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Background <p>Although breastfeeding history is recognized as a potential protective factor against all-cause and cardiovascular disease (CVD) mortality in women, its impact on these outcomes remains underexplored, particularly in the context of diabetes. This study aims to address this gap by investigating the association between ever breastfeeding and mortality risks from all causes and CVD in adult women with and without diabetes.</p> Methods <p>This prospective cohort analysis utilized nationally representative U.S. data from the National Health and Nutrition Examination Survey (NHANES, 1999–2012). Mortality follow-up through December 31, 2019, was established via linkage to the NHANES Public-Use Linked Mortality File using probabilistic matching to National Death Index records. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs), we utilized Cox proportional hazards regression models. We evaluated interactions between ever breastfeeding and diabetes status using both multiplicative and additive scales. The stability of the results was assessed using sensitivity analyses.</p> Results <p>Among the 10,965 parous women studied (mean age 53.2 years), 1,938 had diabetes and 6,310 reported ever breastfeeding at baseline. During median follow-up of 142 months (range: 7–20 years), 2,178 all-cause and 673 CVD deaths occurred. Following multivariable adjustment, ever breastfeeding was significantly linked to reduced all-cause mortality risk among individuals with diabetes (HR 0.76; 95% CI 0.63, 0.92), but not among those without diabetes (HR 1.05; 95% CI 0.93, 1.18). No significant associations were observed for CVD mortality in either group. Significant multiplicative interaction existed between ever breastfeeding and diabetes status for all-cause mortality (P<sub>interaction</sub>=0.012). Additive interaction analyses revealed a relative excess risk due to interaction (RERI) of -0.41 (95% CI -0.69, -0.14), indicating subadditive joint effects. Sensitivity analyses excluding early deaths (≤ 2 years) or cancer histories yielded consistent results (HR range: 0.75–0.77).</p> Conclusions <p>Ever breastfeeding was significantly associated with reduced all-cause mortality risk among women with diabetes, suggesting potential long-term protective effects of breastfeeding on maternal survival in this population.</p> Graphical Abstract <p></p>

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Associations of ever breastfeeding with risk of all-cause and cardiovascular disease mortality among women with and without diabetes: a cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月12日

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  • Wenjuan Zhou,
  • Lingdan Zhou,
  • Dan Li,
  • Hua Li,
  • Le Huang

摘要

Background

Although breastfeeding history is recognized as a potential protective factor against all-cause and cardiovascular disease (CVD) mortality in women, its impact on these outcomes remains underexplored, particularly in the context of diabetes. This study aims to address this gap by investigating the association between ever breastfeeding and mortality risks from all causes and CVD in adult women with and without diabetes.

Methods

This prospective cohort analysis utilized nationally representative U.S. data from the National Health and Nutrition Examination Survey (NHANES, 1999–2012). Mortality follow-up through December 31, 2019, was established via linkage to the NHANES Public-Use Linked Mortality File using probabilistic matching to National Death Index records. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs), we utilized Cox proportional hazards regression models. We evaluated interactions between ever breastfeeding and diabetes status using both multiplicative and additive scales. The stability of the results was assessed using sensitivity analyses.

Results

Among the 10,965 parous women studied (mean age 53.2 years), 1,938 had diabetes and 6,310 reported ever breastfeeding at baseline. During median follow-up of 142 months (range: 7–20 years), 2,178 all-cause and 673 CVD deaths occurred. Following multivariable adjustment, ever breastfeeding was significantly linked to reduced all-cause mortality risk among individuals with diabetes (HR 0.76; 95% CI 0.63, 0.92), but not among those without diabetes (HR 1.05; 95% CI 0.93, 1.18). No significant associations were observed for CVD mortality in either group. Significant multiplicative interaction existed between ever breastfeeding and diabetes status for all-cause mortality (Pinteraction=0.012). Additive interaction analyses revealed a relative excess risk due to interaction (RERI) of -0.41 (95% CI -0.69, -0.14), indicating subadditive joint effects. Sensitivity analyses excluding early deaths (≤ 2 years) or cancer histories yielded consistent results (HR range: 0.75–0.77).

Conclusions

Ever breastfeeding was significantly associated with reduced all-cause mortality risk among women with diabetes, suggesting potential long-term protective effects of breastfeeding on maternal survival in this population.

Graphical Abstract