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Ethnic differences in hormone replacement prescribing patterns

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Abstract

OBJECTIVE: To determine whether prescription patterns of hormone replacement therapy (HRT) differ in African-American, Asian, Latina, Soviet immigrant, and white women.

DESIGN: Retrospective review of computerized medical records.

SETTING: The general internal medicine, family medicine, and gynecology practices of an academic medical center.

PATIENTS: Women aged 50 years or older with at least one outpatient visit from January 1, 1992, to November 30, 1995.

MEASUREMENTS AND MAIN RESULTS: Use of HRT was defined as documentation of systemic estrogen use. The main predictor variable was self-identified ethnicity. Age, diagnosis (coronary heart disease, hypertension, diabetes, osteoporosis, or breast cancer), and median income were included in the analysis. Of the 8,968 women (mean age, 65.4 years) included, 50% were white, 20% Asian, 15% African American, 9% Latina, and 6% Soviet immigrants. Whites (33%) were significantly more likely to be prescribed HRT than Asians (21%), African Americans (25%), Latinas (23%), or Soviet immigrants (6.6%), p<0.01 for each. Multivariate analysis, comparing ethnic groups and controlling for confounding variables, showed that Asians (odds ratio [OR] 0.56; 95% confidence interval [CI] 0.49, 0.64), African Americans (OR 0.70; 95% CI 0.60, 0.81), Latinas (OR 0.70; 95% CI 0.58, 0.84), and Soviet immigrants (OR 0.14; 95% CI 0.10, 0.20) were each less likely to be prescribed HRT than were white women. Although women with osteoporosis were more likely to receive HRT (OR 2.28; 95% CI 1.71, 2.99), those with coronary heart disease were not (OR 0.88; 95% CI 0.68, 1.09).

CONCLUSIONS: Physicians at this medical center were more likely to prescribe HRT for white women and women with osteoporosis. Further study is needed to address whether these differences in HRT prescribing result in different health outcomes.

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References

  1. Kiel DP, Felson DT, Anderson JJ, Wilson PW, Moskowitz MA. Hip fracture and the use of estrogens in postmenopausal women: the Framingham study. N Engl J Med. 1987;317:1169–74.

    Article  PubMed  CAS  Google Scholar 

  2. Johnson RE, Specht EE. The risk of hip fracture in postmenopausal females with or without estrogen drug exposure. Am J Public Health. 1981;71:138–44.

    PubMed  CAS  Google Scholar 

  3. Paganini-Hill A, Ross RK, Gerkins VR, Henderson BE, Arthur M, Mack TM. Menopausal estrogen therapy and hip fractures. Ann Intern Med. 1981;95:28–31.

    PubMed  CAS  Google Scholar 

  4. Ettinger B, Genant HK, Cann CE. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med. 1985;102:319–24.

    PubMed  CAS  Google Scholar 

  5. Naessen T, Persson I, Adami HO, Bergstrom R, Bergkvist L. Hormone replacement therapy and the risk for first hip fracture: a prospective, population-based cohort study. Ann Intern Med. 1990;113:95–103.

    PubMed  CAS  Google Scholar 

  6. Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117:1016–37. See comments.

    PubMed  CAS  Google Scholar 

  7. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women: Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767–73. See comments.

    Article  PubMed  CAS  Google Scholar 

  8. Sullivan JM, Vander Zwaag R, Hughes JP, et al. Estrogen replacement and coronary artery disease: effect on survival in postmenopausal women. Arch Intern Med. 1990;150:2557–62.

    Article  PubMed  CAS  Google Scholar 

  9. Stampfer MJ, Colditz GA. Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prev Med. 1991;20:47–63.

    Article  PubMed  CAS  Google Scholar 

  10. Criqui MH, Suarez L, Barrett-Connor E, McPhillips J, Wingard DL, Garland C. Postmenopausal estrogen use and mortality: results from a prospective study in a defined, homogeneous community. Am J Epidemiol. 1988;128:606–14.

