Medication Use by Race and Ethnicity in Women Transitioning Through the Menopause: A Study of Women's Health Across the Nation Drug Epidemiology Study

Abstract

Background: Medication utilization and costs increased over the last decade, but the effects of race/ethnicity have never been well studied in longitudinal data. We analyzed reports of prescription medication use to (1) identify trajectories of use and (2) determine predictors associated with a large increase in use. Specifically, variations in medication use by race/ethnicity were examined.

Methods: We analyzed the Study of Women's Health Across the Nation cohort with a median of 14 years of follow-up. Group-based trajectory models helped distinguish women with a low use of medications versus those with heavy use. Logistic regression was used to estimate the odds ratio (OR) for each racial/ethnic group associated with heavy use, controlling for potential baseline confounders.

Results: The 2,798 women sampled had a mean age of 46 years at baseline and the median number of medications at baseline was 2, increasing to 4 over the follow-up period. Trajectory models identified that 16% of participants demonstrated heavy use of medications, from a median of 5 at baseline to 10 medications at final follow-up. Regression models controlling for age, obesity, number of comorbid conditions, and pain found that Hispanic (OR = 0.085, 95% confidence interval [CI]: 0.037-0.20), Chinese (OR = 0.32, 95% CI: 0.16-0.63), Japanese (OR = 0.33, 95% CI: 0.17-0.64), and Black (OR = 0.79, 95% CI: 0.57-1.11) women had lower odds for heavy use compared with White women.

Conclusions: Longitudinal medication use among women in Study of Women's Health Across the Nation (SWAN) differed by race/ethnicity with non-White women having a lower odds of heavy use.

FIG. 1.

The median number (and interquartile range) of medications as noted at each visit across the span of Study of Women's Health Across the Nation (SWAN), for all women. Visit 11 has missing medication data for all participants.

FIG. 2.

This plot illustrates the proportion of women in SWAN using medications by category of medication. The x-axis (time) is plotted as years before or after the final menstrual period (FMP), which is denoted by a zero.

FIG. 3.

Trajectories of total medication utilization across the span of SWAN, for all women. The black line represents the low medication use trajectory and the grey line the heavy medication use trajectory.

FIG. 4.

LOESS smoothed regression curve plotting the number of medications for women in SWAN during the 5 years before the FMP and the 10 years after.