University of California, San Francisco, CA.
Menopause. 2022 Jul 1;29(7):877-882. doi: 10.1097/GME.0000000000001978.
Racial/ethnic disparities in menopause symptoms and hormone therapy management remain understudied among women served by the Veteran's Health Administration, despite the unique racial/ethnic diversity of this population. Thus, we determined racial/ethnic disparities in medical record-documented menopause symptoms and prescribed menopausal hormone therapy among women veterans.
We conducted cross-sectional analyses of national Veteran's Health Administration electronic health record data from 2014 to 2015. We used logistic regression models to compare medical-record documented menopause symptoms and treatment (eg, vaginal estrogen or systemic hormone therapy) by self-identified race/ethnicity, adjusting for age, body mass index, and depression. Models examining hormone treatment were adjusted for menopause symptoms.
Among 200,901 women veterans (mean age 54.3, SD 5.4 y; 58% non-Hispanic/Latinx White, 33% non-Hispanic/Latinx Black, 4% Hispanic/Latinx, and 4% other), 5% had documented menopause symptoms, 5% were prescribed vaginal estrogen, and 5% were prescribed systemic hormone therapy. In fully adjusted multivariable models, non-Hispanic/Latinx Black women veterans had lower odds of documented menopause symptoms relative to non-Hispanic/Latinx White women (OR 0.82, 95% CI: 0.78-0.86). Moreover, non-Hispanic/Latinx Black women (OR 0.74, 95% CI: 0.70-0.77), as well as Hispanic/Latinx women (OR 0.68, 95% CI: 0.61-0.77), had lower likelihood of systemic hormone therapy prescription. Hispanic/Latinx women had higher odds of vaginal estrogen prescription (OR 1.12 95% CI: 1.02-1.24) than non-Hispanic/Latinx White women. Non-Hispanic/Latinx Black women had lower likelihood of estrogen use (OR 0.78 95% CI: 0.74-0.81) than non-Hispanic/Latinx White women.
Despite evidence suggesting higher menopause symptom burden among Black women in community samples, documented menopause symptoms and hormone therapy were less common among Black, compared with White, women veterans. Additionally, Hispanic/Latinx women veterans had lower odds of prescribed systemic menopause therapy and yet higher odds of prescribed vaginal estrogen, despite no difference in documented symptoms. These findings may signal important disparities in symptom reporting, documentation, and/or treatment for minority women veterans.
尽管退伍军人健康管理局服务的女性人群具有独特的种族/民族多样性，但在绝经症状和激素治疗管理方面的种族/民族差异仍在医学研究中鲜有涉及。因此，我们旨在确定退伍军人健康管理局女性患者的医疗记录中记录的绝经症状和规定的绝经激素治疗方面的种族/民族差异。
我们对 2014 年至 2015 年全国退伍军人健康管理局电子健康记录数据进行了横断面分析。我们使用逻辑回归模型，根据自我认同的种族/民族，比较医疗记录中记录的绝经症状和治疗方法（例如阴道雌激素或全身激素治疗），同时调整年龄、体重指数和抑郁状况。检查激素治疗的模型则根据绝经症状进行调整。
在 200901 名女性退伍军人中（平均年龄 54.3±5.4 岁；58%为非西班牙裔/拉丁裔白人，33%为非西班牙裔/拉丁裔黑人，4%为西班牙裔/拉丁裔，4%为其他），有 5%有记录的绝经症状，5%接受了阴道雌激素治疗，5%接受了全身激素治疗。在完全调整后的多变量模型中，非西班牙裔/拉丁裔黑人女性退伍军人记录的绝经症状的可能性低于非西班牙裔/拉丁裔白人女性（OR 0.82，95%CI：0.78-0.86）。此外，非西班牙裔/拉丁裔黑人（OR 0.74，95%CI：0.70-0.77）以及西班牙裔/拉丁裔女性（OR 0.68，95%CI：0.61-0.77）接受全身激素治疗的可能性更低。西班牙裔/拉丁裔女性接受阴道雌激素治疗的可能性更高（OR 1.12，95%CI：1.02-1.24）而非西班牙裔/拉丁裔白人女性。与非西班牙裔/拉丁裔白人女性相比，非西班牙裔/拉丁裔黑人女性使用雌激素的可能性更低（OR 0.78，95%CI：0.74-0.81）。
尽管有证据表明在社区样本中黑人女性的绝经症状负担更高，但与白人女性相比，黑人女性退伍军人记录的绝经症状和激素治疗的情况较少。此外，尽管记录的症状没有差异，但西班牙裔/拉丁裔女性退伍军人接受规定的全身绝经治疗的可能性较低，而接受阴道雌激素治疗的可能性较高。这些发现可能表明少数民族女性退伍军人在症状报告、记录和/或治疗方面存在重要差异。
