant (p = 0.4387). Red meat
excluding processed red meat, processed red meat, alcohol, regular coffee, decaffeinated coffee,
black tea, and physical activity were also considered, but no more than 10% change occurred for
the estimates.

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Table 19. Multivariate models of factors related to diet and lifestyle for FI across ethnic groups

total White Black Hawaiian Japanese Latinos Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 1072 667 327 209 196 111 70 40 313 205 118 75
Total Vegetables (g/day) 0.6092
0.15-<119.37 255 (23.8%) 167 (25.0%) 77 (23.5%) 47 (22.5%) 53 (27.0%) 36 (32.4%) 17 (24%) 9 (22%) 70 (22.4%) 46 (22.4%) 27 (22.9%) 20 (26.7%)
119.37-<162.63 267 (24.9%) 184 (27.6%) 1.03 0.77 - 1.38 77 (23.5%) 62 (29.7%) 1.29 0.75 - 2.22 47 (24.0%) 31 (27.9%) 0.93 0.40 - 2.15 20 (29%) 12 (30%) 1.16 0.36 - 3.77 77 (24.6%) 51 (24.9%) 0.93 0.52 - 1.67 34 (28.8%) 19 (25.3%) 0.46 0.15 - 1.36
162.63-<219.78 257 (24.0%) 175 (26.2%) 1.02 0.75 - 1.38 85 (26.0%) 54 (25.8%) 1.03 0.58 - 1.83 48 (24.5%) 26 (23.4%) 0.68 0.31 - 1.51 14 (20%) 8 (20%) 1.29 0.37 - 4.43 67 (21.4%) 60 (29.3%) 1.23 0.66 - 2.27 33 (28.0%) 22 (29.3%) 0.74 0.25 - 2.19
219.78-1131 293 (27.3%) 141 (21.1%) 0.70** 0.51 - 0.96 88 (26.9%) 46 (22.0%) 0.69 0.38 - 1.25 48 (24.5%) 18 (16.2%) 0.62 0.27 - 1.44 19 (27%) 11 (28%) 0.81 0.23 - 2.83 99 (31.6%) 48 (23.4%) 0.75 0.41 - 1.34 24 (20.3%) 14 (18.7%) 0.84 0.26 - 2.76
Trend Test p-value 0.0291 0.1357 0.1929 0.8256 0.3921 0.878
Total Fruits and Juice (g/day) 0.2125
0-<101.18 260 (24.3%) 173 (25.9%) 78 (23.9%) 53 (25.4%) 40 (20.4%) 31 (27.9%) 22 (31%) 14 (35%) 72 (23.0%) 47 (22.9%) 33 (28.0%) 19 (25.3%)
101.18-<175.79 271 (25.3%) 156 (23.4%) 0.84 0.62 - 1.13 81 (24.8%) 52 (24.9%) 0.84 0.47 - 1.50 49 (25.0%) 16 (14.4%) 0.33** 0.13 - 0.83 21 (30%) 9 (22%) 0.46 0.12 - 1.72 72 (23.0%) 53 (25.9%) 1.15 0.65 - 2.02 38 (32.2%) 21 (28.0%) 0.42* 0.16 - 1.13
175.79-<272.92 274 (25.6%) 158 (23.7%) 0.84 0.62 - 1.15 92 (28.1%) 40 (19.1%) 0.66 0.36 - 1.23 49 (25.0%) 28 (25.2%) 0.75 0.33 - 1.74 14 (20%) 7 (18%) 0.35 0.07 - 1.66 80 (25.6%) 61 (29.8%) 1.14 0.65 - 2.00 27 (22.9%) 13 (17.3%) 0.26** 0.07 - 0.89
272.92-1219 267 (24.9%) 180 (27.0%) 1.03 0.76 - 1.40 76 (23.2%) 64 (30.6%) 1.16 0.64 - 2.10 58 (29.6%) 36 (32.4%) 0.96 0.43 - 2.16 13 (19%) 10 (25%) 0.87 0.20 - 3.84 89 (28.4%) 44 (21.5%) 0.73 0.40 - 1.35 20 (16.9%) 22 (29.3%) 1.2 0.38 - 3.77
Trend Test p-value 0.7653 0.6436 0.7051 0.7566 0.3683 0.9038
Density for Vitamin D (IU/1000 kcal/day) 0.1141
0.44-38.02 241 (22.5%) 137 (20.5%) 44 (13.5%) 37 (17.7%) 49 (25.0%) 29 (26.1%) 14 (20%) 6 (15%) 96 (30.7%) 51 (24.9%) 29 (24.6%) 10 (13.3%)
38.02-<60.85 281 (26.2%) 172 (25.8%) 1.04 0.77 - 1.40 70 (21.4%) 51 (24.4%) 0.92 0.48 - 1.73 63 (32.1%) 21 (18.9%) 0.64 0.27 - 1.48 22 (31%) 15 (38%) 2.12 0.49 - 9.22 79 (25.2%) 62 (30.2%) 1.28 0.77 - 2.11 32 (27.1%) 17 (22.7%) 1.15 0.38 - 3.54
60.85-<91.87 285 (26.6%) 167 (25.0%) 0.99 0.73 - 1.34 106 (32.4%) 44 (21.1%) 0.46** 0.24 - 0.85 44 (22.4%) 28 (25.2%) 1.75 0.76 - 4.03 15 (21%) 11 (28%) 2.94 0.58 - 14.85 82 (26.2%) 56 (27.3%) 1 0.59 - 1.70 28 (23.7%) 21 (28.0%) 3.79** 1.20 - 11.97
91.87-515 265 (24.7%) 191 (28.6%) 1.2 0.89 - 1.63 107 (32.7%) 77 (36.8%) 0.84 0.47 - 1.52 40 (20.4%) 33 (29.7%) 1.5 0.66 - 3.41 19 (27%) 8 (20%) 1.97 0.39 - 9.83 56 (17.9%) 36 (17.6%) 1.09 0.62 - 1.94 29 (24.6%) 27 (36.0%) 3.70** 1.19 - 11.53
Trend Test p-value 0.2822 0.3781 0.1157 0.4528 0.9393 0.004
Calories (Kcal/day) 0.6552
427-<1324.27 289 (27.0%) 177 (26.5%) 86 (26.3%) 61 (29.2%) 79 (40.3%) 37 (33.3%) 12 (17%) 5 (12%) 81 (25.9%) 45 (22.0%) 22 (18.6%) 24 (32.0%)
1324.27-<1749.475 259 (24.2%) 164 (24.6%) 0.93 0.69 - 1.26 91 (27.8%) 55 (26.3%) 0.74 0.43 - 1.28 35 (17.9%) 24 (21.6%) 1.02 0.42 - 2.48 12 (17%) 3 (8%) 0.5 0.08 - 3.00 89 (28.4%) 60 (29.3%) 1.23 0.72 - 2.11 23 (19.5%) 16 (21.3%) 0.64 0.19 - 2.12
