The Impact of Comorbidities on Hormone Use

OBJECTIVE: Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow‐up) release of the Women�...

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Published in:Journal of general internal medicine : JGIM 2005-04, Vol.20 (4), p.350-356
Main Authors: Newton, Katherine M., Buist, Diana S.M., Miglioretti, Diana L., Beverly, Kevin, Hartsfield, Cynthia L., Chan, K. Arnold, Andrade, Susan E., Wei, Feifei, Connelly, Maureen T., Kessler, Larry
Format: Article
Language:English
Subjects:
Cardiovascular disease
Cardiovascular diseases
Comorbidity
Confidence intervals
Diabetes
Diabetes mellitus
estrogen
Estrogens
fracture
Health risks
Heart diseases
hormone therapy
Internal medicine
menopause
Pharmacy
Progestin
women
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container_end_page 356
container_issue 4
container_start_page 350
container_title Journal of general internal medicine : JGIM
container_volume 20
creator Newton, Katherine M.
Buist, Diana S.M.
Miglioretti, Diana L.
Beverly, Kevin
Hartsfield, Cynthia L.
Chan, K. Arnold
Andrade, Susan E.
Wei, Feifei
Connelly, Maureen T.
Kessler, Larry
description OBJECTIVE: Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow‐up) release of the Women's Health Initiative EPT trial results (WHI). DESIGN, SETTING, AND PARTICIPANTS: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs. METHODS: We used pharmacy data to identify ET and EPT users. A woman was a user any month she filled ≥1 estrogen prescription and in subsequent months based upon the number of pills/patches dispensed. We used inpatient and outpatient claims to identify fracture January 1, 1999 to June 30, 2002 and pharmacy data to identify disease‐based groups of medications for diabetes and cardiovascular disease. MEASURES: EPT/ET prevalence, initiation, and discontinuation rates. RESULTS: Baseline to follow‐up EPT and ET prevalence declined 45% and 22%, respectively, with no difference by comorbidity. Follow‐up EPT initiation was half the baseline rate irrespective of comorbidity. Compared to baseline, follow‐up EPT discontinuation rates increased among women with diabetes (relative risk [RR], 6.9; 95% confidence interval [CI], 5.6 to 8.4), cardiovascular disease (RR, 5.5; 95% CI, 4.9 to 6.2), fracture (RR, 3.8; 95% CI, 2.4 to 5.7), and no comorbidity (RR, 4.4; 95% CI, 3.9 to 4.9). The RRs for follow‐up versus baseline EPT discontinuation were higher among women with diabetes (P
doi_str_mv 10.1111/j.1525-1497.2005.04059.x
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Arnold ; Andrade, Susan E. ; Wei, Feifei ; Connelly, Maureen T. ; Kessler, Larry</creator><creatorcontrib>Newton, Katherine M. ; Buist, Diana S.M. ; Miglioretti, Diana L. ; Beverly, Kevin ; Hartsfield, Cynthia L. ; Chan, K. Arnold ; Andrade, Susan E. ; Wei, Feifei ; Connelly, Maureen T. ; Kessler, Larry</creatorcontrib><description>OBJECTIVE: Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow‐up) release of the Women's Health Initiative EPT trial results (WHI). DESIGN, SETTING, AND PARTICIPANTS: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs. METHODS: We used pharmacy data to identify ET and EPT users. A woman was a user any month she filled ≥1 estrogen prescription and in subsequent months based upon the number of pills/patches dispensed. We used inpatient and outpatient claims to identify fracture January 1, 1999 to June 30, 2002 and pharmacy data to identify disease‐based groups of medications for diabetes and cardiovascular disease. MEASURES: EPT/ET prevalence, initiation, and discontinuation rates. RESULTS: Baseline to follow‐up EPT and ET prevalence declined 45% and 22%, respectively, with no difference by comorbidity. Follow‐up EPT initiation was half the baseline rate irrespective of comorbidity. Compared to baseline, follow‐up EPT discontinuation rates increased among women with diabetes (relative risk [RR], 6.9; 95% confidence interval [CI], 5.6 to 8.4), cardiovascular disease (RR, 5.5; 95% CI, 4.9 to 6.2), fracture (RR, 3.8; 95% CI, 2.4 to 5.7), and no comorbidity (RR, 4.4; 95% CI, 3.9 to 4.9). The RRs for follow‐up versus baseline EPT discontinuation were higher among women with diabetes (P&lt;.01) and cardiovascular disease (P&lt;.01) versus women without these comorbidities. ET discontinuation rates among these same groups were elevated 2‐ to 2.8‐fold. CONCLUSIONS: Diabetes and cardiovascular disease were associated with higher EPT discontinuation rates post‐WHI compared to women without comorbidity; comorbidity had little impact on changes in prevalence or initiation of ET/EPT after release of the WHI.