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Mortality in Women with Turner Syndrome in Great Britain: A National Cohort Study

Section of Epidemiology (M.J.S., A.J.S., C.D.H.), Institute of Cancer Research, Sutton SM2 5NG, United Kingdom; Cell and Molecular Genetics Section (A.F.W.), Medical Research Council Human Genetics Unit, Edinburgh EH4 2XU, United Kingdom; and Wessex Regional Genetics Laboratory (P.A.J.), Salisbury District Hospital, Salisbury SP2 8BJ, United Kingdom

Address all correspondence and requests for reprints to: Dr. Minouk Schoemaker, Section of Epidemiology, Sir Richard Doll Building, Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom. E-mail: minouk{at}icr.ac.uk.

Context: Turner syndrome is characterized by complete or partial X chromosome monosomy. It is associated with substantial morbidity, but mortality risks and causes of death are not well described.

Objectives: Our objective was to investigate mortality and causes of death in women with Turner syndrome.

Design and Setting: We constructed a cohort of women diagnosed with Turner syndrome at almost all cytogenetic centers in Great Britain and followed them for mortality.

Patients: A total of 3439 women diagnosed between 1959–2002 were followed to the end of 2006.

Outcome Measures: Standardized mortality ratios (SMRs) and absolute excess risks were evaluated.

Results: In total, 296 deaths occurred. Mortality was significantly raised overall [SMR = 3.0; 95% confidence interval (CI) = 2.7–3.4] and was raised for nearly all major causes of death. Circulatory disease accounted for 41% of excess mortality, with greatest SMRs for aortic aneurysm (SMR = 23.6; 95% CI = 13.8–37.8) and aortic valve disease (SMR = 17.9; 95% CI = 4.9–46.0), but SMRs were also raised for other circulatory conditions. Other major contributors to raised mortality included congenital cardiac anomalies, diabetes, epilepsy, liver disease, noninfectious enteritis and colitis, renal and ureteric disease, and pneumonia. Absolute excess risks of death were considerably greater at older than younger ages.

Conclusions: Mortality in women with Turner syndrome is 3-fold higher than in the general population, is raised for almost all major causes of death, and is raised at all ages, with the greatest excess mortality in older adulthood. These risks need consideration in follow-up and counseling of patients and add to reasons for continued follow-up and preventive measures in adult, not just pediatric, care.

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