Ethnic differences in hormone replacement prescribing patterns
Cite this article as: Brown, A.F., Pérez-Stable, E.J., Whitaker, E.E. et al. J GEN INTERN MED (1999) 14: 663. doi:10.1046/j.1525-1497.1999.10118.x Abstract OBJECTIVE: To determine whether prescription patterns of hormone replacement therapy (HRT) differ in African-American, Asian, Latina, Soviet immigrant, and white women. DESIGN: Retrospective review of computerized medical records. SETTING: The general internal medicine, family medicine, and gynecology practices of an academic medical center. PATIENTS: Women aged 50 years or older with at least one outpatient visit from January 1, 1992, to November 30, 1995. MEASUREMENTS AND MAIN RESULTS: Use of HRT was defined as documentation of systemic estrogen use. The main predictor variable was self-identified ethnicity. Age, diagnosis (coronary heart disease, hypertension, diabetes, osteoporosis, or breast cancer), and median income were included in the analysis. Of the 8,968 women (mean age, 65.4 years) included, 50% were white, 20% Asian, 15% African American, 9% Latina, and 6% Soviet immigrants. Whites (33%) were significantly more likely to be prescribed HRT than Asians (21%), African Americans (25%), Latinas (23%), or Soviet immigrants (6.6%), p<0.01 for each. Multivariate analysis, comparing ethnic groups and controlling for confounding variables, showed that Asians (odds ratio [OR] 0.56; 95% confidence interval [CI] 0.49, 0.64), African Americans (OR 0.70; 95% CI 0.60, 0.81), Latinas (OR 0.70; 95% CI 0.58, 0.84), and Soviet immigrants (OR 0.14; 95% CI 0.10, 0.20) were each less likely to be prescribed HRT than were white women. Although women with osteoporosis were more likely to receive HRT (OR 2.28; 95% CI 1.71, 2.99), those with coronary heart disease were not (OR 0.88; 95% CI 0.68, 1.09). CONCLUSIONS: Physicians at this medical center were more likely to prescribe HRT for white women and women with osteoporosis. Further study is needed to address whether these differences in HRT prescribing result in different health outcomes. Key Words hormone replacement therapy postmenopausal women ethnicity physician prescribing prevention
This project was supported by grant HS07373-01 from the Agency for Health Care Policy and Research and by grant 1P30 AG15272 awarded by the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Minority Health.
Kiel DP, Felson DT, Anderson JJ, Wilson PW, Moskowitz MA. Hip fracture and the use of estrogens in postmenopausal women: the Framingham study. N Engl J Med. 1987;317:1169–74.
Johnson RE, Specht EE. The risk of hip fracture in postmenopausal females with or without estrogen drug exposure. Am J Public Health. 1981;71:138–44.
Paganini-Hill A, Ross RK, Gerkins VR, Henderson BE, Arthur M, Mack TM. Menopausal estrogen therapy and hip fractures. Ann Intern Med. 1981;95:28–31.
Ettinger B, Genant HK, Cann CE. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med. 1985;102:319–24.
Naessen T, Persson I, Adami HO, Bergstrom R, Bergkvist L. Hormone replacement therapy and the risk for first hip fracture: a prospective, population-based cohort study. Ann Intern Med. 1990;113:95–103.
Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117:1016–37. See comments.
Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women: Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767–73. See comments.
Sullivan JM, Vander Zwaag R, Hughes JP, et al. Estrogen replacement and coronary artery disease: effect on survival in postmenopausal women. Arch Intern Med. 1990;150:2557–62.
Stampfer MJ, Colditz GA. Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prev Med. 1991;20:47–63.
Criqui MH, Suarez L, Barrett-Connor E, McPhillips J, Wingard DL, Garland C. Postmenopausal estrogen use and mortality: results from a prospective study in a defined, homogeneous community. Am J Epidemiol. 1988;128:606–14.