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1111/j.1525-1497.2005.04059.x</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Inc</publisher><subject>Cardiovascular disease ; Cardiovascular diseases ; Comorbidity ; Confidence intervals ; Diabetes ; Diabetes mellitus ; estrogen ; Estrogens ; fracture ; Health risks ; Heart diseases ; hormone therapy ; Internal medicine ; menopause ; Pharmacy ; Progestin ; women</subject><ispartof>Journal of general internal medicine : JGIM, 2005-04, Vol.20 (4), p.350-356</ispartof><rights>Society of General Internal Medicine 2005.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1889-23cede97ebc935dd0eee784fa1ca9352e1089654f6f89a4a8ace9ae956db44d33</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Newton, Katherine M.</creatorcontrib><creatorcontrib>Buist, Diana S.M.</creatorcontrib><creatorcontrib>Miglioretti, Diana L.</creatorcontrib><creatorcontrib>Beverly, Kevin</creatorcontrib><creatorcontrib>Hartsfield, Cynthia L.</creatorcontrib><creatorcontrib>Chan, K. Arnold</creatorcontrib><creatorcontrib>Andrade, Susan E.</creatorcontrib><creatorcontrib>Wei, Feifei</creatorcontrib><creatorcontrib>Connelly, Maureen T.</creatorcontrib><creatorcontrib>Kessler, Larry</creatorcontrib><title>The Impact of Comorbidities on Hormone Use</title><title>Journal of general internal medicine : JGIM</title><description>OBJECTIVE: Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow‐up) release of the Women's Health Initiative EPT trial results (WHI). DESIGN, SETTING, AND PARTICIPANTS: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs. METHODS: We used pharmacy data to identify ET and EPT users. A woman was a user any month she filled ≥1 estrogen prescription and in subsequent months based upon the number of pills/patches dispensed. We used inpatient and outpatient claims to identify fracture January 1, 1999 to June 30, 2002 and pharmacy data to identify disease‐based groups of medications for diabetes and cardiovascular disease. MEASURES: EPT/ET prevalence, initiation, and discontinuation rates. RESULTS: Baseline to follow‐up EPT and ET prevalence declined 45% and 22%, respectively, with no difference by comorbidity. Follow‐up EPT initiation was half the baseline rate irrespective of comorbidity. Compared to baseline, follow‐up EPT discontinuation rates increased among women with diabetes (relative risk [RR], 6.9; 95% confidence interval [CI], 5.6 to 8.4), cardiovascular disease (RR, 5.5; 95% CI, 4.9 to 6.2), fracture (RR, 3.8; 95% CI, 2.4 to 5.7), and no comorbidity (RR, 4.4; 95% CI, 3.9 to 4.9). The RRs for follow‐up versus baseline EPT discontinuation were higher among women with diabetes (P&lt;.01) and cardiovascular disease (P&lt;.01) versus women without these comorbidities. ET discontinuation rates among these same groups were elevated 2‐ to 2.8‐fold. CONCLUSIONS: Diabetes and cardiovascular disease were associated with higher EPT discontinuation rates post‐WHI compared to women without comorbidity; comorbidity had little impact on changes in prevalence or initiation of ET/EPT after release of the WHI.</description><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>estrogen</subject><subject>Estrogens</subject><subject>fracture</subject><subject>Health risks</subject><subject>Heart diseases</subject><subject>hormone therapy</subject><subject>Internal medicine</subject><subject>menopause</subject><subject>Pharmacy</subject><subject>Progestin</subject><subject>women</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><recordid>eNo9kE9Lw0AQxRdRMFa_w4I3IXH_JrsXQYK2kYKX9rxsNhNMaLJx02L77U1acS4zzDzm8X4IYUoSOtVzm1DJZEyFzhJGiEyIIFInxysU_R-uUUSUErHKuLhFd-PYEkI5YypCT5svwEU3WLfHvsa573wom6rZNzBi3-OVD53vAW9HuEc3td2N8PDXF2j7_rbJV_H6c1nkr-vYUaV0zLiDCnQGpdNcVhUBgEyJ2lJnpwUDSpROpajTWmkrrLIOtAUt06oUouJ8gR4vf4fgvw8w7k3rD6GfLA1LU5EqomU2qV4uqp9mByczhKaz4WQoMTMW05o5vZnTmxmLOWMxR_OxLM4j_wVLpldT</recordid><startdate>200504</startdate><enddate>200504</enddate><creator>Newton, Katherine M.