Clinical Epidemiology (Jul 2019)
Mortality in 43,598 men with infertility – a Swedish nationwide population-based cohort study
Abstract
Frida E Lundberg,1 Anna LV Johansson,1 Jonas F Ludvigsson1,21Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; 2Department of Pediatrics, Orebro University Hospital, Orebro, SwedenBackground: Previous studies indicate a higher risk of comorbidity in men with infertility; however, research on mortality is scarce and the few studies that do exist have rarely differentiated between infertility and infertility-related diagnoses.Objective: To examine mortality in men with an infertility or infertility-related diagnosis.Design, setting, and participants: Population-based cohort study of men born in 1944–1992 in Sweden. We used Cox regression estimated hazard ratios (HRs) for infertility while adjusting for number of children, education, year of birth, country of birth, diabetes, hypertension, liver disease and end-stage renal disease. In all, 43,598 men with a diagnosis of infertility and 57,733 men with an infertility-related diagnosis were compared with 2,762,254 men (reference group) without such diagnoses.Outcome measures: All-cause and cause-specific mortality at age 20 to 69 years.Results and limitations: The 2,863,585 men in the study were followed for a median time of 22.0 years. During follow-up, 439 men with a diagnosis of infertility died, corresponding to a crude incidence rate of 1.56 deaths per 1,000 person-years. These figures can be compared with 1,400 deaths in men with an infertility-related diagnosis (1.96 deaths/1,000 person-years) and 99,463 deaths in reference individuals (2.17 deaths/1,000 person-years). Overall, men with a diagnosis of infertility did not have a higher risk of death (adjusted [a]HR=0.98; 95% confidence interval [95% CI]=0.89–1.08), but had a higher risk of death before age 30 (20–29 years) (aHR=3.26; 95% CI=2.42–4.41). This early excess mortality was largely explained by cancer diagnosed before infertility. Having an infertility-related diagnosis was associated with death (aHR=1.23; 95% CI=1.17–1.30). Limitations include the lack of general screening for infertility in Sweden and the lack of information on semen parameters.Conclusion: Men with a diagnosis of infertility are not at a higher risk of death than the general population, although having a diagnosis related to infertility may be linked to a higher risk of death.Patient summary: Men with a diagnosis of infertility do not seem to have a higher risk of death though an infertility-related diagnosis in men is associated with the risk of death.Keywords: cancer, death, infertility
