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AbstractObjectiveTo prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years).DesignProspective cohort studySettingThe Nurses’ Health Study II, United States (1989-2019).Participants110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer.Main outcome measuresHazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires.Results4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids.ConclusionWomen with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health.

High monthly turnover rates of nurses and senior doctors are associated with more deaths among patients admitted as emergencies to NHS hospitals in England, an observational study published in The BMJ has found.1Researchers from Cambridge University Hospitals Foundation Trust and the universities of Surrey and Aberdeen looked at the yearly records of 236 000 nurses, 41 800 senior doctors, and 8.1 million patients admitted to hospital in England from April 2010 to March 2019.After adjusting for patient age, sex, and pre-existing conditions, they found that a one standard deviation increase in monthly turnover of nurses at a single trust (equivalent to around 20 nurses quitting) was associated with 35 additional deaths per 100 000 admissions in any given month (0.035 (95% confidence interval 0.024 to 0.045)).Among senior doctors—defined as consultants and specialist, associate specialist, and specialty doctors—a one standard deviation increase was equivalent to about seven doctors quitting and was...

AbstractObjectiveTo investigate the association between monthly turnover rates of hospital nurses and senior doctors and patient health outcomes (mortality and unplanned hospital readmissions).DesignRetrospective longitudinal study.SettingAll 148 NHS acute trusts in England (1 April 2010 to 30 March 2019), excluding specialist and community NHS hospital trusts.ParticipantsYearly records on 236 000 nurses, 41 800 senior doctors (specialist, associate specialist and specialty doctors, and consultants), and 8.1 million patients admitted to hospital.Main outcome measuresThe panel data regression analysis used nine years of monthly observations from administrative datasets at healthcare worker and patient levels. Associations using linear and unconditional quantile regressions were estimated, including controls for seasonality and NHS hospital trust. Four hospital quality indicators (risk adjusted by patient age, sex, and Charlson index comorbidities) were used and measured at a monthly frequency on a percentage scale: mortality risk within 30 days from all cause, emergency, or elective admission to hospital, and risk of unplanned emergency readmission within 30 days from discharge after elective hospital treatment.ResultsA 1 standard deviation (SD) increase in turnover rate for nurses was associated with 0.035 (95% confidence interval 0.024 to 0.045) and 0.052 (0.037 to 0.067) percentage point increases in risks of all cause and emergency admission mortality, respectively, at 30 days. The corresponding values for senior doctors were 0.014 (0.005 to 0.024) and 0.019 (0.006 to 0.033) percentage point increases. Higher nurse turnover rate was associated with higher mortality risk at 30 days in surgical (P<0.01) and general medicine (P<0.01) specialties, as well as mortality for patients admitted to hospital with infectious and parasitic diseases (international classification of diseases, 10th revision; P<0.05) and injury, poisoning, and consequences of external causes (P<0.01). Higher turnover rates for senior doctors were associated with higher mortality risk at 30 days for patients admitted to hospital with infectious and parasitic diseases (P<0.05), mental and behavioural disorders (P<0.05), and diseases of the respiratory system (P<0.05). Turnover rates for hospital nurses and senior doctors were not statistically significantly associated with risk adjusted hospital mortality and unplanned emergency readmissions for elective patients.ConclusionsLower turnover rates for nurses and senior doctors at hospital level were associated with better health outcomes for patients with emergency hospital admissions.Study registrationIntegrated Research Application System project ID 271302.