Heterogeneity across race and ethnicity for menopause onset
The heterogeneity onset of menopause varies across racial and ethnic groups, yet this heterogeneity may partially reflect methodological differences rather than true biological differences. Using the All of Us Research Program Controlled Tier dataset (v8), we analyzed age at first menopause diagnosis across three progressively refined cohorts: a full ICD-based cohort (Cohort 1, n = 11,306), a survey-linked subcohort adjusted for neighborhood deprivation, smoking, and alcohol use (Cohort 2, n = 10,639), and a confirmatory sensitivity cohort applying SNOMED-based surgical exclusions to the same adjusted framework (Cohort 3, n = 10,222). Asian & Pacific Islander and Indigenous/Other individuals experienced significantly earlier menopause onset than White individuals across both adjusted cohorts. The Black-White heterogeneity was attenuated after covariate adjustment and did not re-emerge after surgical exclusion. Current smoking was the sole significant behavioral predictor across adjusted models. These findings demonstrate that menopause definition and cohort selection critically shape estimates across race and ethnicity, and that EHR-based ascertainment combined with structured surgical exclusion yields broadly consistent adjusted results.
