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Use of Hormone Replacement Therapy by Postmenopausal Women in the United States
- Nancy L. Keating, MD, MPH;
- Paul D. Cleary, PhD;
- Alice S. Rossi, PhD;
- Alan M. Zaslavsky, PhD; and
- John Z. Ayanian, MD, MPP
- From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and University of Massachusetts, Amherst, Massachusetts.
Abstract
Background: The benefits and risks of hormone replacement therapy (HRT) in postmenopausal women are not fully defined, and individual characteristics and preferences may influence decisions to use this therapy. Previous studies of postmenopausal women who use HRT have been conducted in local or highly selected cohorts or have not focused on current use.
Objective: To examine sociodemographic, clinical, and psychological factors associated with current use of HRT in a national population-based cohort.
Design: Random-digit telephone survey.
Setting: Probability sample of U.S. households with a telephone.
Participants: 495 postmenopausal women 50 to 74 years of age in 1995.
Measurements: Current use of HRT.
Results: Current use of HRT was reported by 37.6% of women (58.7% of those who underwent hysterectomy and 19.6% of those who did not undergo hysterectomy; P = 0.001). In multivariable analyses, use of HRT was more common among women in the South (adjusted odds ratio, 2.67 [95% CI, 1.08 to 6.59]) and West (odds ratio, 2.76 [CI, 1.01 to 7.53]) than the Northeast. Use was more common among college graduates (odds ratio, 3.72 [CI, 1.29 to 10.71]) and less common among women with diabetes mellitus (odds ratio, 0.17 [CI, 0.05 to 0.51]). Other cardiac risk factors and most psychological characteristics were not associated with HRT use.
Conclusions: Sociodemographic factors, such as region and education, may be more strongly associated with use of HRT than clinical factors, such as risk for cardiovascular disease. Future efforts should focus on understanding sociodemographic variations, defining which women are most likely to benefit, and targeting therapy to them.
Article and Author Information
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This study was presented at the plenary session of the 20th Annual Meeting of the Society of General Internal Medicine, Washington, D.C., 2 May 1997.
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Acknowledgments: The authors thank the members and associates of the John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development (Orville Gilbert Brim, PhD, Director) for their contributions to the design of this national survey; John Orav, PhD, for advice on statistical analyses; Mannie Liu, PhD, and Larry Zaborski, MA, MS, for assistance with computer programming; and Arnold M. Epstein, MD, MA, Matthew H. Liang, MD, MPH, and Barbara J. McNeil, MD, PhD, for helpful comments on an earlier draft of the manuscript.
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Grant Support: By a grant from the John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development (http://midmac.med.harvard.edu/home.html). Dr. Keating is a recipient of a National Research Service Award from the Agency for Health Care Policy and Research. Dr. Ayanian is a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation.
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Requests for Reprints: John Z. Ayanian, MD, MPP, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
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Current Author Addresses: Drs. Keating, Cleary, Zaslavsky, and Ayanian: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
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Dr. Rossi: 34 Stagecoach Road, Amherst, MA 01002.
- Copyright ©2004 by the American College of Physicians
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