The impact of comorbidities on hormone use
After the 2002 release of the women’s health initiative
Accepted: 25 October 2004 DOI:
Cite this article as: Newton, K.M., Buist, D.S.M., Miglioretti, D.L. et al. J GEN INTERN MED (2005) 20: 350. doi:10.1111/j.1525-1497.2005.04059.x Abstract Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow-up) release of the Women’s Health Initiative EPT trial results (WHI). OBJECTIVE: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs. DESIGN, SETTING, AND PARTICIPANTS: We used pharmacy data to identify ET and EPT users. A woman was a user any month she filled ≥ 1 estrogen prescription and in subsequent months based upon the number of pills/patches dispensed. We used inpatient and outpatient claims to identify fracture January 1, 1999 to June 30, 2002 and pharmacy data to identify disease-based groups of medications for diabetes and cardiovascular disease. METHODS: EPT/ET prevalence, initiation, and discontinuation rates. MEASURES: Baseline to follow-up EPT and ET prevalence declined 45% and 22%, respectively, with no difference by comorbidity. Follow-up EPT initiation was half the baseline rate irrespective of comorbidity. Compared to baseline, follow-up EPT discontinuation rates increased among women with diabetes (relative risk [RR], 6.9; 95% confidence interval [CI], 5.6 to 8.4), cardiovascular disease (RR, 5.5; 95% CI, 4.9 to 6.2), fracture (RR, 3.8; 95% CI, 2.4 to 5.7), and no comorbidity (RR, 4.4; 95% CI, 3.9 to 4.9). The RRs for follow-up versus baseline EPT discontinuation were higher among women with diabetes ( RESULTS: P<.01) and cardiovascular disease ( P<.01) versus women without these comorbidities. ET discontinuation rates among these same groups were elevated 2- to 2.8-fold. Diabetes and cardiovascular disease were associated with higher EPT discontinuation rates post-WHI compared to women without comorbidity; comorbidity had little impact on changes in prevalence or initiation of ET/EPT after release of the WHI. CONCLUSIONS: Key words hormone therapy women menopause estrogen fracture
There are no conflicts of interest.
This study was funded by a cooperative agreement from the National Cancer Institute (U19-CA-79689-05). The Cancer Research Network (CRN) consists of the research programs, enrollee populations, and databases of 10 HMOs that are members of the HMO Research Network. The health care delivery systems participating in the CRN are: GHC, Harvard Pilgrim Health Care, Henry Ford Health System, HealthPartners, the Meyers Primary Care Institute of the Fallon Healthcare System/University of Massachusetts, and Kaiser Permanente in five regions: Colorado, Hawaii, Northwest (Oregon and Washington), Northern California, and Southern California. The overall goal of the CRN is to increase the effectiveness of preventive, curative, and supportive interventions that span the natural history of major cancer among diverse populations and health systems, through a program of collaborative research.
Dr. Buist’s time was supported in part by a grant from the American Cancer Society (CRTG-03-024-01-CCE). We would like to thank Drs. Robert Davis, Martin Brown, Marsha Raebel, Andrea Z. LaCroix, Richard Platt, and Edward Wagner, and Linda Shultz, MPH and Sarah Greene, MPH for their assistance with this project, We would also like to acknowledge all of the investigators who worked on the HMO Research Network Center for Education and Research on Therapeutics Patient Safety Project.
Data collection for the Patient Safety Project was funded by a grant from the Agency for Healthcare Research and Quality (AHRQ U18HS11843-01). We would also like to acknowledge all of the programmers from participating sites who worked on the HMO Research Network Center for Education and Research on Therapeutics Patient Safety Project (Julia Hecht, PhD, GHC; Doris Milan, Harvard Pilgrim; Jackie C. Fuller, Meyers Primary Care Institute; David L. McClure, MS, KP Colorado; and Gerald Amundson, HealthPartners).
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