Ethnic differences in use of hormone replacement therapy: community based survey

Hormone replacement therapy is widely promoted to prevent cardiovascular disease and osteoporosis and relieve menopausal symptoms, although concern exists that much of the cardiovascular effect may be due to its selection by healthy women.[1] Little is known about its use by women from different ethnic groups in the United Kingdom, particularly women of south Asian origin, who are at increased risk of coronary heart disease,[2] osteoporosis,[3] and diabetes[4] compared with white women.

Subjects, methods, and results

A population based survey was carried out in Wandsworth, south London, where roughly 12% of residents are from the Caribbean or west Africa (that is, of African descent) and 6% are of Indian, Pakistani, or Bangladeshi origin (that is, south Asian). Women aged 40-59 were invited from nine general practices as part of a cardiovascular screening study.[4] The response rate was 66% (941/1429). Of the 941 women screened, 882 were from one of the ethnic groups being studied.

Ethnic group was recorded at interview on the basis of answers to several questions, including questions on country of birth, language, religion, history of migration, and parental country of birth. Women were asked to bring someone to translate if they could not speak English. This analysis is restricted to data recorded at the interview, as we were interested in factors in the history that could have influenced hormone prescribing. Proportions were compared with [chi square] and Fisher's exact tests. The odds of current hormone use was modelled using logistic regression.

White ethnic group, hysterectomy, smoking, and greater age were associated with current hormone use and were included in the model to produce adjusted odds ratios (table). All except smoking remained independently associated with hormone use. Adjusting for practice made little difference to the estimated odds ratios for other variables (data not shown). Restricting analyses to women over 50 gave similar differences between ethnic groups.