Use of postmenopausal hormone replacement therapy by African American women - The importance of physician discussion

Background: Although nationally the use of hormone replacement therapy (HRT) has increased dramatically in the last decade, little is known about its use by disadvantaged, minority women or the role that physician discussion plays in determining its use. Methods: In 1994, we surveyed a total of 328 predominantly indigent, African American women (refusals, 22) who attended public hospital medical continuity of care clinics staffed by internal medicine house officers. Results: Of the 328 women who completed the survey, the mean age was 63 years, 302 women (92%) were African American, and 286 (87.3%) had yearly incomes of less than $10000. Of the 328 women, 52 (15.6%) were receiving HRT at the time of the survey, varying from 22 (28.2%) of 78 women aged 50 to 59 years to 1 (3%) of 33 women older than 80 years (P=.006). In a logistic regression model adjusting for age and ethnicity, women who had previously undergone a hysterectomy were significantly more likely to use HRT, with an odds ratio of 2.76 (95% confidence interval, 1.44-5.30; P=.002). The levels of education and income and the history of myocardial infarction were not significantly associated with the use of HRT (P>.20). Although all women who were currently receiving HRT recalled discussing HRT with their physicians, of the 276 women who were not receiving HRT, only 62 (22%) recalled any such discussion (P<.001). Conclusions: In poor, African American women who reside in the inner city, younger age, undergoing a hysterectomy, and physician discussion of HRT are significantly associated with current use of HRT. Physician discussion of HRT may need greater emphasis in internal medicine training programs.