1749.475-<2345.409 251 (23.4%) 152 (22.8%) 0.9 0.67 - 1.22 86 (26.3%) 50 (23.9%) 0.88 0.52 - 1.49 27 (13.8%) 21 (18.9%) 1.99 0.84 - 4.70 14 (20%) 9 (22%) 1.51 0.22 - 10.24 81 (25.9%) 53 (25.9%) 1.04 0.59 - 1.82 28 (23.7%) 15 (20.0%) 0.43 0.16 - 1.18
2345.409-7742 273 (25.5%) 174 (26.1%) 1.07 0.80 - 1.42 64 (19.6%) 43 (20.6%) 1 0.57 - 1.76 55 (28.1%) 29 (26.1%) 1.49 0.69 - 3.24 32 (46%) 23 (57%) 1.36 0.35 - 5.28 62 (19.8%) 47 (22.9%) 1.37 0.76 - 2.47 45 (38.1%) 20 (26.7%) 0.42* 0.16 - 1.11
Trend Test p-value 0.6992 0.8907 0.2012 0.3778 0.4413 0.0499
BMI (kg/m2) 0.1825
<25 502 (47.9%) 333 (50.8%) 170 (52.1%) 113 (54.6%) 41 (22.4%) 34 (32.7%) 18 (26%) 11 (28%) 209 (67.6%) 142 (70.0%) 38 (32.5%) 24 (32.0%)
25-<30 321 (30.6%) 194 (29.6%) 1 0.78 - 1.27 84 (25.8%) 58 (28.0%) 1.01 0.65 - 1.56 68 (37.2%) 32 (30.8%) 0.56 0.27 - 1.17 27 (39%) 14 (36%) 0.77 0.26 - 2.30 80 (25.9%) 50 (24.6%) 0.94 0.59 - 1.51 46 (39.3%) 31 (41.3%) 2 0.75 - 5.29
30+ 226 (21.5%) 128 (19.5%) 0.91 0.68 - 1.22 72 (22.1%) 36 (17.4%) 0.81 0.49 - 1.32 74 (40.4%) 38 (36.5%) 0.46** 0.22 - 0.96 24 (35%) 14 (36%) 0.77 0.25 - 2.36 20 (6.5%) 11 (5.4%) 0.76 0.32 - 1.85 33 (28.2%) 20 (26.7%) 2.80* 0.85 - 9.18
Trend Test p-value 0.574 0.4507 0.0376 0.653 0.5768 0.0639
Packs of Cigarette per year 0.4387
Never 607 (58.3%) 374 (57.5%) 146 (45.2%) 101 (49.0%) 101 (54.3%) 48 (45.3%) 39 (57%) 22 (56%) 215 (70.3%) 136 (68.0%) 71 (64.5%) 48 (64.9%)
< 12 210 (20.2%) 127 (19.5%) 1.09 0.84 - 1.43 69 (21.4%) 35 (17.0%) 0.88 0.54 - 1.44 52 (28.0%) 28 (26.4%) 1.09 0.52 - 2.27 10 (14%) 4 (10%) 0.64 0.13 - 3.15 43 (14.1%) 39 (19.5%) 1.65* 0.98 - 2.79 27 (24.5%) 16 (21.6%) 1.15 0.49 - 2.67
>= 12 225 (21.6%) 150 (23.0%) 1.23 0.94 - 1.61 108 (33.4%) 70 (34.0%) 1.07 0.70 - 1.64 33 (17.7%) 30 (28.3%) 2.36** 1.05 - 5.31 20 (29%) 13 (33%) 1.58 0.60 - 4.16 48 (15.7%) 25 (12.5%) 0.84 0.46 - 1.55 12 (10.9%) 10 (13.5%) 1.35 0.39 - 4.73
Trend Test p-value 0.1216 0.8172 0.0483 0.3395 0.8683 0.6099
*** p<0.01, ** p<0.05, * p<0.1
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4.3.5. Multivariate models of all variables for FI risk
In the full model, the same variables were used to measure the associations between these
variables and FI (Table 20). Estrogen use was positively associated with risk of FI for African
Americans, Hawaiians, and Latinos, but no associations were statistically significant. Previous
progesterone users were 2.76 times to get FI compared to those who never took progesterone
(95%CI: 1.42-5.37), but no positive association was observed for current progesterone users. The
association between progesterone use and FI only existed among Whites, and no heterogeneity
was found (p=0.8631). No association between parity and risk of FI was found.
Red meat excluding processed red meat seemed to be inversely associated with FI, but
the association only existed among Whites with a significant heterogeneity across racial/ethnic
groups (p=0.0312). No association between processed red meat and FI was found, but processed
red meat was inversely associated with risk FI among African-American with heterogeneity test
significant (p=0.0062). Total fruits and juice was inversely associated with risk of FI with
women eating between 175.79 g/day and 272.92 g/day were 50% decrease to get FI compared to
those eating less than 101.18 g/day (95%CI: 0.27-0.96). However, no inverse association was
observed among any racial/ethnic groups.
Women who smoked equal to or more than 12 packs of cigarette per year were highly
possible to get FI compared to those who never smoked among African-American with
heterogeneity was tested across racial/ethnic groups (p=0.0223). Coffee was inversely associated
with risk of FI in this model. Women who drank 2 or 3 cups of coffee per day were 0.51 times to
get FI compared to those who never drank coffee (95%CI: 0.28-0.96), and drinking 4 or more
cups of coffee per day could reduce the risk of FI significantly. However, the negative
Page | 67

