J Gen Intern Med 1999 Nov;14(11):663-9
Ethnic differences in hormone replacement prescribing patterns.
Brown AF, Perez-Stable EJ, Whitaker EE, Posner SF, Alexander M, Gathe
J, Washington AE.
Medical Effectiveness Research Center for Diverse Populations, University
of California, San Francisco 94143-0320, USA.
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. KEY WORDS: hormone replacement therapy;
postmenopausal women; ethnicity; physician prescribing; prevention.
PMID: 10571714 [PubMed - indexed for MEDLINE]
