Identifying socioeconomic and ethnic disparities in key health outcomes by hormone replacement therapy use in older women

Research question Do risks of health outcomes in older women differ by socioeconomic or ethnic group and by HRT use?

Background There are known disparities in hormone replacement therapy (HRT) prescribing for treating menopause symptoms in the UK.

The research team have been awarded funding to identify factors associated with HRT prescriptions, which will tell us about disparities in HRT use by ethnicity, socioeconomic status and region of the UK using routinely collected primary care data.

Some health outcomes are of particular importance in relation to HRT use, including cancers, cardiovascular disease, dementia and osteoporosis.

Risks of these will differ depending on the type of HRT used and the duration of use, but it is not known if risks differ in women from different ethnic or socioeconomic groups or in those living with other health conditions.

Aims and objectives Aim: identify socioeconomic or ethnic disparities in the diagnosis of key health outcomes in older women stratified by HRT use.

Objectives: Describe ethnic and social disparities in older women who develop cancer (breast, endometrial and ovarian), CVD, thrombosis, dementia, osteoporosis and all-cause mortality by HRT use.

Develop robust evidence from which subsequent work can be undertaken to develop communication tools to share findings with women and their clinicians to improve clinical decision making for HRT.

Quantify risk of breast, endometrial or ovarian cancer, CVD, thrombosis, dementia, osteoporosis and all-cause mortality associated with type and duration of HRT use in different ethnic and social deprivation groups and in those with early menopause.

Methods We will use data from a cohort of women aged between 40 and 80-years in the QResearch primary care dataset linked with hospital records and cancer registries over a 20-year follow-up from 2004-2024. 1.Descriptive analysis reporting numbers and percent of women with breast, endometrial and ovarian cancer, CVD, dementia, osteoporosis and all-cause mortality stratified by HRT use, ethnicity, socioeconomic status, geographic area and type of HRT where there are sufficient numbers. 2.

A series of nested case control studies to identify factors associated with a new diagnosis of cancer (breast, endometrial and ovarian), CVD, thrombosis, dementia and osteoporosis by HRT use, reporting odds ratios for hormone replacement therapy adjusted for ethnicity, socioeconomic group, smoking status, alcohol consumption, comorbidities and family history. 3.Compile data and develop infographics to share with women and GPs and inform NIHR Programme grant application Timelines for delivery This is a 12-month study starting 1 Sept 2024 Anticipated impact and dissemination We will present work at academic conferences and publish in academic journals.

We will design and share infographics with women s groups and social media networks. This work will inform the design of a study to develop a risk tool for HRT.