association between coffee and FI only existed in Hawaiians. The inverse dose-response trend
was found for all women combined, and trend test was also significant among Whites and
Hawaiian with the test of heterogeneity significant (p=0.0441). Vigorous activity over 0.36 hours
per day was inversely associated with FI, but the association was only statistically significant for
Japanese with significant heterogeneity across racial/ethnic groups (p=0.0392). Model was not
adjusted for progesterone use among African-American, and progesterone use, menopausal
status, red meat excluding red meat, processed red meat and total fruits and juice were not in the
model for Hawaiians. Some ORs were missing due to small sample sizes or no within-group
variance.

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Table 20. Multivariate models of all variables for FI across ethnic groups

total White Black Hawaiian Japanese Latinos Interaction p
Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI Control Case OR 95%CI
N 1072 667 327 209 196 111 70 40 313 205 118 75
Estrogen Use 0.028
No 438 (47.9%) 219 (38.5%) 117 (39.3%) 57 (30.2%) 98 (59.0%) 53 (57.6%) 36 (55%) 16 (47%) 129 (45.4%) 68 (36.8%) 58 (58.0%) 25 (36.2%)
Yes, previously 182 (19.9%) 86 (15.1%) 0.34*** 0.15 - 0.73 65 (21.8%) 34 (18.0%) 0.16 0.01 - 3.02 37 (22.3%) 16 (17.4%) 1.53 0.23 - 10.00 7 (11%) 5 (15%) 3.06 0.18 - 53.08 56 (19.7%) 19 (10.3%) 0.11** 0.02 - 0.76 17 (17.0%) 12 (17.4%) 1.14 0.06 - 23.35
Yes, currently 294 (32.2%) 264 (46.4%) 0.97 0.46 - 2.05 116 (38.9%) 98 (51.9%) 0.49 0.06 - 4.26 31 (18.7%) 23 (25.0%) 14.51* 0.80 - 264.52 23 (35%) 13 (38%) 1.75 0.19 - 15.79 99 (34.9%) 98 (53.0%) 1.25 0.20 - 7.74 25 (25.0%) 32 (46.4%) 32.88 0.36 - 3,000.36
Trend Test p-value 0.3218 0.9933 0.0595 0.4504 0.4006 0.0647
Menopausal status 0.1688
Pre-Menopausal 72 (8.5%) 32 (6.1%) 30 (10.6%) 14 (7.8%) 8 (5.2%) 3 (3.5%) 10 (18%) 2 (6%) 21 (8.0%) 10 (6.1%) 3 (3%) 3 (5%)
Natural Menopause 495 (58.2%) 278 (52.7%) 1.78 0.34 - 9.42 165 (58.3%) 84 (46.9%) 0.21 0.00 - 11.32 67 (43.2%) 40 (46.5%) 267.58* 0.92 - 77,931.92 27 (47%) 15 (47%) / / 175 (67.0%) 106 (64.2%) 8.52 0.07 - 1,000.12 61 (64%) 33 (50%) / /
Surgical Menopause 284 (33.4%) 218 (41.3%) 2.49 0.44 - 14.07 88 (31.1%) 81 (45.3%) 0.61 0.01 - 28.73 80 (51.6%) 43 (50.0%) 195.78* 0.82 - 46,698.27 20 (35%) 15 (47%) / / 65 (24.9%) 49 (29.7%) 7.23 0.06 - 936.68 31 (33%) 30 (45%) / /
Trend Test p-value 0.1759 0.2915 0.6297 0.904
Progesterone Use 0.8631
No 381 (63.3%) 250 (59.7%) 125 (59.2%) 79 (54.1%) 82 (83%) 52 (83%) 25 (60%) 10 (48%) 110 (57.3%) 76 (55.9%) 39 (67%) 33 (62%)
Yes, previously 75 (12.5%) 71 (16.9%) 2.76*** 1.42 - 5.37 33 (15.6%) 31 (21.2%) 15.93** 1.62 - 156.875 (5%) 5 (8%) / / 8 (19%) 8 (38%) / / 22 (11.5%) 16 (11.8%) 2.87 0.59 - 13.98 7 (12%) 11 (21%) 0.51 0.01 - 52.07
Yes, currently 146 (24.3%) 98 (23.4%) 0.95 0.47 - 1.93 53 (25.1%) 36 (24.7%) 0.99 0.15 - 6.67 12 (12%) 6 (10%) / / 9 (21%) 3 (14%) / / 60 (31.2%) 44 (32.4%) 0.42 0.07 - 2.61 12 (21%) 9 (17%) 0.09 0.00 - 118.62
Trend Test p-value 0.5709 0.4475 0.7465 0.4623
Nulliparity 0.3407
no (have 1 or more kids) 804 (86.3%) 518 (89.3%) 253 (84.1%) 160 (83.3%) 145 (85.3%) 87 (91.6%) 64 (97%) 33 (94%) 248 (85.8%) 171 (91.4%) 94 (88.7%) 67 (94.4%)
yes 128 (13.7%) 62 (10.7%) 0.96 0.50 - 1.85 48 (15.9%) 32 (16.7%) 1.41 0.24 - 8.22 25 (14.7%) 8 (8.4%) 0.35 0.01 - 8.41 2 (3%) 2 (6%) 7.08 0.05 - 1,016.01 41 (14.2%) 16 (8.6%) 0.33 0.07 - 1.46 12 (11.3%) 4 (5.6%) 0.01 0.00 - 166.90
Red meat excluding processed red meat (g/day) 0.0312
0-<12.91 292 (27.2%) 196 (29.4%) 98 (30.0%) 79 (37.8%) 65 (33.2%) 35 (31.5%) 8 (11%) 2 (5%) 88 (28.1%) 51 (24.9%) 22 (18.6%) 22 (29.3%)
12.91-<24.95 266 (24.8%) 141 (21.1%) 0.62 0.34 - 1.14 88 (26.9%) 42 (20.1%) 0.17** 0.03 - 0.99 40 (20.4%) 25 (22.5%) 0.31 0.02 - 4.47 20 (29%) 7 (18%) / / 86 (27.5%) 50 (24.4%) 1.49 0.32 - 7.02 22 (18.6%) 14 (18.7%) 0.01 0.00 - 19.39
24.95-<42.98 272 (25.4%) 165 (24.7%) 0.45** 0.23 - 0.88 83 (25.4%) 48 (23.0%) 0.09** 0.01 - 0.59 44 (22.4%) 29 (26.1%) 0.84 0.11 - 6.69 18 (26%) 9 (22%) / / 81 (25.9%) 59 (28.8%) 0.75 0.12 - 4.92 33 (28.0%) 15 (20.0%) 0.04 0.00 - 14.52
42.98-499 242 (22.6%) 165 (24.7%) 1.15 0.54 - 2.45 58 (17.7%) 40 (19.1%) 1.85 0.15 - 23.25 47 (24.0%) 22 (19.8%) 0.73 0.06 - 9.55 24 (34%) 22 (55%) / / 58 (18.5%) 45 (22.0%) 1.3 0.15 - 11.32 41 (34.7%) 24 (32.0%) 0.73 0.00 - 143.48