    PubMed  CAS  Google Scholar 

  11. Ettinger B, Friedman GD, Bush T, Quesenberry CP Jr. Reduced mortality associated with long-term postmenopausal estrogen therapy. Obstet Gynecol. 1996;87:6–12.

    Article  PubMed  CAS  Google Scholar 

  12. Colditz GA, Egan KM, Stampfer MJ. Hormone replacement therapy and risk of breast cancer: results from epidemiologic studies. Am J Obstet Gynecol. 1993;168:1473–80.

    PubMed  CAS  Google Scholar 

  13. Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995;332:1589–93. See comments.

    Article  PubMed  CAS  Google Scholar 

  14. Stanford JL, Weiss NS, Voigt LF, Daling JR, Habel LA, Rosing MA. Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women. JAMA. 1995;274:137–42. See comments.

    Article  PubMed  CAS  Google Scholar 

  15. Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitti D. Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstet Gynecol. 1995;85:304–13.

    Article  PubMed  CAS  Google Scholar 

  16. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA. 1998;280:605–13.

    Article  PubMed  CAS  Google Scholar 

  17. Hemminki E, Kennedy DL, Baum C, McKinlay SM. Prescribing of noncontraceptive estrogens and progestins in the United States, 1974–86. Am J Public Health. 1988;78:1479–81.

    PubMed  CAS  Google Scholar 

  18. Cauley JA, Cummings SR, Black DM, Mascioli SR, Seeley DG. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol. 1990;163:1438–44.

    PubMed  CAS  Google Scholar 

  19. Griffiths F, Convery B. Women’s use of hormone replacement therapy for relief of menopausal symptoms, for prevention of osteoporosis, and after hysterectomy. Br J Gen Pract. 1995;45:355–8.

    PubMed  CAS  Google Scholar 

  20. Barrett-Connor E, Wingard DL, Criqui MH. Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited. JAMA. 1989;261:2095–100.

    Article  PubMed  CAS  Google Scholar 

  21. Campbell-Brown M, McEwan HP. Scottish gynaecologists: their views on hormone replacement therapy. Health Bull (Edinb). 1992;50:248–51. Erratum. Health Bull (Edinb). 1992;50(4):314.

    CAS  Google Scholar 

  22. Ponte CD, Swinker ML, Madhavan S. Estrogen replacement therapy: a pilot survey of primary care physicians in West Virginia. DICP-Ann Pharmacother. 1989;23:977–9.

    CAS  Google Scholar 

  23. Pasley BH, Standfast SJ, Katz SH. Prescribing estrogen during menopause: physician survey of practices in 1974 and 1981. Public Health Rep. 1984;99:424–9.

    PubMed  CAS  Google Scholar 

  24. Anderson E, Hamburger S, Liu JH, Rebar RW. Characteristics of menopausal women seeking assistance. Am J Obstet Gynecol. 1987;156:428–33.

    PubMed  CAS  Google Scholar 

  25. Ferguson KJ, Hoegh C, Johnson S. Estrogen replacement therapy: a survey of women’s knowledge and attitudes. Arch Intern Med. 1989;149:133–6.

    Article  PubMed  CAS  Google Scholar 

  26. Ross RK, Paganini-Hill A, Roy S, Chao A, Henderson BE. Past and present preferred prescribing practices of hormone replacement therapy among Los Angeles gynecologists: possible implications for public health. Am J Public Health. 1988;78:516–9.

    PubMed  CAS  Google Scholar 

  27. Schmitt N, Gogate J, Rothert M, et al. Capturing and clustering women’s judgment policies: the case of hormonal therapy for menopause. J Gerontol. 1991;46:92–101.

    Google Scholar 

  28. Pilote L, Hlatky MA. Attitudes of women toward hormone therapy and prevention of heart disease. Am Heart J. 1995;129:1237–8. Editorial.

