Hormone Therapy Use in Women Veterans Accessing Veterans Health Administration Care: A National Cross-Sectional Study
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The majority of women Veterans using VA (Veterans Administration) care fall in the 45–65 year-old age range. Understanding how menopause is managed in this group is of importance to optimizing their health.
National population estimates showed a prevalence of hormone therapy (HT) use by women over 45 years of 4.7 % (2009–2010). Our study described the frequency of HT use among women Veterans in VA, and examined whether mental health (MH) was predictive of HT use.
This was a cross-sectional analysis of national VA administrative data for fiscal year 2009.
Women Veterans over the age of 45 (N = 157,195) accessing VA outpatient care were included in the analysis.
Logistic regression analyses using HT use as the dependent variable.
Mean age was 59.4 years (SD =12.2, range =46–110), and 16,227 (10.3 %) of all women used HT. Hysterectomy (OR 3.99 [3.53, 4.49]) and osteoporosis (1.34 [1.27, 1.42]) were the strongest medical indicators of HT use. A total of 49,557 (31.5 %) women in the sample received at least one primary diagnosis of a MH disorder and were more likely to use HT than women with no MH diagnoses (unadjusted OR 1.56, 95 % CI [1.50, 1.61]). Women Veterans with a mood disorder (depression/bipolar) or anxiety disorder [post-traumatic stress disorder (PTSD), other anxiety diagnoses] were more likely to use HT after controlling for demographics and medical comorbidity.
The prevalence of HT use among women Veterans using VA is more than twice that of the general population. Prior work suggested that women Veterans were discontinuing HT at comparable rates, but these data demonstrate that decline in VA HT use has not kept pace with that of civilian medical care. The association of MH diagnosis with HT use suggests that MH plays an important role in VA rates. Further study is needed to understand contributing patient and provider factors.
KEY WORDSwomen Veterans hormone therapy mental health
The authors wish to acknowledge the assistance of Melissa Skanderson, MSW.
Funding to support database creation was provided by National Center for PTSD (NCPTSD), U.S. Department of Veterans Affairs, Executive Division, White River Junction, VT.
This work was supported in part by Career Development Award (Japuntich) #1IK2CX000918-01A1from the United States Department of Veterans Affairs Clinical Sciences Research and Development Service.
This study was presented in abstract form at the Society for General Internal Medicine (SGIM), 36th Annual Meeting, April 26, 2013, Denver, CO.
The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the United States Government.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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