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Lancet. 1981 Mar 7;1(8219):541-6.

Further analyses of mortality in oral contraceptive users. Royal College of General Practitioners' Oral Contraception Study.

[No authors listed]



An analysis has been made of the 249 deaths which were reported during the course of the Royal College of General Practitioners' prospective study of the health associations of (OC) oral contraception. As in the past, women who had used the pill were reported to have a 40% higher death rate than women who had never taken OCs. Virtually all excess mortality was due to diseases of the circulatory system. Women who had used OCs had a relative risk of 4.3 for deaths attributed to vascular diseases. Most of these were from ischemic heart disease (relative risk 4.1) and subarachnoid hemorrhage (relative risk 4.0). The larger number of cases now reported has permitted greater discrimination than was possible earlier between subjects with high and low risks. There were few deaths under 35 years of age and the excess annual death rates of 1/77,000 women in nonsmokers and 1/10,000 women in smokers have wide confidence limits, and could have arisen by chance. For women aged 35-44 years, the excess annual death rate was 1/6700 women in nonsmokers and 1/2000 women in smokers; at 45 years and above the risks were 1 in 2500 and 1 in 500, respectively. There is now no evidence that the risk is associated with duration of OC use. The demonstrated positive association of risk with parity in pill users needs confirmation. Former users were noted to have an increased risk of death from vascular disease, but it was not possible to determine whether this represents a residual effect of OCs on the vascular system.

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