    Article  PubMed  CAS  Google Scholar 

  29. Groeneveld FP, Bareman FP, Barentsen R, Dokter HJ, Drogendijk AC, Hoes AW. Relationships between attitude towards menopause, well-being and medical attention among women aged 45–60 years. Maturitas. 1993;17:77–88.

    Article  PubMed  CAS  Google Scholar 

  30. Stafford RS, Saglam D, Causino N, Blumenthal D. Low rates of hormone replacement therapy by U.S. physicians. J Gen Intern Med. 1996;11 (suppl 1): 89. Abstract.

    Google Scholar 

  31. Keating NL, Cleary PD, Rossi AS, Zaslavsky AM, Ayanian JZ. Use of hormone replacement therapy by postmenopausal women in the United States. Ann Intern Med. 1999;130:545–53.

    PubMed  CAS  Google Scholar 

  32. Nabulsi AA, Folsom AR, White A, et al. Association of hormonereplacement therapy with various cardiovascular risk factors in postmenopausal women. The Atherosclerosis Risk in Communicties Study Investigators. N Engl J Med. 1993;328:1069–75. See comments.

    Article  PubMed  CAS  Google Scholar 

  33. Egeland GM, Matthews KA, Kuller LH, Kelsey SF. Characteristics of noncontraceptive hormone users. Prev Med. 1988;17:403–11.

    Article  PubMed  CAS  Google Scholar 

  34. Bartman BA, Moy E. Racial differences in estrogen use among middle-aged and older women. Women’s Health Issues. 1998;8:32–44.

    Article  PubMed  CAS  Google Scholar 

  35. Bachhuber TL, Baybrook SL, Philbrick JT. Hormone replacement therapy: knowledge, attitudes and use among low income women. J Gen Intern Med. 1996;11(suppl 1):139. Abstract.

    Google Scholar 

  36. Pham KC, Freeman EW, Grisso TA. Ovarian aging and hormone replacement therapy: attitudes of Afro-american and Caucasian women. J Gen Intern Med. 1996;11(suppl 1):136. Abstract.

    Google Scholar 

  37. Jahnige K, Fiebach N. Postmenopausal estrogen use among African American and white patients at an urban clinic. J Women’s Health. 1997;6:93–101.

    Article  CAS  Google Scholar 

  38. McNagny SE, Wenger NK, Frank E. Personal use of postmenopausal hormone replacement therapy by women physicians in the United States. Ann Intern Med. 1997;127:1093–6.

    PubMed  CAS  Google Scholar 

  39. Holmes MM, Rovner DR, Rothert ML, et al. Women’s and physicians’ utilities for health outcomes in estrogen replacement therapy. J Gen Intern Med. 1987;2:178–82.

    Article  PubMed  CAS  Google Scholar 

  40. Garton M, Reid D, Rennie E. The climacteric, osteoporosis and hormone replacement; views of women aged 45–49. Maturitas. 1995;21:7–15.

    Article  PubMed  CAS  Google Scholar 

  41. Griffiths F. Women’s health concerns. Is the promotion of hormone replacement therapy for prevention important to women? Fam Pract. 1995;12:54–9.

    Article  PubMed  CAS  Google Scholar 

  42. Lip G, Beevers M, Churchill D, Beevers DG. Do clinicians prescribe HRT for hypertensive postmenopausal women? Br J Clin Pract. 1995;49:61–4.

    PubMed  CAS  Google Scholar 

  43. Carlisle DM, Leake BD, Shapiro MF. Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. Am J Public Health. 1995;85:352–6.

    PubMed  CAS  Google Scholar 

  44. Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med. 1996;334:635–41. See comments.

    Article  PubMed  CAS  Google Scholar 

  45. Norman SG, Studd JW. A survey of views on hormone replacement therapy. Br J Obstet Gynaecol. 1994;101:879–87.

    PubMed  CAS  Google Scholar 

  46. Sinclair HK, Bond CM, Taylor RJ. Hormone replacement therapy: a study of women’s knowledge and attitudes. Br J Gen Pract. 1993;43:365–70.

