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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
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From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and University of Massachusetts, Amherst, Massachusetts.

Ann Intern Med. 1999;130(7):545-553. doi:10.7326/0003-4819-130-7-199904060-00002
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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.


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Figure 1.
Use of hormone replacement therapy among postmenopausal women 50 to 74 years of age by U.S. region in 1995.P

Bars represent frequencies ± SD. = 0.02 for comparison of the four regions by the stratified Mantel-Haenszel chi-square test.

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Figure 2.
Use of hormone replacement therapy among postmenopausal women 50 to 74 years of age by cardiac risk factors in 1995.P

Bars represent frequencies ± SD. = 0.004 for comparison of the four regions by the stratified Mantel-Haenszel chi-square test. White bars represent the presence of a cardiac risk factor; striped bars represent the absence of a cardiac risk factor. MI = myocardial infarction.

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Grahic Jump Location
Figure 3.
Multivariable correlates of use of postmenopausal hormone replacement therapy.

A main-effects logistic regression model was used to adjust for all variables shown, as well as ethnicity, marital status, number of children, waist-to-hip ratio, income, somatic amplification, self-reported depression, worry about illness, hypertension, high cholesterol level, smoking, family history of myocardial infarction, and personal history of angina or myocardial infarction. Adjusted odds ratios are shown with corresponding 95% CIs on a logarithmic scale.

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