Hormone therapy use in women veterans accessing veterans health administration care: a national cross-sectional study.
The majority of women Veterans using VA (Veterans Administration) care fall in the 45-65 year-old age range. Understanding how menopause is managed in this group is of importance to optimizing their health.


OBJECTIVE
National population estimates showed a prevalence of hormone therapy (HT) use by women over 45 years of 4.7 % (2009-2010). Our study described the frequency of HT use among women Veterans in VA, and examined whether mental health (MH) was predictive of HT use.


METHODS
This was a cross-sectional analysis of national VA administrative data for fiscal year 2009.


METHODS
Women Veterans over the age of 45 (N = 157,195) accessing VA outpatient care were included in the analysis.


METHODS
Logistic regression analyses using HT use as the dependent variable.


RESULTS
Mean age was 59.4 years (SD =12.2, range =46-110), and 16,227 (10.3 %) of all women used HT. Hysterectomy (OR 3.99 [3.53, 4.49]) and osteoporosis (1.34 [1.27, 1.42]) were the strongest medical indicators of HT use. A total of 49,557 (31.5 %) women in the sample received at least one primary diagnosis of a MH disorder and were more likely to use HT than women with no MH diagnoses (unadjusted OR 1.56, 95 % CI [1.50, 1.61]). Women Veterans with a mood disorder (depression/bipolar) or anxiety disorder [post-traumatic stress disorder (PTSD), other anxiety diagnoses] were more likely to use HT after controlling for demographics and medical comorbidity.


CONCLUSIONS
The prevalence of HT use among women Veterans using VA is more than twice that of the general population. Prior work suggested that women Veterans were discontinuing HT at comparable rates, but these data demonstrate that decline in VA HT use has not kept pace with that of civilian medical care. The association of MH diagnosis with HT use suggests that MH plays an important role in VA rates. Further study is needed to understand contributing patient and provider factors.
Women Veterans Program, VA Boston Healthcare System, 150 S. Huntington Avenue PC11/WHC, Jamaica Plain, MA, Boston, 02130, USA, Megan.gerber@va.gov.
Megan R
MR
Gerber
Matthew W
MW
King
Suzanne L
SL
Pineles
Shannon
S
Wiltsey-Stirman
Bevanne
B
Bean-Mayberry
Sandra J
SJ
Japuntich
Sally G
SG
Haskell
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D020249:Hormone Replacement Therapy / Q000379:methods / Q000639:trends*; D006801:Humans; D008603:Mental Health / Q000639:trends*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans / Q000523:psychology; D058014:Veterans Health / Q000639:trends*; D016387:Women's Health / Q000639:trends*