Differences in hormone replacement therapy use by social class, region and psychological symptoms

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Abstract

Objective To describe the relationship between socio-demographic factors, heart disease risk factors, psychological symptoms and the use of hormone replacement therapy by English women.

Design Cross-sectional analysis of a population-based survey.

Setting England.

Population 13,214 women aged 40–69 years who participated in the nurse-administered schedule of the Health Survey for England between 1993 and 1996.

Outcome Current hormone replacement therapy use.

Results Women from social classes II and I and women who live in the south of England were more likely to use hormone replacement therapy independently of a range of socio-demographic factors including education. The adjusted odds ratio for social classes II and I compared with social classes IV and V was 1.51 (95% CI 1.20 to 1.91) and for women in the South of England was 1.38 (95% CI 1.18 to 1.62). Women with a history of heart disease and those with high cholesterol levels were less likely to use hormone replacement therapy. Women with psychological symptoms were more likely to be prescribed hormone replacement therapy, as were those who had recently seen a doctor.

Conclusion There is marked socio-demographic inequity in use of hormone replacement therapy. This may accentuate existing inequalities in health and reduce any potential benefits of Hormone Replacement Therapy for public health. The relationship between psychological symptoms, use of medical services and use of hormone replacement therapy suggests that hormone replacement therapy is prescribed for the management of psychological symptoms.

Introduction

The use of hormone replacement therapy (HRT) is advocated both for the relief of menopausal symptoms and prevention of chronic disease. There is still uncertainty on the risks and benefits of HRT, particularly with regards to the prevention of ischaemic heart disease and the increased risk of breast cancer1., 2.. There is, however, evidence that prescription of HRT is influenced by social circumstances and is not solely based on an objective assessment of risks and benefits. Studies in the United States and Europe have found that women with higher social and educational status are more likely to receive HRT, while women at high risk of osteoporosis and heart disease are less likely to receive HRT3., 4., 5., 6., 7..

There is limited information on the pattern of use of HRT in the United Kingdom with conflicting findings with regard to the role of social circumstances8., 9., 10., 11., 12., 13.. A follow up of the contraceptive study8 conducted by the Royal College of General Practitioners failed to find a relationship between social class and use of hormone replacement therapy. However, analysis of the VAMP general practice database found an effect for social class but not education9. Most of these studies are limited either by sample size or representativeness. In this paper, we use the Health Survey for England to describe inequalities in use of HRT and compare risk factors for ischaemic heart disease and self-reported psychological status between users and non-users in a national sample of women.

Section snippets

Methods

Our study used data from the Health Survey for England for the four years, 1993 to 1996. The Health Survey for England is an annual survey of people living in households in England commissioned by The Department of Health14., 15., 16., 17.. The survey is conducted in two stages with an initial administered questionnaire followed by a nurse visit for physical measurements and biological sampling. The survey aims to include a representative sample of the population and asks a variable range of

Results

One thousand nine hundred and forty-one women (14.6%) aged 40 to 69 were users of HRT. Use was highest among 50-54 year olds (28.9%) and lowest among women over the age of 65 (4%). Use increased annually from 12.6% in 1993 to 16.2% in 1996 (OR for year =1.10 (95% CI: 1.05-1.14)). Use was commoner among women who reported that their periods stopped as a result of an operation (Table 1).

Women from social classes I and II were more likely to use hormone replacement therapy as were women who live

Discussion

In this study we have described patterns of use of hormone replacement therapy in a large representative sample of English women. Large inequalities in use exist in relation to social class, region and ethnicity. We have also found that women with a history of ischaemic heart disease and women with high cholesterol levels are less likely to receive HRT. Women with psychological symptoms and those who have seen a doctor recently are more likely to use HRT.

Our study addressed two of the major

Acknowledgements

The data for this study were provided by The Data Archive of the University of Essex. The authors would like to thank the Data Archive and the depositors of the information for permission to use the data. Material from the Health Survey for England is Crown Copyright and has been made available by the Office of National Statistics, the Joint Health Surveys Unit of Social and Community Planning Research and the Department of Epidemiology and Public Health at University College, London. Neither

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