Women with PCOS May Face Increased Mortality Risk, Study Finds

Terhi Piltonen, MD, PhD
Credit: Oulu University Hospital

A study led by investigators from Finland is calling attention to an apparent increased risk of premature mortality among women with polycystic ovary syndrome (PCOS).

Presented at the Endocrine Society 2023 annual meeting, results of the study, which included data from more than 80,000 women, suggest women with PCOS had a 47% greater risk of mortality, with further analysis breaking down risk by specific causes and purporting a more than 3-fold increase in risk of death from both diabetes and bronchitis.¹

“The results highlight the need for improving the care of diabetes, lung infections and cardiovascular diseases to prevent the excess mortality of women with PCOS,” said study investigator Terhi Piltonen, MD, PhD, associate professor in the Department of Obstetrics and Gynecology at the University of Oulu and a consultant in Obstetrics and Gynecology at the Oulu University Hospital.²

One of the most common conditions impacting women, with the US CDC estimating a prevalence of 6-12% among women of reproductive age in the US, PCOS represents a leading causing of female infertility but also a significant threat to overall health if left unmanaged.³ Recognizing the burden of multimorbidity in this patient population, Piltonen and a team of colleagues from University of Oulu and Oulu University Hospital launched the current study with identifying the effect of PCOS on mortality risk.¹

To do so, investigators designed the study as a retrospective, register-based, matched case-control analysis of women with PCOS and women without PCOS using data from the Finnish Care Register for Health Care. Using ICD-8, -9, and -10 codes, investigators identified women with PCOS and these women were matched in a 1:3 ratio to women without PCOS according to year of birth and residential area.¹

The primary outcome of interest for the analysis was risk of all-cause mortality among women with PCOS compared to those in the control cohort. Secondary outcomes of interest included cause-specific mortality, including mortality from tumors, metabolic disease, disease of the circulatory system, diabetes, and bronchitis. Investigators noted the time and cause of death were extracted from the register of Statistics Finland.¹

From 1969-2019, investigators identified 9,839 women with PCOS and 70,705 controls for inclusion in their analyses. Among these cohorts, 1003 controls and 177 women with PCOS died during the follow-up period. Compared to those without PCOS, women with PCOS died at a significantly younger age and unadjusted analysis indicated they were at a 53% greater risk of mortality than the control cohort (Hazard ratio [HR], 1.53; 95% Confidence interval [CI], 1.28-1.84; P <.001). Investigators noted unadjusted analysis also suggested women with PCOS were at an increased risk of mortality due to tumors (HR, 1.42; 95% CI, 1.06-1.90), endocrine, nutrition, or metabolic diseases (HR, 2.45; 95% CI, 1.02-5.96), and diseases of the circulatory system (HR, 1.77; 95% CI, 1.19-2.62).¹

In their adjusted analysis, investigators found women with PCOS were at a 47% greater risk of all-cause mortality relative to their counterparts without PCOS (HR, 1.47; 95% CI, 1.23-1.76). Investigators also pointed out adjusted analysis of secondary outcomes of interest revealed an increased risk of mortality due to due to diabetes (HR, 3.07; 95% CI, 1.16-8.08), other diseases of the circulatory system (HR, 2.07; 95% CI, 1.00-4.25), and bronchitis (HR, 3.61; 95% CI, 1.01-12.88) in women with PCOS relative to the control cohort.¹

“The major finding of this study is that women with PCOS had 47% higher risk for overall mortality than control women. The mortality due to diseases of the cardiovascular system was increased by 67% and mortality due to tumors by 38% when compared to the control group. Women with PCOS also had triple the risk of death due to diabetes and lung infection,” Piltonen added.²

References:

1. Ollila M, Arffman RK, Morin-Papunen LM, et al. Polycystic Ovary Syndrome Is Associated with an Increased Mortality Risk. Paper presented at: the Endocrine Society annual meeting. June 15 – 18, 2023.
2. Women with polycystic ovary syndrome may face increased risk of death. Newswise. June 9, 2023. Accessed June 19, 2023. https://www.newswise.com/faseb/women-with-polycystic-ovary-syndrome-may-face-increased-risk-of-death/.
3. PCOS (polycystic ovary syndrome) and diabetes. Centers for Disease Control and Prevention. December 30, 2022. Accessed June 19, 2023. https://www.cdc.gov/diabetes/basics/pcos.html.