Postmenopausal estrogen use among African American and white patients at an urban clinic

Our objective was to compare the use of estrogen replacement therapy (ERT) in African American and white women patients in clinical practice using a cross-sectional survey of patients and their primary medical providers. Participants were perimenopausal and postmenopausal African American women (n = 88) and white women (n = 53) who were active patients at the hospital-based clinic of an urban academic medical center. The outcome measurements were the proportion of women for whom ERT was indicated according to authoritative guidelines, past and present use of ERT, and the proportion of women with an ERT gap (i.e., women for whom ERT was indicated but who had never used it). The effect on ERT use of personal and medical characteristics (e.g., coronary heart disease risk) was also assessed. African-American patients were significantly younger than white patients and significantly more often had histories of hysterectomy or high coronary heart disease risk. Education level was similar in the two groups, with only a small proportion of women having any education beyond high school. Thirty percent of African American patients had used ERT compared with 21% of white patients (p > 0.1). Age-adjusted and multivariate analyses confirmed that race was not independently associated with ERT use. ERT was indicated for 71% of African American patients and 58% of white patients. This difference was not significant, nor was there a significant difference in the proportion of women with an ERT gap in the two groups. In contrast to previously published reports, African American women in our sample of active patients were not less likely to have used ERT than white women. This finding may reflect similar access to care, comparable level of education, or increasing awareness in clinical practice that ERT should be considered for African American patients for indications other than osteoporosis, such as past hysterectomy or coronary disease risk. According to authoritative guidelines, ERT was substantially underused in patients of both races. Our study did not have sufficient sample size or diversity of sites to exclude conclusively lower rates of ERT use in African American patients than in white patients, but our findings suggest that additional, larger studies of ERT use among women of diverse races should be undertaken.