</creator><creator>Buist, Diana S.M.</creator><creator>Miglioretti, Diana L.</creator><creator>Beverly, Kevin</creator><creator>Hartsfield, Cynthia L.</creator><creator>Chan, K. Arnold</creator><creator>Andrade, Susan E.</creator><creator>Wei, Feifei</creator><creator>Connelly, Maureen T.</creator><creator>Kessler, Larry</creator><general>Blackwell Science Inc</general><general>Springer Nature B.V</general><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope></search><sort><creationdate>200504</creationdate><title>The Impact of Comorbidities on Hormone Use</title><author>Newton, Katherine M. ; Buist, Diana S.M. ; Miglioretti, Diana L. ; Beverly, Kevin ; Hartsfield, Cynthia L. ; Chan, K. 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Arnold</creatorcontrib><creatorcontrib>Andrade, Susan E.</creatorcontrib><creatorcontrib>Wei, Feifei</creatorcontrib><creatorcontrib>Connelly, Maureen T.</creatorcontrib><creatorcontrib>Kessler, Larry</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Newton, Katherine M.</au><au>Buist, Diana S.M.</au><au>Miglioretti, Diana L.</au><au>Beverly, Kevin</au><au>Hartsfield, Cynthia L.</au><au>Chan, K. Arnold</au><au>Andrade, Susan E.</au><au>Wei, Feifei</au><au>Connelly, Maureen T.</au><au>Kessler, Larry</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Comorbidities on Hormone Use</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><date>2005-04</date><risdate>2005</risdate><volume>20</volume><issue>4</issue><spage>350</spage><epage>356</epage><pages>350-356</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>OBJECTIVE: Determine the impact of fracture, coronary disease, and diabetes on changes in rates of discontinuation and initiation of estrogen therapy with (EPT) and without (ET) progestin, before (September 1, 1999 to June 30, 2002, baseline) versus 5 months after (follow‐up) release of the Women's Health Initiative EPT trial results (WHI). DESIGN, SETTING, AND PARTICIPANTS: Observational cohort; 169,586 women 40 to 80 years old from 5 U.S. HMOs. METHODS: We used pharmacy data to identify ET and EPT users. A woman was a user any month she filled ≥1 estrogen prescription and in subsequent months based upon the number of pills/patches dispensed. We used inpatient and outpatient claims to identify fracture January 1, 1999 to June 30, 2002 and pharmacy data to identify disease‐based groups of medications for diabetes and cardiovascular disease. MEASURES: EPT/ET prevalence, initiation, and discontinuation rates. RESULTS: Baseline to follow‐up EPT and ET prevalence declined 45% and 22%, respectively, with no difference by comorbidity. Follow‐up EPT initiation was half the baseline rate irrespective of comorbidity. Compared to baseline, follow‐up EPT discontinuation rates increased among women with diabetes (relative risk [RR], 6.9; 95% confidence interval [CI], 5.6 to 8.4), cardiovascular disease (RR, 5.5; 95% CI, 4.9 to 6.2), fracture (RR, 3.8; 95% CI, 2.4 to 5.7), and no comorbidity (RR, 4.4; 95% CI, 3.9 to 4.9). The RRs for follow‐up versus baseline EPT discontinuation were higher among women with diabetes (P&lt;.01) and cardiovascular disease (P&lt;.01) versus women without these comorbidities. ET discontinuation rates among these same groups were elevated 2‐ to 2.8‐fold. CONCLUSIONS: Diabetes and cardiovascular disease were associated with higher EPT discontinuation rates post‐WHI compared to women without comorbidity; comorbidity had little impact on changes in prevalence or initiation of ET/EPT after release of the WHI.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Inc</pub><doi>10.1111/j.1525-1497.2005.04059.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source Open Access: PubMed Central; Springer Nature
subjects Cardiovascular disease
Cardiovascular diseases
Comorbidity
Confidence intervals
Diabetes
Diabetes mellitus
estrogen
Estrogens
fracture
Health risks
Heart diseases
hormone therapy
Internal medicine
menopause
Pharmacy
Progestin
women
title The Impact of Comorbidities on Hormone Use
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