Ettinger B, Friedman GD, Bush T, Quesenberry CP Jr. Reduced mortality associated with long-term postmenopausal estrogen therapy. Obstet Gynecol. 1996;87:6–12.
Colditz GA, Egan KM, Stampfer MJ. Hormone replacement therapy and risk of breast cancer: results from epidemiologic studies. Am J Obstet Gynecol. 1993;168:1473–80.
Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995;332:1589–93. See comments.
Stanford JL, Weiss NS, Voigt LF, Daling JR, Habel LA, Rosing MA. Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women. JAMA. 1995;274:137–42. See comments.
Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitti D. Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstet Gynecol. 1995;85:304–13.
Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA. 1998;280:605–13.
Hemminki E, Kennedy DL, Baum C, McKinlay SM. Prescribing of noncontraceptive estrogens and progestins in the United States, 1974–86. Am J Public Health. 1988;78:1479–81.
Cauley JA, Cummings SR, Black DM, Mascioli SR, Seeley DG. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol. 1990;163:1438–44.
Griffiths F, Convery B. Women’s use of hormone replacement therapy for relief of menopausal symptoms, for prevention of osteoporosis, and after hysterectomy. Br J Gen Pract. 1995;45:355–8.
Barrett-Connor E, Wingard DL, Criqui MH. Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited. JAMA. 1989;261:2095–100.
Campbell-Brown M, McEwan HP. Scottish gynaecologists: their views on hormone replacement therapy. Health Bull (Edinb). 1992;50:248–51. Erratum. Health Bull (Edinb). 1992;50(4):314.
Ponte CD, Swinker ML, Madhavan S. Estrogen replacement therapy: a pilot survey of primary care physicians in West Virginia. DICP-Ann Pharmacother. 1989;23:977–9.
Pasley BH, Standfast SJ, Katz SH. Prescribing estrogen during menopause: physician survey of practices in 1974 and 1981. Public Health Rep. 1984;99:424–9.
Anderson E, Hamburger S, Liu JH, Rebar RW. Characteristics of menopausal women seeking assistance. Am J Obstet Gynecol. 1987;156:428–33.
Ferguson KJ, Hoegh C, Johnson S. Estrogen replacement therapy: a survey of women’s knowledge and attitudes. Arch Intern Med. 1989;149:133–6.
Ross RK, Paganini-Hill A, Roy S, Chao A, Henderson BE. Past and present preferred prescribing practices of hormone replacement therapy among Los Angeles gynecologists: possible implications for public health. Am J Public Health. 1988;78:516–9.
Schmitt N, Gogate J, Rothert M, et al. Capturing and clustering women’s judgment policies: the case of hormonal therapy for menopause. J Gerontol. 1991;46:92–101.
Pilote L, Hlatky MA. Attitudes of women toward hormone therapy and prevention of heart disease. Am Heart J. 1995;129:1237–8. Editorial.
Groeneveld FP, Bareman FP, Barentsen R, Dokter HJ, Drogendijk AC, Hoes AW. Relationships between attitude towards menopause, well-being and medical attention among women aged 45–60 years. Maturitas. 1993;17:77–88.
Stafford RS, Saglam D, Causino N, Blumenthal D. Low rates of hormone replacement therapy by U.S. physicians. J Gen Intern Med. 1996;11 (suppl 1): 89. Abstract.
Keating NL, Cleary PD, Rossi AS, Zaslavsky AM, Ayanian JZ. Use of hormone replacement therapy by postmenopausal women in the United States. Ann Intern Med. 1999;130:545–53.
Nabulsi AA, Folsom AR, White A, et al. Association of hormonereplacement therapy with various cardiovascular risk factors in postmenopausal women. The Atherosclerosis Risk in Communicties Study Investigators. N Engl J Med. 1993;328:1069–75. See comments.
Egeland GM, Matthews KA, Kuller LH, Kelsey SF. Characteristics of noncontraceptive hormone users. Prev Med. 1988;17:403–11.
