Socioeconomic status and HRT prescribing: a study of practice-level data in England.
cross-sectional studies
female
general practice
hormone replacement therapy
menopause
prescribing
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
19
02
2020
accepted:
07
05
2020
pubmed:
30
9
2020
medline:
25
6
2021
entrez:
29
9
2020
Statut:
epublish
Résumé
Concerns have been raised that women from deprived backgrounds are less likely to be receiving hormone replacement therapy (HRT) treatment and its benefits, although evidence in support of this is lacking. To investigate general practice HRT prescription trends and their association with markers of socioeconomic deprivation. Cross-sectional study of primary care prescribing data in England in 2018. Practice-level prescribing rate was defined as the number of items of HRT prescribed per 1000 registered female patients aged ≥40 years. The association between Index of Multiple Deprivation (IMD) score and HRT prescribing rate was tested using multivariate Poisson regression, adjusting for practice proportions of obesity, smoking, hypertension, diabetes, coronary heart disease and cerebrovascular disease, and practice list size. The overall prescribing rate of HRT was 29% lower in practices from the most deprived quintile compared with the most affluent (incidence rate ratio [IRR] = 0.71; 95% confidence interval [CI] = 0.68 to 0.73). After adjusting for all cardiovascular disease outcomes and risk factors, the prescribing rate in the most deprived quintile was still 18% lower than in the least deprived quintile (adjusted IRR = 0.82; 95% CI = 0.77 to 0.86). In more deprived practices, there was a significantly higher tendency to prescribe oral HRT than transdermal preparations ( This study highlights inequalities associated with HRT prescription. This may reflect a large unmet need in terms of menopause care in areas of deprivation. Further research is needed to identify the factors from patient and GP perspectives that may explain this.
Sections du résumé
BACKGROUND
Concerns have been raised that women from deprived backgrounds are less likely to be receiving hormone replacement therapy (HRT) treatment and its benefits, although evidence in support of this is lacking.
AIM
To investigate general practice HRT prescription trends and their association with markers of socioeconomic deprivation.
DESIGN AND SETTING
Cross-sectional study of primary care prescribing data in England in 2018.
METHOD
Practice-level prescribing rate was defined as the number of items of HRT prescribed per 1000 registered female patients aged ≥40 years. The association between Index of Multiple Deprivation (IMD) score and HRT prescribing rate was tested using multivariate Poisson regression, adjusting for practice proportions of obesity, smoking, hypertension, diabetes, coronary heart disease and cerebrovascular disease, and practice list size.
RESULTS
The overall prescribing rate of HRT was 29% lower in practices from the most deprived quintile compared with the most affluent (incidence rate ratio [IRR] = 0.71; 95% confidence interval [CI] = 0.68 to 0.73). After adjusting for all cardiovascular disease outcomes and risk factors, the prescribing rate in the most deprived quintile was still 18% lower than in the least deprived quintile (adjusted IRR = 0.82; 95% CI = 0.77 to 0.86). In more deprived practices, there was a significantly higher tendency to prescribe oral HRT than transdermal preparations (
CONCLUSION
This study highlights inequalities associated with HRT prescription. This may reflect a large unmet need in terms of menopause care in areas of deprivation. Further research is needed to identify the factors from patient and GP perspectives that may explain this.
Identifiants
pubmed: 32988956
pii: bjgp20X713045
doi: 10.3399/bjgp20X713045
pmc: PMC7523922
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e772-e777Informations de copyright
© British Journal of General Practice 2020.
Références
Endocr Pract. 2017 Jul;23(7):869-880
pubmed: 28703650
J Psychosom Res. 1976;20(5):425-30
pubmed: 1003364
J Antimicrob Chemother. 2019 Jan 1;74(1):242-250
pubmed: 30239809
Endocr Rev. 2017 Jun 1;38(3):173-188
pubmed: 28323934
Lancet Psychiatry. 2019 Feb;6(2):140-150
pubmed: 30580987
BJOG. 2002 Dec;109(12):1319-30
pubmed: 12504965
J Clin Pharm Ther. 2001 Apr;26(2):93-101
pubmed: 11350531
JAMA. 2002 Jul 17;288(3):321-33
pubmed: 12117397
Climacteric. 2012 Jun;15(3):281-7
pubmed: 22612616
Fam Pract. 2020 Mar 25;37(2):194-199
pubmed: 31641756
Fam Pract. 2010 Oct;27(5):499-506
pubmed: 20530133
J Epidemiol Community Health. 1995 Aug;49(4):389-94
pubmed: 7650462
Arch Gynecol Obstet. 2011 Jan;283(1):83-90
pubmed: 20013287