Trend Test p-value 0.9857 0.2196 0.9506 0.9171 0.9453
Processed red meat (g/day) 0.0062
0-<3.96 254 (23.7%) 166 (24.9%) 107 (32.7%) 61 (29.2%) 39 (19.9%) 30 (27.0%) 13 (19%) 2 (5%) 69 (22.0%) 44 (21.5%) 18 (15.3%) 24 (32.0%)
3.96-<8.96 296 (27.6%) 171 (25.6%) 1.53 0.87 - 2.68 87 (26.6%) 59 (28.2%) 1.57 0.32 - 7.65 60 (30.6%) 29 (26.1%) 0.03*** 0.00 - 0.33 9 (13%) 7 (18%) / / 94 (30.0%) 48 (23.4%) 1.4 0.37 - 5.27 32 (27.1%) 22 (29.3%) 0.27 0.00 - 780.57
8.96-<17.18 258 (24.1%) 173 (25.9%) 1.91* 0.97 - 3.74 68 (20.8%) 58 (27.8%) 3.56 0.54 - 23.64 49 (25.0%) 20 (18.0%) 0.06** 0.01 - 0.54 15 (21%) 11 (28%) / / 92 (29.4%) 62 (30.2%) 0.5 0.09 - 2.62 23 (19.5%) 16 (21.3%) 3.21 0.03 - 396.70
17.18-222 264 (24.6%) 157 (23.5%) 1.49 0.70 - 3.18 65 (19.9%) 31 (14.8%) 1.93 0.25 - 14.82 48 (24.5%) 32 (28.8%) 0.88 0.08 - 10.06 33 (47%) 20 (50%) / / 58 (18.5%) 51 (24.9%) 0.33 0.04 - 2.74 45 (38.1%) 13 (17.3%) 0.09 0.00 - 25.58
Trend Test p-value 0.1956 0.3095 0.0905 0.2778 0.5917
Total Vegetables (g/day) 0.0738
0.15-<119.37 255 (23.8%) 167 (25.0%) 77 (23.5%) 47 (22.5%) 53 (27.0%) 36 (32.4%) 17 (24%) 9 (22%) 70 (22.4%) 46 (22.4%) 27 (22.9%) 20 (26.7%)
119.37-<162.63 267 (24.9%) 184 (27.6%) 1.25 0.70 - 2.23 77 (23.5%) 62 (29.7%) 0.54 0.09 - 3.13 47 (24.0%) 31 (27.9%) 0.14* 0.01 - 1.38 20 (29%) 12 (30%) 1.52 0.15 - 15.92 77 (24.6%) 51 (24.9%) 1.72 0.40 - 7.40 34 (28.8%) 19 (25.3%) / /
162.63-<219.78 257 (24.0%) 175 (26.2%) 1.34 0.74 - 2.45 85 (26.0%) 54 (25.8%) 0.61 0.10 - 3.90 48 (24.5%) 26 (23.4%) 0.21 0.02 - 1.99 14 (20%) 8 (20%) 4.43 0.41 - 48.14 67 (21.4%) 60 (29.3%) 1.82 0.29 - 11.34 33 (28.0%) 22 (29.3%) / /
219.78-1131 293 (27.3%) 141 (21.1%) 0.9 0.46 - 1.75 88 (26.9%) 46 (22.0%) 0.11* 0.01 - 1.23 48 (24.5%) 18 (16.2%) 0.23 0.02 - 2.38 19 (27%) 11 (28%) 2.14 0.29 - 15.99 99 (31.6%) 48 (23.4%) 1.6 0.30 - 8.54 24 (20.3%) 14 (18.7%) / /
Trend Test p-value 0.8674 0.0507 0.2299 0.3072 0.6278
Total Fruits and Juice (g/day) 0.5101
0-<101.18 260 (24.3%) 173 (25.9%) 78 (23.9%) 53 (25.4%) 40 (20.4%) 31 (27.9%) 22 (31%) 14 (35%) 72 (23.0%) 47 (22.9%) 33 (28.0%) 19 (25.3%)
101.18-<175.79 271 (25.3%) 156 (23.4%) 0.61 0.34 - 1.11 81 (24.8%) 52 (24.9%) 1.1 0.18 - 6.63 49 (25.0%) 16 (14.4%) 0.10* 0.01 - 1.30 21 (30%) 9 (22%) / / 72 (23.0%) 53 (25.9%) 1 0.20 - 4.93 38 (32.2%) 21 (28.0%) / /
175.79-<272.92 274 (25.6%) 158 (23.7%) 0.51** 0.27 - 0.96 92 (28.1%) 40 (19.1%) 0.52 0.06 - 4.44 49 (25.0%) 28 (25.2%) 0.12* 0.01 - 1.41 14 (20%) 7 (18%) / / 80 (25.6%) 61 (29.8%) 0.8 0.15 - 4.33 27 (22.9%) 13 (17.3%) / /
272.92-1219 267 (24.9%) 180 (27.0%) 1.14 0.60 - 2.17 76 (23.2%) 64 (30.6%) 1.26 0.17 - 9.31 58 (29.6%) 36 (32.4%) 0.42 0.07 - 2.74 13 (19%) 10 (25%) / / 89 (28.4%) 44 (21.5%) 0.96 0.13 - 6.88 20 (16.9%) 22 (29.3%) / /
Trend Test p-value 0.8391 0.8134 0.5049 0.9162
Density for Vitamin D (IU/1000 kcal/day) 0.5929
0.44-38.02 241 (22.5%) 137 (20.5%) 44 (13.5%) 37 (17.7%) 49 (25.0%) 29 (26.1%) 14 (20%) 6 (15%) 96 (30.7%) 51 (24.9%) 29 (24.6%) 10 (13.3%)
38.02-<60.85 281 (26.2%) 172 (25.8%) 1.33 0.74 - 2.39 70 (21.4%) 51 (24.4%) 1.38 0.12 - 16.43 63 (32.1%) 21 (18.9%) 0.44 0.04 - 4.58 22 (31%) 15 (38%) 0.62 0.07 - 5.25 79 (25.2%) 62 (30.2%) 1.42 0.36 - 5.61 32 (27.1%) 17 (22.7%) / /
60.85-<91.87 285 (26.6%) 167 (25.0%) 1.08 0.58 - 1.99 106 (32.4%) 44 (21.1%) 0.8 0.06 - 10.40 44 (22.4%) 28 (25.2%) 2.67 0.33 - 22.00 15 (21%) 11 (28%) 0.38 0.02 - 6.89 82 (26.2%) 56 (27.3%) 1.16 0.32 - 4.14 28 (23.7%) 21 (28.0%) / /
91.87-515 265 (24.7%) 191 (28.6%) 1.27 0.71 - 2.28 107 (32.7%) 77 (36.8%) 0.49 0.04 - 5.86 40 (20.4%) 33 (29.7%) 3.98 0.60 - 26.57 19 (27%) 8 (20%) 0.44 0.03 - 6.35 56 (17.9%) 36 (17.6%) 1.24 0.34 - 4.49 29 (24.6%) 27 (36.0%) / /
Trend Test p-value 0.5991 0.305 0.0321 0.5691 0.7934
Calories (Kcal/day) 0.0224
427-<1324.27 289 (27.0%) 177 (26.5%) 86 (26.3%) 61 (29.2%) 79 (40.3%) 37 (33.3%) 12 (17%) 5 (12%) 81 (25.9%) 45 (22.0%) 22 (18.6%) 24 (32.0%)
1324.27-<1749.475 259 (24.2%) 164 (24.6%) 0.97 0.50 - 1.89 91 (27.8%) 55 (26.3%) 2 0.31 - 13.00 35 (17.9%) 24 (21.6%) 0.24 0.02 - 3.23 12 (17%) 3 (8%) 0.04 0.00 - 4.49 89 (28.4%) 60 (29.3%) 1.86 0.34 - 10.09 23 (19.5%) 16 (21.3%) 0.13 0.00 - 387.66
1749.475-<2345.409 251 (23.4%) 152 (22.8%) 1.27 0.66 - 2.46 86 (26.3%) 50 (23.9%) 1.23 0.22 - 6.93 27 (13.8%) 21 (18.9%) 6.55 0.61 - 69.99 14 (20%) 9 (22%) 0.26 0.01 - 7.55 81 (25.9%) 53 (25.9%) 2.64 0.47 - 14.76 28 (23.7%) 15 (20.0%) 0.3 0.00 - 42.63
