Journal of General Internal Medicine

, Volume 20, Issue 4, pp 350–356 | Cite as

The impact of comorbidities on hormone use

After the 2002 release of the women’s health initiative
  • Katherine M. Newton
  • Diana S. M. Buist
  • Diana L. Miglioretti
  • Kevin Beverly
  • Cynthia L. Hartsfield
  • K. Arnold Chan
  • Susan E. Andrade
  • Feifei Wei
  • Maureen T. Connelly
  • Larry Kessler
Original Articles

Abstract

OBJECTIVE: 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).

DESIGN, SETTING, AND PARTICIPANTS: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs.

METHODS: 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.

MEASURES: EPT/ET prevalence, initiation, and discontinuation rates.

RESULTS: 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 (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.

CONCLUSIONS: 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.

Key words

hormone therapy women menopause estrogen fracture 

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References

  1. 1.
    Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Shumaker SA, Legault C, Rapp SR, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003;289:2651–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Rapp SR, Espeland MA, Shumaker SA, et al. Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003;289:2663–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Chlebowski RT, Hendrix SL, Langer RD, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA. 2003;289:3243–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Hays J, Ockene JK, Brunner RL, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med. 2003;348:1839–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Wassertheil-Smoller S, Hendrix SL, Limacher M, et al. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women’s Health Initiative: a randomized trial. JAMA. 2003;289:2673–84.PubMedCrossRefGoogle Scholar
  7. 7.
    Buist D, Newton KM, Miglioretti DL, et al. Hormone therapy prescribing patterns in the United States. Obstet Gynecol. 2004;104(5pt 1):1042–50.PubMedGoogle Scholar
  8. 8.
    Ettinger B, Grady D, Tosteson AN, Pressman A, Macer JL. Effect of the Women’s Health Initiative on women’s decisions to discontinue postmenopausal hormone therapy. Obstet Gynecol. 2003;102:1225–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Grady D, Ettinger B, Tosteson AN, Pressman A, Macer JL. Predictors of difficulty when discontinuing postmenopausal hormone therapy. Obstet Gynecol. 2003;102:1233–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Lawton B, Rose S, McLeod D, Dowell A. Changes in use of hormone replacement therapy after the report from the Women’s Health Initiative: cross sectional survey of users. BMJ. 2003;327:845–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA. 2004;291:47–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Platt R, Davis R, Finkelstein J. et al. Multicenter epidemiologic and health services research on therapeutics in the HMO Research Network Center for Education and Research on Therapeutics. Pharmacoepidemiol Drug Saf. 2001;10:373–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Clark D, Von Korff M, Saunders K, Baluch W, Simon G. A chronic disease score with empirically derived weights. Med Care. 1995;33:783–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Diggle PJ, Heagerty P, Liang KY, Zeger SL. Analysis of Longitudinal Data. New York, NY: Oxford University Press; 2002.Google Scholar
  15. 15.
    Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. JAMA. 1998;280:605–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004;291:1701–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Katon W, von Korff M, Ciechanowski P, et al. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care. 2004;27:914–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Newton KM, LaCroix AZ. Association of body mass index with reinfarction and survival after first myocardial infarction in women. J Womens Health. 1996;5:433–44.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Katherine M. Newton
    • 1
    • 2
  • Diana S. M. Buist
    • 1
    • 2
  • Diana L. Miglioretti
    • 1
    • 2
  • Kevin Beverly
    • 1
  • Cynthia L. Hartsfield
    • 3
  • K. Arnold Chan
    • 4
    • 5
  • Susan E. Andrade
    • 6
  • Feifei Wei
    • 7
  • Maureen T. Connelly
    • 8
    • 9
  • Larry Kessler
    • 10
  1. 1.Center for Health StudiesGroup Health CooperativeSeattleUSA
  2. 2.School of Public Health and Community MedicineUniversity of WashingtonSeattleUSA
  3. 3.Kaiser PermanenteDenverUSA
  4. 4.Channing LaboratoryBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  5. 5.HMO Research Network’s Center for Education and Research on TherapeuticsUSA
  6. 6.Meyers Primary Care InstituteWorcesterUSA
  7. 7.HealthPartners Research FoundationMinneapolisUSA
  8. 8.Department of Ambulatory Care and PreventionHarvard Pilgrim Health Care and Harvard Medical SchoolBostonUSA
  9. 9.Menopause Consultation ServiceHarvard Vanguard Medical AssociatesBostonUSA
  10. 10.Office of Science and Technology, Center for Devices and Radiological HealthFood and Drug AdministrationRockvilleUSA

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