Neighborhood Vulnerability and Age of Natural Menopause and Menopausal Symptoms Among Midlife Women
Authors: Zhi Lin, Sheryl L. Rifas-Shiman, Wei Perng, Melissa Pérez Capotosto, Jan L. Shifren, Hadine Joffe, Marie-France Hivert, Jorge E. Chavarro, Emily Oken, Izzuddin M. Aris
Journal: JAMA Network Open (2025)

Importance Women experiencing more severe menopausal symptoms exhibit poorer quality of life, and those with early menopause have a higher risk of developing chronic diseases. However, the extent to which neighborhood disadvantage contributes to menopause onset and symptom severity remains understudied. Objective To examine the association of Social Vulnerability Index (SVI) with age of natural menopause onset and menopausal symptom severity. Design, Setting, and Participants This cohort study used data from a prospective cohort of women participating in Project Viva who were initially enrolled in eastern Massachusetts and followed up from pregnancy to midlife between April 1999 and August 2021. Participant inclusion required geocoded residential addresses at enrollment (1999-2002), 8-year follow-up (2006-2010), and 13-year follow-up (2012-2016); age at natural menopause; and menopausal symptoms. Data were analyzed between March 1 and June 30, 2024. Exposures SVI grouped into 5 categories: very low (&amp;amp;lt;20th percentile), low (20th to &amp;amp;lt;40th percentile), moderate (40th to &amp;amp;lt;60th percentile), high (60th to &amp;amp;lt;80th percentile), or very high (≥80th percentile) vulnerability. Main Outcomes and Measures Age at natural menopause and self-reported menopausal symptoms based on the presence and severity of 11 symptoms over the past year. These symptoms were assessed using the Menopause Rating Scale (total score range: 0-44, with higher scores indicating greater severity). Results Of the 691 women included in the study (mean [SD] enrollment age, 33.7 [3.8] years; 41 with Asian [6.0%], 79 with Black [11.5%], 39 with Hispanic [5.7%], 507 with White [73.6%], and 23 with other [3.3%] race and ethnicity), 87 (12.6%) resided in neighborhoods with very high SVI at enrollment, 38 of 635 (6.0%) at 8-year follow-up, and 41 of 660 (6.2%) at 13-year follow-up. The Kaplan-Meier estimate for median age of natural menopause was earlier in women residing in neighborhoods with very high vs very low SVI at enrollment (52.0 [95% CI, 51.0-53.0] years vs 53.0 [95% CI, 53.0-54.0] years), 8-year follow-up (51.0 [95% CI, 50.0-53.0] years vs 53.0 [95% CI, 53.0-54.0] years), and 13-year follow-up (51.0 [95% CI, 50.0-53.0] years vs 53.0 [95% CI, 53.0-54.0] years). After adjusting for covariates, residence in neighborhoods with very high (but not low, moderate, or high) vs very low SVI at enrollment (adjusted hazard ratio [AHR], 1.36; 95% CI, 0.90-2.06), 8-year follow-up (AHR, 2.23 (95% CI, 1.29-3.85), and 13-year follow-up (AHR, 2.18 (95% CI, 1.30-3.66) was associated with higher risk of earlier natural menopause. SVI was not associated with menopausal symptoms. Conclusions and Relevance In this cohort study, women who resided in neighborhoods with very high vulnerability within 10 years of the perimenopause period exhibited higher risk of earlier natural menopause. Future research is warranted to explore whether initiatives to improve neighborhood conditions could mitigate the association of neighborhood disadvantage with earlier menopause onset.