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Health-Related Quality of Life in a Multiethnic Sample of Middle-Aged Women: Study of Women’s Health Across the Nation (SWAN)

Avis, Nancy E. PhD*; Ory, Marcia PhD; Matthews, Karen A. PhD; Schocken, Miriam PhD§; Bromberger, Joyce PhD; Colvin, Alicia MPHpar;

doi: 10.1097/01.MLR.0000093479.39115.AF
Original Articles

Background.  Relatively little is known about the association between menopause and health-related quality of life (HRQL) across ethnic groups.

Objectives.  To examine the association between HRQL and early perimenopause and ethnicity, adjusting for health, lifestyle, psychosocial, and sociodemographic factors.

Research Design.  Questionnaires were administered to pre- and early perimenopausal women.

Subjects.  We studied a cohort of 3302 black, Chinese, Hispanic, Japanese, and white women aged 42 to 52 years from the multisite Study of Women’s Health Across the Nation (SWAN).

Measures.  We measured HRQL, menstrual regularity, and a variety of covariates. HRQL was assessed with 5 subscales from the Short Form-36; impaired functioning was defined as being in the 25% most impaired on a subscale.

Results.  In unadjusted, but not adjusted, analyses, significantly more early perimenopausal women, as compared with premenopausal women, were classified as having impaired functioning on each of the 5 subscales. For 4 of the subscales, the effect of menopausal status was explained by menopause-related symptoms. There were significant ethnic group differences across all 5 subscales in unadjusted analyses. Ethnicity was no longer significant for the Vitality or Role–Emotional subscales when adjusted for health variables or for the Role–Physical subscale when analyses were adjusted for socioeconomic status, health, lifestyle, or social circumstances. Ethnicity remained significant for the Bodily Pain and Social Functioning subscales, even in adjusted analyses.

Conclusions.  Early perimenopause is not associated with impaired functioning when adjusted for symptoms. Significant ethnic differences in HRQL exist. Some, but not all, differences can be explained by differences in health, lifestyle, and social circumstances.

From *Wake Forest University School of Medicine, Department of Public Health Sciences, Winston-Salem, North Carolina.

From †Texas A&M University System, School of Rural Public Health, College Station, Texas.

From the ‡University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, Pennsylvania.

From the §University of California at Los Angeles School of Medicine, Division of Geriatrics, Los Angeles, California.

From the par;University of Pittsburgh Medical Center, Graduate School of Public Health, Pittsburgh, Pennsylvania.

The Study of Women’s health Across the Nation (SWAN) was funded by the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health of the National Institutes of Health. Supplemental funding from National Institute of Mental Health, the National Institute on Child Health and Human Development, the National Center on Complementary and Alternative Medicine, and the Office of AIDS Research is also gratefully acknowledged.

Address correspondence and reprint requests to: Nancy E. Avis, PhD, Wake Forest University School of Medicine, Department of Public Health Sciences, Section on Social Sciences and Health Policy, Piedmont Plaza II, 2nd floor, Winston-Salem, NC 27157-1063. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.