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2019 HSR&D/QUERI National Conference Abstract

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4129 — Multi-Racial/Ethnic Differences in Menopausal Symptoms and Hormone Therapy Use in a National Sample of Midlife Women Veterans

Lead/Presenter: Kyle Self,  San Francisco VA Medical Center
All Authors: Self KJ (SFVAMC), Gibson, CJ (SFVAMC, University of California San Francisco, School of Psychiatry), Li, Y (SFVAMC) Huang, A (University of California San Francisco, School of Psychiatry) Inslicht, S (SFVAMC, University of California San Francisco, School of Psychiatry) Maguen, S (SFVAMC, University of California San Francisco, School of Psychiatry) Byers, A (SFVAMC, University of California San Francisco, School of Psychiatry) Seal, KH (SFVAMC, University of California San Francisco, School of Psychiatry)

Objectives:
Nearly half of women Veterans who utilize VA services are in midlife (age 45-64). Yet, little is known about the experience or clinical management of age-related symptomatology, such as menopause, among women Veterans. Thus, we determined prevalence of menopausal symptoms and use of menopausal hormone therapy specifically between multi-racial/ethnic disparities in a national sample of midlife women Veterans.

Methods:
Cross-sectional analyses of national VA medical and pharmacy records (2014-2015) were conducted to examine prevalence of documented menopausal symptoms and menopausal hormone therapy use among women Veterans aged 45-64 with > 1 clinical encounter during the observed period. Race and ethnicity were categorized in accordance with established federal standards (White, Black/African American, American Indian/Alaska Native, Asian, Multi-race, and Native Hawaiian/other Pacific Islander; Hispanic/Latina or non-Hispanic/Latina). Chi-square analyses were used to compare diagnoses and hormone therapy use by race and ethnicity.

Results:
In the full sample (n = 188,763, mean age 54.3, SD 5.4 years), 5% had documented diagnoses indicating menopausal symptoms, while 14% were prescribed menopausal hormone therapy. In targeted comparisons, white women were more likely to have documented menopausal symptoms (5.7%) than black women (4.5%, chi sq. = 119.0, p < .001), but not Asian women (5.7%, chi sq. = .01, p = .94); there were no differences in documented symptoms in non-Hispanic/Latina and Hispanic/Latina women (5.3% vs. 5.6%, chi sq. = .22, p = .23). White women were also more likely to be prescribed hormone therapy (15.4%) than black women (13.3%, chi sq. = 149.8, p < .001), and Asian women (8.5%, chi sq. = 56.7, p < .001); non-Hispanic/Latina women were more likely to be prescribed hormone therapy than Hispanic/Latina women (14.6% vs. 11.8%, chi sq. = 79.3, p < .001).

Implications:
Although data from community samples consistently shows higher rates of self-reported menopausal symptoms among black and Hispanic/Latina women, these findings suggest that white women Veterans were more likely to have documented menopausal symptoms and to receive menopausal hormone therapy than women Veterans in other multi-racial/ethnic groups. These findings may signal disparities in symptom reporting, documentation, and/or treatment for minority women Veterans in the VA setting.

Impacts:
VA providers should discuss menopausal symptoms and management with all midlife women in their care, and adjust treatment and approaches to care accordingly to accommodate women Veterans of color.