Racial/ethnic disparities in the diagnosis and management of menopause symptoms among midlife women veterans.
Racial/ethnic disparities in the diagnosis and management of menopause symptoms among midlife women veterans.
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DOI：
10.1097/gme.0000000000001978
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发表时间：
2022-07-01
期刊：
影响因子：
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通讯作者：
Seal K
中科院分区：
文献类型：
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作者：
Blanken A;Gibson CJ;Li Y;Huang AJ;Byers AL;Maguen S;Inslicht S;Seal K
尽管退伍军人健康管理局（VA）服务的女性具有独特的种族/民族多样性，但她们在更年期症状和激素治疗管理方面的种族/民族差异仍然没有得到充分研究。因此，我们确定了种族/民族的差异，在医疗记录记录的更年期症状和规定的更年期激素治疗的女性退伍军人。我们对2014-2015年全国VA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来比较病历记录的更年期症状和治疗（例如，阴道雌激素或全身性激素治疗），根据自我确定的种族/民族，调整年龄、体重指数和抑郁症。检查激素治疗的模型根据更年期症状进行调整。在200，901名女性退伍军人中（平均年龄54.3岁，标准差5.4岁; 58%为非西班牙裔/拉丁裔白色人，33%为非西班牙裔/拉丁裔黑人，4%为西班牙裔/拉丁裔人，4%为其他人），5%有记录的更年期症状，5%接受阴道雌激素治疗，5%接受全身激素治疗。在完全校正的多变量模型中，非西班牙裔/拉丁裔黑人女性退伍军人相对于非西班牙裔/拉丁裔白色女性有较低的记录更年期症状的几率（OR 0.82，95% CI：0.78-0.86）。此外，非西班牙裔/拉丁裔黑人女性（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）接受全身激素治疗处方的可能性较低。西班牙裔/拉丁裔女性阴道雌激素处方的几率（OR 1.12 95% CI：1.02-1.24）高于非西班牙裔/拉丁裔白色女性。非西班牙裔/拉丁裔黑人女性使用雌激素的可能性（OR 0.78 95% CI：0.74-0.81）低于非西班牙裔/拉丁裔白色女性。尽管有证据表明，在社区样本中，黑人妇女的更年期症状负担较高，但与白色女性退伍军人相比，黑人妇女的更年期症状和激素治疗较不常见。此外，西班牙裔/拉丁裔女性退伍军人有较低的几率规定的全身更年期治疗，但较高的几率规定的阴道雌激素，尽管没有记录的症状的差异。这些发现可能表明少数族裔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。
Racial/ethnic disparities in menopause symptoms and hormone therapy management remain understudied among women served by the Veteran’s Health Administration (VA), 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 VA electronic health record data from 2014–2015. We used logistic regression models to compare medical-record documented menopause symptoms and treatment (e.g., 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 years; 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 to 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.