MacDougall L A, Barzilay J I, Helmick C G
Massachusetts Cancer Registry, Bureau of Health Statistics, Research, and Evaluation, Massachusetts Department of Public Health, Boston, USA.
J Womens Health Gend Based Med. 1999 Nov;8(9):1203-11. doi: 10.1089/jwh.1.1999.8.1203.
Previous studies of factors important in a woman's decision to use hormone replacement therapy (HRT) infrequently have simultaneously considered the effects of personal concern for chronic medical disorders that begin at the time of the menopause (such as osteoporosis and heart disease) and knowledge of the beneficial and adverse effects of HRT on these conditions (increased risk of uterine and breast cancers). Moreover, few studies have been performed in broad-based populations that have included black women. This study was undertaken to determine the cross-sectional association of concern for chronic medical disorders that begin at the time of the menopause and knowledge of the effects of HRT on these disorders on the ever use of HRT in a biracial cohort of postmenopausal women. Two hundred eight-eight women, aged 50-54 years, who were members of an HMO, who reported their last menstrual period to be more than 1 year ago, and who were aware of HRT, were examined by questionnaire. Of the cohort, 21.2% were black. Concern for chronic medical disorders that begin at the time of the menopause was modest (approximately 50%). Knowledge of the effects of HRT on breast cancer, uterine cancer, and heart disease was low (approximately 30%). Only for osteoporosis was knowledge high (approximately 65%). On adjusted analysis, concern for heart disease was weakly associated with ever use of HRT, but only for white women. The factors most strongly associated with initiating HRT were a doctor's recommendation to use HRT and satisfaction with a doctor's counseling. Having menopausal symptoms was associated with ever use of HRT in black women. Black women were only 30% as likely as white women to ever use HRT after adjustment for baseline differences.
In this study, personal concerns for medical conditions that begin at the time of the menopause and knowledge of the effects of HRT on these conditions were low. Only personal concern for heart disease among white women was independently, but weakly, associated with ever use of HRT. Black women were less likely than white women to ever use HRT, even after adjustment for baseline differences between them.
以往关于女性决定使用激素替代疗法（HRT）的重要因素的研究很少同时考虑到对绝经时开始出现的慢性疾病（如骨质疏松症和心脏病）的个人关注，以及对HRT对这些疾病的利弊（子宫癌和乳腺癌风险增加）的了解。此外，很少有研究在包括黑人女性在内的数据广泛的人群中进行。本研究旨在确定在一个双种族绝经后女性队列中，对绝经时开始出现的慢性疾病的关注以及对HRT对这些疾病影响的了解与HRT的既往使用之间的横断面关联。通过问卷调查对288名年龄在50 - 54岁、是健康维护组织（HMO）成员、报告其末次月经时间在1年以上且知晓HRT的女性进行了调查。该队列中21.2%为黑人。对绝经时开始出现的慢性疾病的关注程度适中（约50%）。对HRT对乳腺癌、子宫癌和心脏病影响的了解程度较低（约30%）。仅对骨质疏松症的了解程度较高（约65%）。经调整分析，对心脏病的关注与HRT的既往使用呈弱关联，但仅在白人女性中如此。与开始使用HRT关联最密切的因素是医生建议使用HRT以及对医生咨询的满意度。有更年期症状与黑人女性使用HRT有关。在对基线差异进行调整后，黑人女性使用HRT的可能性仅为白人女性的30%。
在本研究中，对绝经时开始出现的医疗状况的个人关注以及对HRT对这些状况影响的了解程度较低。仅白人女性对心脏病的个人关注与HRT的既往使用独立但呈弱关联。即使在对黑人女性和白人女性之间的基线差异进行调整后，黑人女性使用HRT的可能性仍低于白人女性。
