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

Objective To describe the relationship between socio-demographic factors, h eart disease risk factors, psychological symptoms and the use of hormone re placement 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-admi nistered 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 independentl y 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 thos e with high cholesterol levels were less likely to use hormone replacement therapy. Women with psychological symptoms were more likely to be prescribe d hormone replacement therapy, as were those who had recently seen a doctor . Conclusion There is marked socio-demographic inequity in use of hormone rep lacement therapy. This may accentuate existing inequalities in health and r educe any potential benefits of Hormone Replacement Therapy for public heal th, The relationship between psychological symptoms, use of medical service s and use of hormone replacement therapy suggests that hormone replacement therapy is prescribed for the management of psychological symptoms.