White women 50 years of age and older are more apt to be prescribed hormone replacement therapy (HRT) than women who are black, Asian, or Hispanic, or who are Soviet immigrants. Yet, with the exception of osteoporosis, women from these other ethnic groups are more likely to have medical conditions that would warrant HRT, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS07373).
Among the participants in this study, black women were more likely than white women to have hypertension, diabetes, and coronary heart disease (CHD) but less likely to have osteoporosis. Asian women were significantly more likely to have hypertension and diabetes, while Latinas were more apt to have hypertension. Soviet immigrants were more apt than whites to have hypertension and diabetes but less apt to have osteoporosis. There were no significant differences in breast cancer, usually a contraindication to HRT.
White women were significantly more likely to be prescribed HRT (33 percent) than Asians (21 percent), blacks (25 percent), Latinas (23 percent), or Soviet immigrants (6.6 percent). Also, women with osteoporosis were more than twice as likely (odds ration, 2.28) to be prescribed HRT, but those with CHD were not. These findings suggest that risk for osteoporosis is a more influential factor in doctors' decisions to prescribe HRT than know CHD risk factors.
This finding is particularly significant for black women, who have coronary mortality rates over 30 percent higher than white women and have not been included in most trials of postmenopausal HRT on CHD, according to lead author Arleen F. Brown, M.D. Dr. Brown, principal investigator A. Eugene Washington, M.D., M.Sc., and their colleagues at the Medical Effectiveness Research Center for Diverse Populations at the University of California, San Francisco (UCSF) analyzed the medical records of nearly 9,000 UCSF Medical Center female outpatients aged 50 and older who were prescribed HRT sometime during the 3-year study period.
More details are in "Ethnic differences in hormone replacement prescribing patterns," by Dr. Brown, Eliseo J. Perez-Stable, M.D., Eric E. Whitaker, M.D., M.P.H., and others, in the Journal of General Internal Medicine 14, pp. 663-669, 1999.