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Health Care Use and Delivery

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Use of hormone replacement therapy may be more strongly linked to sociodemographic than clinical factors

A new national study provides a glimpse into factors associated with current use of hormone replacement therapy (HRT) by postmenopausal women. It found that women at risk for heart disease, who are reported to gain the most health benefits from HRT, are no more likely to use HRT than other women. In fact, a woman's educational level, age, and location were more strongly associated with HRT use than heart disease risk or other clinical factors. The study was supported in part by the Agency for Health Care Policy and Research (National Research Service Award training grant T32 HS00020).

Nancy L. Keating, M.D., M.P.H., of Harvard Medical School, and her colleagues examined patterns of HRT use in a national sample of postmenopausal women during 1995. They found that about 38 percent of postmenopausal women were using HRT in 1995. Three times as many women who had undergone a hysterectomy were currently using HRT compared with women who had an intact uterus (59 percent vs. 20 percent). Women in the latter group who choose to take HRT usually also take progestin—which may cause bloating, depression, and fatigue—to prevent breakthrough bleeding.

Rates of HRT use did not significantly differ by smoking status, family history of heart attack, personal history of hypertension or elevated cholesterol, or other cardiovascular risk factors. In fact, women with diabetes, a condition that increases the risk for heart disease, were substantially less likely than women without diabetes to use HRT (17 percent vs. 39 percent).

On the other hand, college graduates were nearly four times more apt to use HRT than women who had not graduated from high school, and women in the South and West were nearly three times more likely to use HRT than those in the Northeast. Use of HRT decreased with increasing age, possibly because older women experienced menopause at a time when HRT was less commonly prescribed. Well-educated women may be more likely to read articles about HRT, have more substantive discussions with physicians about personal benefits and risks, and seek this treatment, explain the researchers.

See "Use of hormone replacement therapy by postmenopausal women in the United States," by Dr. Keating, Paul D. Cleary, Ph.D., Alice S. Rossi, Ph.D., and others, in the April 6, 1999 Annals of Internal Medicine 130, pp. 545-553.

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