2345.409-7742 273 (25.5%) 174 (26.1%) 1.34 0.71 - 2.55 64 (19.6%) 43 (20.6%) 7.92* 0.85 - 73.95 55 (28.1%) 29 (26.1%) 0.29 0.03 - 2.83 32 (46%) 23 (57%) 0.38 0.03 - 5.15 62 (19.8%) 47 (22.9%) 5.11 0.59 - 44.46 45 (38.1%) 20 (26.7%) 0.06 0.00 - 4.97
Trend Test p-value 0.2756 0.1141 0.6227 0.9109 0.1074 0.124
BMI (kg/m2) 0.4818
<25 502 (47.9%) 333 (50.8%) 170 (52.1%) 113 (54.6%) 41 (22.4%) 34 (32.7%) 18 (26%) 11 (28%) 209 (67.6%) 142 (70.0%) 38 (32.5%) 24 (32.0%)
25-<30 321 (30.6%) 194 (29.6%) 0.93 0.55 - 1.56 84 (25.8%) 58 (28.0%) 1.32 0.28 - 6.17 68 (37.2%) 32 (30.8%) 1.27 0.23 - 6.90 27 (39%) 14 (36%) 0.57 0.04 - 8.20 80 (25.9%) 50 (24.6%) 0.96 0.29 - 3.12 46 (39.3%) 31 (41.3%) 1.05 0.08 - 13.56
30+ 226 (21.5%) 128 (19.5%) 0.69 0.38 - 1.28 72 (22.1%) 36 (17.4%) 0.07** 0.01 - 0.84 74 (40.4%) 38 (36.5%) 0.97 0.13 - 7.27 24 (35%) 14 (36%) 0.2 0.01 - 2.95 20 (6.5%) 11 (5.4%) 0.22 0.02 - 1.99 33 (28.2%) 20 (26.7%) 0.19 0.01 - 4.41
Trend Test p-value 0.2581 0.0553 0.9956 0.1405 0.2944 0.3129
Packs of Cigarette per year 0.0223
Never 607 (58.3%) 374 (57.5%) 146 (45.2%) 101 (49.0%) 101 (54.3%) 48 (45.3%) 39 (57%) 22 (56%) 215 (70.3%) 136 (68.0%) 71 (64.5%) 48 (64.9%)
< 12 210 (20.2%) 127 (19.5%) 0.83 0.47 - 1.46 69 (21.4%) 35 (17.0%) 0.32 0.06 - 1.62 52 (28.0%) 28 (26.4%) 1.34 0.21 - 8.66 10 (14%) 4 (10%) 2.28 0.12 - 44.79 43 (14.1%) 39 (19.5%) 1.59 0.36 - 7.03 27 (24.5%) 16 (21.6%) 0.38 0.00 - 91.80
>= 12 225 (21.6%) 150 (23.0%) 1.34 0.77 - 2.33 108 (33.4%) 70 (34.0%) 3.88 0.62 - 24.27 33 (17.7%) 30 (28.3%) 16.50** 1.29 - 210.77 20 (29%) 13 (33%) 3.38 0.43 - 26.87 48 (15.7%) 25 (12.5%) 0.37 0.09 - 1.60 12 (10.9%) 10 (13.5%) 23.23 0.03 - 16,543.87
Trend Test p-value 0.3703 0.3025 0.0081 0.2325 0.281 0.4212
alcohol (g/day) 0.0783
none 660 (61.6%) 407 (61.0%) 116 (35.5%) 87 (41.6%) 136 (69.4%) 67 (60.4%) 49 (70%) 27 (68%) 250 (79.9%) 164 (80.0%) 71 (60.2%) 42 (56.0%)
<=14 316 (29.5%) 191 (28.6%) 1.63* 0.98 - 2.71 144 (44.0%) 78 (37.3%) 1.01 0.22 - 4.72 50 (25.5%) 34 (30.6%) 3.09 0.62 - 15.25 17 (24%) 11 (28%) 2.4 0.32 - 18.26 56 (17.9%) 36 (17.6%) 3.59* 0.99 - 13.07 41 (34.7%) 25 (33.3%) / /
>14 96 (9.0%) 69 (10.3%) 0.89 0.40 - 1.99 67 (20.5%) 44 (21.1%) 0.31 0.04 - 2.38 10 (5.1%) 10 (9.0%) 0.94 0.04 - 23.87 4 (6%) 2 (5%) 1.67 0.06 - 48.20 7 (2.2%) 5 (2.4%) 6 (5.1%) 8 (10.7%) / /
Trend Test p-value 0.5083 0.2751 0.3337 0.5572 0.5959
Coffee: (Cups/day) 0.0441
none 342 (31.9%) 248 (37.2%) 92 (28.1%) 68 (32.5%) 88 (44.9%) 56 (50.5%) 25 (36%) 22 (55%) 99 (31.6%) 69 (33.7%) 22 (18.6%) 23 (30.7%)
>=1 493 (46.0%) 284 (42.6%) 0.92 0.56 - 1.53 142 (43.4%) 88 (42.1%) 1.59 0.36 - 7.04 83 (42.3%) 40 (36.0%) 0.98 0.24 - 3.95 31 (44%) 14 (35%) 0.28 0.03 - 2.50 150 (47.9%) 97 (47.3%) 0.72 0.22 - 2.42 68 (57.6%) 34 (45.3%) / /
>1/<=4 197 (18.4%) 113 (16.9%) 0.51** 0.28 - 0.96 75 (22.9%) 43 (20.6%) 0.20* 0.03 - 1.24 24 (12.2%) 13 (11.7%) 0.15 0.01 - 1.84 10 (14%) 4 (10%) 0.03**0.00 - 0.85 55 (17.6%) 33 (16.1%) 0.33 0.06 - 1.88 21 (17.8%) 16 (21.3%) / /
>4 40 (3.7%) 22 (3.3%) 0.09*** 0.02 - 0.51 18 (5.5%) 10 (4.8%) 1 (0.5%) 2 (1.8%) 0.03 0.00 - 34.45 4 (6%) 0 (0%) 9 (2.9%) 6 (2.9%) 0.79 0.06 - 11.18 7 (5.9%) 2 (2.7%) / /
Trend Test p-value 0.0019 0.0101 0.2379 0.0021 0.3168
Vigorous activity (vigorous work and sports) hours per day 0.0392
none 587 (58.7%) 370 (58.6%) 155 (49.8%) 102 (50.7%) 124 (71.3%) 70 (68.0%) 25 (37%) 14 (38%) 191 (64.3%) 119 (61.3%) 63 (60.0%) 49 (70.0%)
<= 0.11 161 (16.1%) 115 (18.2%) 0.62 0.34 - 1.11 58 (18.6%) 40 (19.9%) 0.17* 0.02 - 1.14 26 (14.9%) 19 (18.4%) 3.26 0.33 - 32.15 9 (13%) 11 (30%) 0.82 0.07 - 9.13 48 (16.2%) 32 (16.5%) 0.34 0.08 - 1.52 15 (14.3%) 10 (14.3%) / /
> 0.11 - <=0.36 109 (10.9%) 77 (12.2%) 0.62 0.30 - 1.32 40 (12.9%) 36 (17.9%) 3.77 0.42 - 33.96 14 (8.0%) 7 (6.8%) 7.34 0.27 - 197.15 13 (19%) 4 (11%) 1.01 0.06 - 17.25 27 (9.1%) 22 (11.3%) 1.6 0.17 - 14.99 13 (12.4%) 3 (4.3%) / /
>0.36 143 (14.3%) 69 (10.9%) 0.41** 0.21 - 0.83 58 (18.6%) 23 (11.4%) 0.18 0.01 - 2.36 10 (5.7%) 7 (6.8%) 1.32 0.08 - 23.04 21 (31%) 8 (22%) 0.5 0.08 - 3.04 31 (10.4%) 21 (10.8%) 0.15** 0.02 - 1.00 14 (13.3%) 8 (11.4%) / /
Trend Test p-value 0.0093 0.5819 0.4475 0.422 0.0783
*** p<0.01, ** p<0.05, * p<0.1; missing data are due to small sample sizes
Page | 69

