THE DECLINING IMPACT OF RACE AND INSURANCE STATUS ON HORMONE REPLACEMENT THERAPY

Objective Socioeconomic barriers may limit the adoption of hormone rep lacement therapy, but little is known about recent trends in their inf luence. We evaluated trends in the impact of race and insurance status on national rates of hormone replacement therapy. Design: We analyzed 32,608 physician office visits by nonpregnant women 40 years of age a nd older available from the 1989 through 1996 National Ambulatory Medi cal Care Surveys. The proportion of visits with new or continuing use of noncontraceptive estrogens reported was the main outcome measured. Multiple logistic regression was used to evaluate the independent. eff ects of year, race, and expected payment source on hormone replacement therapy. Results: Overall, the report of hormone replacement therapy increased from 5.7% of visits in 1989-1990 to 10.9% in 1995-1996. In 1 989-1990, hormone replacement therapy was less likely in nonwhite wome n (3.6% vs. 6.3% for whites) and in women with Medicaid coverage (1.3% vs. 8.4% for privately insured women). These differences diminished o ver time, particularly for women without menopausal symptoms. In 1989- 1990. the adjusted odds ratio of hormone replacement in women without menopausal symptoms was 0.31 (95% confidence interval 0.2-0.5) in nonw hites compared with whites, but increased to 0.57 (0.4-0.8) 1995-1996. In 1989-1990, the adjusted odds ratio far hormone replacement among w omen with Medicaid was 0.31 (0.09-1.0) compared with those with privat e insurance. This ratio increased to 0.86 (0.5-1.4) by 1995-1996. Conc lusions: Racial and payment source influences on hormone replacement t herapy appeared to have lessened over time. Despite these changes subs tantial socioeconomic differences in treatment patterns remain to be a ddressed. ((Menopause 1998,5.140-144. (C) 1998, The North American Men opause Society.)