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Multicenter Study
. 2005 Apr;20(4):350-6.
doi: 10.1111/j.1525-1497.2005.04059.x.

The impact of comorbidities on hormone use. After the 2000 release of the Women's Health Initiative

Katherine M Newton  1 , Diana S M Buist, Diana L Miglioretti, Kevin Beverly, Cynthia L Hartsfield, K Arnold Chan, Susan E Andrade, Feifei Wei, Maureen T Connelly, Larry Kessler
Affiliations
Multicenter Study

The impact of comorbidities on hormone use. After the 2000 release of the Women's Health Initiative

Katherine M Newton et al. J Gen Intern Med. 2005 Apr.

Abstract

Objective: Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow-up) release of the Women's Health Initiative EPT trial results (WHI).

Design, setting, and participants: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs.

Methods: We used pharmacy data to identify ET and EPT users. A woman was a user any month she filled > or =1 estrogen prescription and in subsequent months based upon the number of pills/patches dispensed. We used inpatient and outpatient claims to identify fracture January 1, 1999 to June 30, 2002 and pharmacy data to identify disease-based groups of medications for diabetes and cardiovascular disease.

Measures: EPT/ET prevalence, initiation, and discontinuation rates.

Results: Baseline to follow-up EPT and ET prevalence declined 45% and 22%, respectively, with no difference by comorbidity. Follow-up EPT initiation was half the baseline rate irrespective of comorbidity. Compared to baseline, follow-up EPT discontinuation rates increased among women with diabetes (relative risk [RR], 6.9; 95% confidence interval [CI], 5.6 to 8.4), cardiovascular disease (RR, 5.5; 95% CI, 4.9 to 6.2), fracture (RR, 3.8; 95% CI, 2.4 to 5.7), and no comorbidity (RR, 4.4; 95% CI, 3.9 to 4.9). The RRs for follow-up versus baseline EPT discontinuation were higher among women with diabetes (P<.01) and cardiovascular disease (P<.01) versus women without these comorbidities. ET discontinuation rates among these same groups were elevated 2- to 2.8-fold.

Conclusions: Diabetes and cardiovascular disease were associated with higher EPT discontinuation rates post-WHI compared to women without comorbidity; comorbidity had little impact on changes in prevalence or initiation of ET/EPT after release of the WHI.

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Figures

FIGURE 1
FIGURE 1
Study time line. WHI, Women's Health Initiative estrogen plus progestin (EPT) primary results publication; CERT, HMO Research Network's Center for Education and Research on Therapeutics Patient Safety Study Cohort.
FIGURE 2
FIGURE 2
Prevalence of estrogen (ET) use and estrogen plus progestin (EPT), among women age 40 to 80 years, with and without comorbidity (fracture, diabetes, or cardiovascular disease) from baseline* through December 2002. *Baseline includes combined data from September 1999 to June 2002. WHI, Women's Health Initiative EPT publication.
FIGURE 3
FIGURE 3
Rate of estrogen (ET) and estrogen plus progestin (EPT) initiation among women age 40 to 80 years, with and without comorbidity (fracture, diabetes, or cardiovascular disease) from baseline* through December 2002. *Baseline includes combined data from September 1999 to June 2002. WHI, Women's Health Initiative EPT publication.
FIGURE 4
FIGURE 4
Rate of estrogen (ET) and estrogen plus progestin (EPT) discontinuation among women age 40 to 80 years, with and without comorbidity (fracture, diabetes, or cardiovascular disease) from baseline* through December 2002. *Baseline includes combined data from September 1999 to June 2002. WHI, Women's Health Initiative EPT publication.
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References

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