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


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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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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