Disparities in hormone replacement therapy use by socioeconomic status in a primary care population

The use of hormone replacement therapy (HRT) is a controversial decision fo r many women, yet few studies have evaluated the socio-demographic, psychol ogical, and behavioral correlates of HRT use. This cross-sectional, mailed survey evaluated the associations of socioeconomic status, preventive healt h behaviors, knowledge and perceptions about HRT-related risks and benefits with HRT use among 428 women 50-70 years old in Vermont. The overall preva lence of HRT use was 40%. Women of moderate to high income were three times more likely than those of low income to use HRT. HRT use was significantly higher among women whose physician had encouraged use (58%) than among tho se who received ambivalent recommendations from their physicians (20%). Hys terectomy, higher income, younger age, regular adherence to cervical cancer screening, and recommendation by a provider were significantly associated with HRT use in multivariate analyses. There were no differences in HRT use according to level of concern about heart disease, osteoporosis, or breast cancer. A recommendation by a health care provider is a powerful predictor of HRT use, but disparities in use exist by socioeconomic status. Future r esearch should examine why lower income women are less likely to use HRT an d whether the discrepancy is due to inconsistent recommendations by health care providers.