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\begin{document}

\title{The effect of hormone replacement therapy on the survival of UK women: a
retrospective cohort study 1984-2017}



\author[1]{Nurunnahar Akter}%
\author[1]{Elena Kulinskaya}%
\author[1]{Nicholas Steel}%
\author[1]{Ilyas Bakbergenuly}%
\affil[1]{University of East Anglia}%


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  \date{May 24, 2024}


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\begin{abstract}
\textbf{Objective:} To estimate the effect of oestrogen-only and
combined hormone replacement therapy (HRT) on the hazards of overall and
age-specific all-cause mortality in healthy women aged 46 to 65 at first
prescription.

\textbf{Design:} Matched cohort study.~

\textbf{Setting:} Electronic primary care records from The Health
Improvement Network (THIN) database, UK (1984-2017).

\textbf{Population:} 105,199 HRT users (cases) and 224,643 non-users
(controls) matched on age and general practice.

\textbf{Methods:~}Weibull-Double-Cox regression models adjusted for age
at first treatment, birth cohort, type 2 diabetes, hypertension and
hypertension treatment, coronary heart disease,
oophorectomy/hysterectomy, body mass index, smoking, and deprivation
status.~

\textbf{Main outcome measures:} All-cause mortality.

\textbf{Results:}~A total of 21,751 women died over an average of 13.5
years follow-up per participant, of whom 6,329 were users and 15,422
non-users. The adjusted hazard ratio (HR) of overall all-cause mortality
in combined HRT users was 0.91 (95\%CI 0.88-0.94), and in oestrogen-only
users was 0.99 (0.93-1.07), compared to non-users. Age-specific adjusted
HRs for participants aged 46-50, 51-55, 56-60, and 61-65 years at first
treatment were 0.98 (0.92-1.04), 0.87 (0.82-0.92), 0.88 (0.82-0.93), and
0.92 (0.85-0.98), for combined HRT users compared to non-users, and 1.01
(0.84-1.21), 1.03 (0.89-1.18), 0.98 (0.86-1.12), and 0.93 (0.81-1.07)
for oestrogen-only users, respectively.

\textbf{Conclusions:} Combined HRT was associated with a 9\% lower risk
of all-cause mortality and oestrogen-only formulation was not associated
with any significant changes.

\textbf{~Funding:} IFoA.

\textbf{Keywords:} Hormone replacement therapy, menopause, mortality,
primary care records, THIN.

\textbf{Tweetable abstract:} Oestrogen-only HRT is not associated with
all-cause mortality and combined HRT reduces the risks.%
\end{abstract}%



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\textbf{Hosted file}

\verb`Main document revised.docx`  available at \url{https://authorea.com/users/422815/articles/528456-the-effect-of-hormone-replacement-therapy-on-the-survival-of-uk-women-a-retrospective-cohort-study-1984-2017}

\textbf{The effect of hormone replacement therapy on the survival of UK
women: a retrospective cohort study 1984-2017}

\textbf{Nurunnahar Akter,\textsuperscript{a} Elena
Kulinskaya,\textsuperscript{a} Nicholas Steel,\textsuperscript{b} Ilyas
Bakbergenuly\textsuperscript{a}}

\textsuperscript{a} School of Computing Sciences, University of East
Anglia, Norwich, UK

\textsuperscript{b} Norwich Medical School, University of East Anglia,
Norwich, UK

\emph{\textbf{Correspondence}:} Nurunnahar Akter, School of Computing
Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4
7TJ, UK. Email: n.akter@uea.ac.uk

\textbf{Running title:} HRT and its impact on all-cause mortality.\selectlanguage{english}
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