4.3.6. Summary of findings for FI
Table 21 also summarized the relationship between reproductive, lifestyle, dietary factors and
risk of FI.

Page | 70

Table 21. Summary for the association between reproductive, lifestyle, dietary factors and risk of FI

Total White Black Hawaiian Japanese Latinos
Reproductive factors
Estrogen Use
Progesterone use
Menopausal status Positive and sig
Nulliparity Positive but not-sig
no association
Lifestyle Negtive but not-sig
Smoking Negtive and sig
Alcohol
Coffee
Vitamin D
BMI
Physical activity
Diet
Red meat excluding processed red meat
Processed red meat
Total vegetables
Total fruits and juice
Page | 71

5. Discussion
In conclusion, estrogen use was significantly positively associated with risk of UI and POP, not
FI. The positive association between estrogen use and risk of UI were statistically significantly
for Whites, Hawaiians, and Japanese American, and the positive association between estrogen
use and risk of POP significantly existed among African-American, Hawaiians, Japanese
American and us-born Latinos. Progesterone use was also positively associated with PFD,
especially UI. Progesterone use was statistically significantly associated with risk of UI among
Whites, African-American, and Japanese American. Parity was a significant risk factors for UI
and POP. The protective effect of nulliparity on POP was identified for all racial/ethnic groups
(No large sample size to examine the effect on Hawaiians).
Obesity was a risk factor for PFDs, especially for UI and POP. The positive association
between BMI and risk of UI was significant among White, Japanese, and foreign-born Latinos,
and the positive association between BMI and risk of POP statistically significantly existed
among White and African-American. Therefore, obesity could be a significant risk factor for UI
and POP among Whites.
Smoking was inversely associated with risk of POP among Hawaiians and Latinos, but
the association only significantly existed among us-born Latinos. Also, negative association
between alcohol and risk of POP was found among most of the racial/ethnic groups including
Whites, African-American, Japanese American and foreign-born Latinos, but none of the
associations were statistically significant. Coffee was identified to be inversely associated with
all PFDs, especially Hawaiians and Japanese.
Page | 72

Vitamin D was positively associated with UI and POP, but none of the positive
associations were statistically significant for all women combined. The positive association
between vitamin D and risk of UI only statistically significantly existed among foreign-born
Latinos, and the positive association between vitamin D and risk of POP was only statistically
significantly present among us-born Latinos.

