Hillman, Sarah C., Shantikumar, Saran, Ridha, Ali, Todkill, Daniel and Dale, Jeremy (2020) Socioeconomic status and HRT prescribing : a study of practice-level data in England. British Journal of General Practice, 70 (700). e772. doi:10.3399/bjgp20X713045

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Abstract

Background
Concerns have been raised that women from deprived backgrounds are less likely to be receiving hormone replacement therapy (HRT) treatment and its benefits, although evidence in support of this is lacking.
Aim
To investigate general practice HRT prescription trends and their association with markers of socioeconomic deprivation.
Design
Cross-sectional study of primary care prescribing data in England in 2018.
Method
Practice-level prescribing rate was defined as the number of items of HRT prescribed per 1000 registered female patients over the age of 40 years. The association between Index of Multiple Deprivation (IMD) score and HRT prescribing rate was tested using multivariate Poisson regression, adjusting for practice proportions of obesity, smoking, hypertension, diabetes, coronary heart disease and cerebrovascular disease and practice list size.
Results
The overall prescribing rate of HRT was 29% lower in practices from the most deprived quintile compared with the most affluent (incidence rate ratio [IRR] 0.71, 95% CI 0.68-0.73). After adjusting for all cardiovascular disease outcomes and risk factors, the prescribing rate in the most deprived quintile was still 18% lower than in the least deprived quintile (adjusted IRR 0.82, 95% CI 0.77-0.86). In more deprived practices, there was a significantly higher tendency to prescribe oral HRT than transdermal preparations (p < 0.001).
Conclusion
This study has highlighted inequalities associated with HRT prescription. This may reflect a large unmet need in terms of menopause care in areas of deprivation. Further research is needed to identify the factors from patient and GP perspectives that may explain this.

Item Type:	Journal Article
Subjects:	H Social Sciences > HQ The family. Marriage. Woman R Medicine > R Medicine (General) R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Menopause -- Hormone therapy, Menopause -- Treatment -- Social aspects, Physicians (General practice), Family medicine -- Formulae, receipts, prescriptions , Women -- Economic conditions
Journal or Publication Title:	British Journal of General Practice
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Official Date:	November 2020
Dates:	Date Event November 2020 Published 29 September 2020 Available 7 May 2020 Accepted
Volume:	70
Number:	700
Article Number:	e772
DOI:	10.3399/bjgp20X713045
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Copyright Holders:	© British Journal of General Practice 2020
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272
Related URLs:	Publisher

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