Bartman BA, Moy E. Racial differences in estrogen use among middle-aged and older women. Women’s Health Issues. 1998;8:32–44.
Bachhuber TL, Baybrook SL, Philbrick JT. Hormone replacement therapy: knowledge, attitudes and use among low income women. J Gen Intern Med. 1996;11(suppl 1):139. Abstract.
Pham KC, Freeman EW, Grisso TA. Ovarian aging and hormone replacement therapy: attitudes of Afro-american and Caucasian women. J Gen Intern Med. 1996;11(suppl 1):136. Abstract.
Jahnige K, Fiebach N. Postmenopausal estrogen use among African American and white patients at an urban clinic. J Women’s Health. 1997;6:93–101.
McNagny SE, Wenger NK, Frank E. Personal use of postmenopausal hormone replacement therapy by women physicians in the United States. Ann Intern Med. 1997;127:1093–6.
Holmes MM, Rovner DR, Rothert ML, et al. Women’s and physicians’ utilities for health outcomes in estrogen replacement therapy. J Gen Intern Med. 1987;2:178–82.
Garton M, Reid D, Rennie E. The climacteric, osteoporosis and hormone replacement; views of women aged 45–49. Maturitas. 1995;21:7–15.
Griffiths F. Women’s health concerns. Is the promotion of hormone replacement therapy for prevention important to women? Fam Pract. 1995;12:54–9.
Lip G, Beevers M, Churchill D, Beevers DG. Do clinicians prescribe HRT for hypertensive postmenopausal women? Br J Clin Pract. 1995;49:61–4.
Carlisle DM, Leake BD, Shapiro MF. Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. Am J Public Health. 1995;85:352–6.
Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med. 1996;334:635–41. See comments.
Norman SG, Studd JW. A survey of views on hormone replacement therapy. Br J Obstet Gynaecol. 1994;101:879–87.
Sinclair HK, Bond CM, Taylor RJ. Hormone replacement therapy: a study of women’s knowledge and attitudes. Br J Gen Pract. 1993;43:365–70.
Liao Y, Cooper RS. Continued adverse trends in coronary heart disease mortality among blacks, 1980–91. Public Health Rep. 1995;110:572–9; discussion, 570–2.
Baird DD, Tyroler HA, Heiss G, Chambless LE, Hames CG. Menopausal change in serum cholesterol: black/white differences in Evans County, Georgia. Am J Epidemiol. 1985;122:982–93.
Demirovic J, Sprafka JM, Folsom AR, Laitinen D, Blackburn H. Menopause and serum cholesterol: differences between blacks and whites. The Minnesota Heart Survey. Am J Epidemiol. 1992;136:155–64.
Nicholson WK, Brown AF, Gathe J, Grumbach K, Washington AE, Pérez-Stable EJ. Hormone replacement therapy for African-American women: missed opportunities for effective intervention. Menopause. 1999; 6(2):147–55.
Nabulsi AA, Folsom AR, White A, et al. Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. The Atherosclerosis Risk in Communities Study Investigators. N Engl J Med. 1993;328:1069–75. See comments.
Cronkright PJ, DeHaven K, Kraev IA. Issues in the provision of health care to Soviet emigrants. Arch Fam Med. 1993;2:425–8.
Haywood LJ, Ell K, de Guman M, Norris S, Blumfield D, Sobel E. Chest pain admissions: characteristics of black, Latino, and white patients in low- and mid-socioeconomic strata. J Natl Med Assoc. 1993;85:749–57. Erratum. J Natl Med Assoc. 1993;85(12):950.
Stroup-Benham CA, Treviño FM. Reproductive characteristics of Mexican-American, mainland Puerto Rican, and Cuban-American women: data from the Hispanic Health and Nutrition Examination Survey. JAMA. 1991;265:222–6.
Daley J. Medical uncertainty and practice variation get personal: What should I do about hormone replacement therapy? Ann Intern Med. 1999;130:602–3.
PubMed Copyright information
© Society of General Internal Medicine 1999