5.1. Role of reproductive variables in PFD risk
A recent study reported that the prevalence of UI, FI and POP at a mean of 43 months after first
delivery was 40.8%, 6.6% and 10.2% following vaginal delivery compared to 22.7%, 4.5% and
4.5% following cesarean section [21]. The Epidemiology of Incontinence Cohort Study with
15,307 women found that women who had vaginal deliveries were 2.3 times to get any urinary
incontinence compared to nulliparous women, and women with cesarean sections had 1.5-fold
increase to experience any incontinence after adjusted for age, BMI, parity and year since last
delivery. Besides, women with vaginal deliveries had the highest risk of moderate or severe
incontinence compared to women with cesarean sections and nulliparous women [23]. Third-
and fourth-degree tears after vaginal delivery were a major risk factor for symptoms of UI and
anal incontinence [24]. A case-control study in Italy found that for women with one or two
vaginal birth, the risks of stress and mixed UI were 5.4-fold and 1.6-fold compared to women
with nulliparity, and for women with three or more vaginal birth, the risks of stress and mixed UI
were 5.1-fold and 2.2-fold separately [25].
In addition to UI, childbirth was also reported as a risk factor for POP and FI. A 12-year
longitudinal study in Aberdeen, Birmingham and Dunedin collecting data from 7,725 women
after an index birth, found that parity was significantly associated with prolapse if women had
Page | 73

their first baby after 30 years old [36]. In contrast, women who had all births by caesarean
section had less risk of prolapse compared to women who had all births through spontaneous
vaginal deliveries [36]. The SWEdish Pregnancy, Obesity and Pelvic floor (SWEPOP) study
collecting data from 5,199 women 20 years after one single pregnancy terminating in a vaginal
or surgical delivery, also reported that the prevalence of symptomatic POP was higher among
women who had vaginal births compared to those who had caesarean section [37]. In our
analyses, we did not have delivery method data so we could not consider this. However, we did
find that parity was positively associated with risk of POP, whereas no association was observed
between parity and FI. In our analyses, the positive association between parity and risk of POP
was statistically significantly present among all racial/ethnic groups excluding Hawaiians (small
sample size).
The relationship between menopausal status and risk of PFD is poorly understood.
Surgical menopause was reported to be positively associated with UI for women over 65 years
old in our univariate analyses, especially for Japanese and foreign-born Latinos, but none of the
associations were statistically significant. Similarly, surgical menopause like hysterectomy was
also positively associated with the development of urinary incontinence in young and middle-age
women, especially stress UI [19], and a case-control study in Italy with 1062 women aged 40
years or more found that a history of hysterectomy could increase the risk of all type of urinary
incontinence [25]. The association between hysterectomy and UI may be driven by the muscle
damage of pelvic floor during the surgeries [25]. Alternatively, the use of hormone therapy (HT)
may explain part of this association. In our study, we no longer found an association between
menopausal status and risk of UI, POP, and FI when considering estrogen and progesterone use.
Instead, we found that both hormones associated with the risk of UI, only estrogen use
Page | 74

statistically significantly associated with the risk of POP, and only progesterone use statistically
significantly associated with risk of FI. The positive association between estrogen use and risk of
UI/POP was statistically significantly among Japanese and Hawaiians, and the positive
association between progesterone use and UI/FI only statistically significantly existed among
Whites. In the Heart and Estrogen/Progestin Replacement Study, a randomized clinical trial
including 2763 postmenopausal women less than 80 years old found that estrogen replacement
worsened the symptoms of UI compared to the placebo group [28]. In consistency with this
study, in The Nurses’ Health Study, which included 39,436 post-menopausal women aged 50-75,
they reported that women taking hormone had higher risk of developing UI compared to those
who had never taken hormones, with a relative risk of 1.54 for oral estrogen users [29]. Another
clinical trial of 27,347 postmenopausal women aged 50 to 79 years found that estrogen use alone
increased the risk significantly, while the combination of estrogen and progesterone did not have
significant effect for urgent UI [30].

5.2. Role of obesity and PFD risk
Obesity has been reported to have a strong effect on PFDs, and it is of utmost importance to
evaluate the association between pathologies and the influence obesity has on the risk of PFDs
since the high prevalence of both problems in the world [54]. In this study, we observed that
obesity was a risk factor for UI, and the association was statistically significantly present among
Whites, Japanese American, and foreign-born Latinos. Consistent with this, several cross-
sectional studies found that overweight and obese women were more likely to get UI [18, 26,
27]. A study which collected data from the 1997 national health survey in Belgium showed that
overweight and obese women were 1.53 times and 2.23 times to get UI compared to women with
Page | 75

BMI between 20 kg/m
2
and 25 kg/m
2
after adjusted for age [31]. Another cross-sectional study
of men and women aged 40 years or more from the US, UK, and Sweden found that BMI equal
to or more than 30 kg/m
2
was positively associated with stress UI in women and stress UI with
other incontinence, while being overweight was more likely to have UI in general and stress UI
with and without other incontinence [55]. Consistent with these studies, a systematic review
found that the bariatric surgery was associated with a significant improvement in UI and POP
among obese women [56].
In relation to POP, we observed that only BMI between 25 kg/m
2
and 30 kg/m
2
was
statistically significantly associated with risk of POP, especially Whites and African-American.
This is consistent with the findings of the 12-year longitudinal study in Aberdeen, Birmingham,
and Dunedin that reported that a BMI over 25 kg/m
2
was statistically significantly associated
with risk of POP [36]. The SWEPOP study found that women with BMI between 25 kg/m
2
and
30 kg/m
2
were 1.33 times to get symptomatic POP, and women with BMI equal to or over 30
kg/m
2
had 1.74-fold increase in risk of symptomatic POP compared to those with BMI less than
25 kg/m
2
[37]. A second analysis of the Women’s Health Initiative (WHI) Estrogen plus
Progestin Clinical Trial of 12,667 women found that being overweight and obesity were
positively associated with risk of POP in Whites and Hispanics, but not African-American [34].
No association between BMI and FI was observed in our analyses. In contrast, a cross-
sectional study of prevalent FI in 64,559 women aged 62-87 years found that BMI over 25 kg/m
2

was statistically significantly associated with risk of FI after adjustment for other risk factors
[40].

5.3. Role of smoking, alcohol intake, and coffee/tea intake and risk of PFD
Page | 76

We did not find evidence for a statistically significant association between smoking and risk of
UI and FI, after considering other risk factors that could confound the effect of smoking, such as
alcohol, coffee, vigorous activity and BMI. We did observe some evidence that smoking was
inversely associated with risk of POP. In previous studies smoking has been reported to be
positively associated with the risk of UI. The Norwegian Epidemiology of Incontinence Study
including 27,936 women found that women smoking 20 cigarettes per day was positively
associated with all type of UI After adjustment for age, BMI, coughing, wheezing/dyspnea and
coffee [27]. Also, The National Health and Nutrition Examination Survey (NHANES 2001-
2002) including 2,577 women aged over 20 years in US found that smoking was positively
associated with all UI after adjustment for age, ethnicity, BMI, diabetes, asthma, arthritis,
congestive heart failure, stroke, thyroid problem, parity, hysterectomy, and hormones [57]. A
randomized surgical trial including 650 women with mean age of 51.9 years found that current
smokers had a statistically significant higher number of incontinence episodes compared to non-
smokers [58].
We found an inverse association between coffee and risk of UI in the univariate analyses
and multivariate analyses. Our findings is in agreement with a study within the Swedish Twin
Registry that also reported that high coffee intake was negatively association with UI after
adjusted for parity, BMI, smoking and educational level [59]. However, our findings are in
contrast with those of a prospective cohort study including 65,176 women aged between 37 to 79
years, which reported that caffeine was statistically significantly associated with incontinence,
especially urgent incontinence, present among women who drank over 450 mg/d of coffee
compared to those who drank less than 150 mg/d. The risk increased with higher level of coffee
intake [60]. Another study collecting data from 2005-2006 and 2007-2008 NHANES including
Page | 77

