The goal of this study was to evaluate potential racial differences in physicians' prescription patterns for hormone replacement therapy (HRT). The data for this analysis were derived from the 1993-1995 National Ambulatory Medical Care Surveys and Nation Hospital Ambulatory Medical Care Surveys. Both are nationally representative samples of visits to office-based physicians, outpatient and emergency departments, or nonfederal, short-stay hospitals in the United States. The study excluded emergency room visits and limited the sample to white and black women aged 45 to 64 years.

New or continuing prescriptions for HRT were reported in 9.2% of the total number of visits (95% confidence interval=8.0% to 10.3%). Prescriptions for HRT at visits by white women were double those of black women (9.7% for white women and 4.5% for black women, this difference was statistically significant). This pattern remained after adjusting for other factors such as type of physician, use of other medications, geographic region, and type of insurance (OR for white versus black=2.07, 95% confidence interval=1.48 to 2.90). Despite virtually equal medical care visit rates for black and white women (3.94 for white women versus 3.82 for black women), the rate of medical care visits per year in which HRT was prescribed to white women was more than twice the corresponding rate for black women (0.38 versus 0.17, this difference is statistically significant). The rate of visits to gynecologists was higher among white women, as was the rate of visits covered by private insurance. Visits in these categories tended to be more likely to include HRT prescriptions; so, racial differences in type of physician and insurance may explain at least part of the racial disparity in HRT prescriptions.

The authors state that these data, combined with previous research, suggest that "differences in HRT use by race might result from differences in the proportions of black and white women who receive information about HRT and request prescriptions for it." Another explanation offered is that "patients with physicians of the same race are more likely to take HRT." Finally, because a previous study reported that black women are uncomfortable talking to physicians about menopause, the authors hypothesize that "it is important for medical providers to be aware of differences in the ease with which women of different cultures and races talk about HRT and menopause, and to help break down any barrier to proper treatment."

This analysis is potentially biased by several factors, particularly the possible racial differences in the number or type of contraindications for HRT use or in the number or severity of menopausal symptoms, neither of which were measured.