Endometriosis and Mortality Risk in US Women: Findings From NHANES 1999–2006

Liu L, Shao C, Li L, Wu N
2025 · W7037693688
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Analysis of NHANES data indicates that women diagnosed with endometriosis at age 30 or younger face a significantly elevated risk of all-cause and cardiovascular mortality compared to those diagnosed later.

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This retrospective cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2006 to evaluate the association between endometriosis and all-cause, cancer, and cardiovascular disease mortality in US women. The researchers utilized weighted Cox proportional hazards regression to estimate hazard ratios for a cohort of 5,552 women aged 20 to 54 years over a median follow-up period of approximately 16.75 years. While no significant association was found between endometriosis and mortality in the overall population, stratified analysis revealed that women diagnosed with endometriosis at age 30 or younger had a significantly increased risk of both all-cause and cardiovascular disease mortality. This paper is centrally about endometriosis — specifically examining its long-term mortality risks based on age at diagnosis within a large national health survey dataset.

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Abstract

Lijie Liu,1,* Chuan Shao,2,* Lujia Li,1 Nan Wu2 1Department of Health Care, People’s Liberation Army Navy 971 Hospital, Qingdao, 266071, People’s Republic of China; 2Department of Neurosurgery, Chongqing General Hospital, Chongqing University, Chongqing, 401147, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lujia Li, Department of Health Care, People’s Liberation Army Navy 971 Hospital, Shandong Road, Qingdao, 266071, People’s Republic of China, Email [email protected] Nan Wu, Department of Neurosurgery, Chongqing General Hospital, Chongqing University, 118 Xingguang Boulevard, Liang Jiang New Area, Chongqing, 401147, People’s Republic of China, Tel/Fax +86-23-63390700, Email [email protected]: Less is known about the link between mortality and endometriosis, an often chronic, inflammatory gynecologic condition. We assessed the association between endometriosis and all-cause and cause-specific mortality using a retrospective cohort study design based on data from the National Health and Nutrition Examination Survey (NHANES) 1999– 2006.Materials and Methods: Both crude and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for endometriosis and age at endometriosis with all-cause mortality were estimated using weighted Cox proportional hazards regression. Moreover, we also performed an exploratory analysis assessing the relationship between endometriosis and mortality from cancer and cardiovascular disease (CVD).Results: Between 1999 and 2006, a cohort of 5552 women aged 20 to 54 years was studied, representing a weighted population of approximately 66.07 million. Over a median follow-up duration of 16.75 years, 290 participants died from various causes, which extrapolates to an estimated 3,411,632 female deaths in the broader population. A non-significant association was identified between endometriosis and all-cause mortality (HR 1.51, 95% CI: 0.97– 2.34, P = 0.066), cancer (HR 1.45, 95% CI: 0.76– 2.78, P = 0.260), or CVD (HR 1.75, 95% CI: 0.65– 4.73, P = 0.271) mortality. When accounting for the age at endometriosis was diagnosed, the association was significant only among women diagnosed at age ≤ 30 years (HR = 1.87, 95% CI: 1.15– 3.03, P = 0.011 for all-cause mortality; HR = 4.37, 95% CI: 1.54– 12.36, P = 0.005 for CVD mortality) and was not significant for those diagnosed after age 30 years.Conclusion: In conclusion, women diagnosed with endometriosis at a younger age may be associated with an increased risk of mortality.Keywords: endometriosis, mortality, cohort, NHANES, risk
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International Journal of Women's Health (Jul 2025) Endometriosis and Mortality Risk in US Women: Findings From NHANES 1999–2006 Abstract Lijie Liu,1,* Chuan Shao,2,* Lujia Li,1 Nan Wu2 1Department of Health Care, People’s Liberation Army Navy 971 Hospital, Qingdao, 266071, People’s Republic of China; 2Department of Neurosurgery, Chongqing General Hospital, Chongqing University, Chongqing, 401147, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lujia Li, Department of Health Care, People’s Liberation Army Navy 971 Hospital, Shandong Road, Qingdao, 266071, People’s Republic of China, Email [email protected] Nan Wu, Department of Neurosurgery, Chongqing General Hospital, Chongqing University, 118 Xingguang Boulevard, Liang Jiang New Area, Chongqing, 401147, People’s Republic of China, Tel/Fax +86-23-63390700, Email [email protected]: Less is known about the link between mortality and endometriosis, an often chronic, inflammatory gynecologic condition. We assessed the association between endometriosis and all-cause and cause-specific mortality using a retrospective cohort study design based on data from the National Health and Nutrition Examination Survey (NHANES) 1999– 2006.Materials and Methods: Both crude and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for endometriosis and age at endometriosis with all-cause mortality were estimated using weighted Cox proportional hazards regression. Moreover, we also performed an exploratory analysis assessing the relationship between endometriosis and mortality from cancer and cardiovascular disease (CVD).Results: Between 1999 and 2006, a cohort of 5552 women aged 20 to 54 years was studied, representing a weighted population of approximately 66.07 million. Over a median follow-up duration of 16.75 years, 290 participants died from various causes, which extrapolates to an estimated 3,411,632 female deaths in the broader population. A non-significant association was identified between endometriosis and all-cause mortality (HR 1.51, 95% CI: 0.97– 2.34, P = 0.066), cancer (HR 1.45, 95% CI: 0.76– 2.78, P = 0.260), or CVD (HR 1.75, 95% CI: 0.65– 4.73, P = 0.271) mortality. When accounting for the age at endometriosis was diagnosed, the association was significant only among women diagnosed at age ≤ 30 years (HR = 1.87, 95% CI: 1.15– 3.03, P = 0.011 for all-cause mortality; HR = 4.37, 95% CI: 1.54– 12.36, P = 0.005 for CVD mortality) and was not significant for those diagnosed after age 30 years.Conclusion: In conclusion, women diagnosed with endometriosis at a younger age may be associated with an increased risk of mortality.Keywords: endometriosis, mortality, cohort, NHANES, risk

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