4,309 women aged 20 or more also reported that caffeine intake ≥204 mg/day was associated
with any UI but not with moderate/severe UI after adjustment for most possible confounders
[61]. Coffee works as diuretic, reported to exert an effect on voiding through multiple pathways.
Coffee may promote urinary incontinence by bladder-irritant effects, especially among those
with underlying detrusor overactivity, and an animal study demonstrated that caffeine
consumption could significantly increase contraction pressure and time [62]. The inverse
associations between coffee and risk of POP or FI were also identified, but only the association
between coffee and risk of FI was statistically significant among Hawaiians.

5.4. Role of dietary factors and risk of PFD
We found a positive association between vitamin D and risk of UI in the univariate analyses.
However, this positive association disappeared in the multivariate models in our analyses
suggesting that this association was confounded by estrogen. In contrast with our findings, a
prospective case control study on 120 postmenopausal women showed that vitamin D levels
were significantly lower for women with PFDs compared to those without PFDs [63]. The
University of Alabama at Birmingham Study of Aging with 350 participants aged 73.6 years in
average found that vitamin D insufficiency or deficiency at baseline was positively associated
with cumulative incidence of UI at 42 months [64]. Another study in 200 geriatric females aged
more than 65 years also supports that vitamin D was negatively associated with risk of UI with
mean modified vaginal health index significantly increased after taking vitamin D
supplementation for 3 and 6 months, while no association between vitamin D and FI was found
[65]. Vitamin D is reported to be involved in the regulation of growth and differentiation of
Page | 78

several cells, which are present in vagina [66]. Therefore, vitamin D deficiency could affect
muscle physiology, leading to the dysfunction of pelvic floor [65].

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Abstract (if available)

Abstract Background: Urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) are the three most prevalent pelvic floor disorders (PFD) in the world. In 2010, more than 28 million women in the US were diagnosed with at least one PFD, and the number is expected to increase to 43.8 million in 2050. [REF]The aims of this thesis are to investigate reproductive, lifestyle, and dietary risk factors for the three most common PFDs, UI, POP, and FI, across different racial/ethnic groups including White, Latino, African-American, Native Hawaiians, and Japanese Americans enrolled in the Multiethnic Cohort (MEC). ❧ Method: Data are available from Medicare and Medicaid Services claims (1999-2014) linked to individuals by Social Security number, sex and birthdate. We used these claims to identify women with a PFD, who defined cases for this analysis. All analyses were conducted for three main subtypes of PFD: UI, POP, and FI. For each subtype of PFD, descriptive analyses were performed and we presented frequency distributions of variables of interest and corresponding percentages. These subtype specific results were also presented for each racial/ethnic category. Univariate analyses were conducted by conditional logistic regression for each subtype and each race group adjusting for birth year, and number of months of Medicare coverage (+/- 12 months). Univariate analyses for each subtype were also adjusted for ethnicity. Multivariate conditional logistic regression models including smoking, reproductive factors, diet and other lifestyle factors were also conducted. ❧ Results: This analysis included 30,121 women, with 11,493 PFD patients and 18,628 controls, of these: 9,939 (86.48%) cases were diagnosed with UI, 2928 (25.48%) women had POP symptoms, and 667 (5.80%) women experienced FI. 16,034 controls were selected for patients with UI, 4,756 controls without any PFD were matched for cases with POP, and 1,072 controls were selected to compare with cases with FI. In the univariate analyses, number of children, progesterone use, estrogen use, total duration of estrogen use, surgical menopause, history of asthma or allergy, BMI and vitamin D intake were positively associated with risk of UI, but age at birth of first child, nulliparity, current smoking, coffee and regular coffee had an inverse association with risk of UI. Number of children, parity, progesterone use, estrogen use, duration of estrogen use, history of asthma or allergy, BMI, vitamin D intake and total fruits and juice was positively associated with risk of POP, but nulliparity, current smoking, total number of years smoked, average number of cigarettes per day, packs of cigarette per year, alcohol, coffee, regular coffee and calories were negatively associated with risk of POP. There were positive associations between progesterone use, estrogen use, history of asthma or allergy and risk of FI, and coffee, total vegetables with risk of FI. In the comprehensive models, estrogen use, previous progesterone use and BMI were still significantly positively associated with risk of UI, and nulliparity and coffee consumption were inversely associated with UI. Estrogen use and BMI were still positively associated with risk of POP, and nulliparity and packs of cigarette per year were inversely associated with risk of POP. Progesterone use was positively associated with risk of FI, and estrogen use, red meat (excluding processed red meat), total fruits and juice, coffee, and vigorous activity were inversely associated with risk of FI. ❧ Conclusion: Estrogen use, parity and BMI were positively associated with UI/POP both in the univariate analyses and multivariate models. Trend tests were statistically significant between these variables and risk of UI/POP in the univariate analyses. The positive association between estrogen use and risk of UI/POP was statistically significant among Hawaiians, and Japanese American. The protective effect of nulliparity on POP was identified for all racial/ethnic groups. Obesity was found to be a significant risk factor for UI and POP among Whites. Smoking was inversely associated with risk of POP among Hawaiians and Latinos, but the association only significantly existed among us-born Latinos. Also, negative association between alcohol and risk of POP was found among most of the racial/ethnic groups including Whites, African-American, Japanese American and foreign-born Latinos, but none of the associations were statistically significant. Coffee was identified to be inversely associated with all PFDs, especially among Hawaiians and Japanese. Vitamin D was positively associated with UI and POP, but none of the positive associations were statistically significant for all women combined. The positive association between vitamin D and risk of UI/POP was only significant among Latinos.

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Asset Metadata

Creator Chu, Xiaofang (author)

Core Title Risk factors of pelvic floor disorders in the multiethnic cohort study

School Keck School of Medicine

Degree Master of Science

Degree Program Molecular Epidemiology

Publication Date 08/03/2018

Defense Date 08/02/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag multiethnic,OAI-PMH Harvest,pelvic floor disorders,risk factors

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Advisor Stern, Mariana C. (committee chair), Rodriguez, Larissa V. (committee member), Wu, Anna H. (committee member)

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