    PubMed  CAS  Google Scholar 

  47. Liao Y, Cooper RS. Continued adverse trends in coronary heart disease mortality among blacks, 1980–91. Public Health Rep. 1995;110:572–9; discussion, 570–2.

    PubMed  CAS  Google Scholar 

  48. Baird DD, Tyroler HA, Heiss G, Chambless LE, Hames CG. Menopausal change in serum cholesterol: black/white differences in Evans County, Georgia. Am J Epidemiol. 1985;122:982–93.

    PubMed  CAS  Google Scholar 

  49. Demirovic J, Sprafka JM, Folsom AR, Laitinen D, Blackburn H. Menopause and serum cholesterol: differences between blacks and whites. The Minnesota Heart Survey. Am J Epidemiol. 1992;136:155–64.

    PubMed  CAS  Google Scholar 

  50. Nicholson WK, Brown AF, Gathe J, Grumbach K, Washington AE, Pérez-Stable EJ. Hormone replacement therapy for African-American women: missed opportunities for effective intervention. Menopause. 1999; 6(2):147–55.

    Article  PubMed  CAS  Google Scholar 

  51. Nabulsi AA, Folsom AR, White A, et al. Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. The Atherosclerosis Risk in Communities Study Investigators. N Engl J Med. 1993;328:1069–75. See comments.

    Article  PubMed  CAS  Google Scholar 

  52. Cronkright PJ, DeHaven K, Kraev IA. Issues in the provision of health care to Soviet emigrants. Arch Fam Med. 1993;2:425–8.

    Article  PubMed  CAS  Google Scholar 

  53. Haywood LJ, Ell K, de Guman M, Norris S, Blumfield D, Sobel E. Chest pain admissions: characteristics of black, Latino, and white patients in low- and mid-socioeconomic strata. J Natl Med Assoc. 1993;85:749–57. Erratum. J Natl Med Assoc. 1993;85(12):950.

    PubMed  CAS  Google Scholar 

  54. Stroup-Benham CA, Treviño FM. Reproductive characteristics of Mexican-American, mainland Puerto Rican, and Cuban-American women: data from the Hispanic Health and Nutrition Examination Survey. JAMA. 1991;265:222–6.

    Article  PubMed  CAS  Google Scholar 

  55. Daley J. Medical uncertainty and practice variation get personal: What should I do about hormone replacement therapy? Ann Intern Med. 1999;130:602–3.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Received from the Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, Calif.

    Arleen F. Brown MD,  Eliseo J. Pérez-Stable MD, Eric E. Whitaker MD, MPH, Samuel F. Posner PhD, Mark Alexander PhD, Julia Gathe MD & A. Eugene Washington MD, MSc

  2. the Center for Aging in Diverse Communities, University of California, San Francisco, Calif.

    Eliseo J. Pérez-Stable MD, Mark Alexander PhD & A. Eugene Washington MD, MSc

  3. the Division of General Internal Medicine in the Department of Medicine, University of California, San Francisco, Calif.

    Arleen F. Brown MD & Eric E. Whitaker MD, MPH

  4. the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Calif.

    Samuel F. Posner PhD, Mark Alexander PhD, Julia Gathe MD & A. Eugene Washington MD, MSc

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  1. Arleen F. Brown MD
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  2. Eliseo J. Pérez-Stable MD
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Additional information

This project was supported by grant HS07373-01 from the Agency for Health Care Policy and Research and by grant 1P30 AG15272 awarded by the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Minority Health.

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Brown, A.F., Pérez-Stable, E.J., Whitaker, E.E. et al. Ethnic differences in hormone replacement prescribing patterns. J GEN INTERN MED 14, 663–669 (1999). https://doi.org/10.1046/j.1525-1497.1999.10118.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1999.10118.x

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