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December 2004, Vol 94, No. 12 | American Journal of Public Health 2149-2154
© 2004 American Public Health Association

RESEARCH AND PRACTICE

Socioeconomic Position and Hormone Replacement Therapy Use: Explaining the Discrepancy in Evidence From Observational and Randomized Controlled Trials

Debbie A Lawlor, PhD, MSc, MBChB, George Davey Smith, DSc, MD and Shah Ebrahim, DM, MSc

The authors are with the Department of Social Medicine, University of Bristol, Bristol, United Kingdom.

Correspondence: Requests for reprints should be sent to Debbie A. Lawlor, PhD, MSc, MBChB, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS7 8QA, United Kingdom (email: d.a.lawlor{at}bristol.ac.uk).

Objectives. We assessed the association between life-course socioeconomic status or position (SEP) and hormone replacement therapy (HRT).

Methods. We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years.

Results. Women experiencing adverse socioeconomic circumstances across the life course were less likely to have used HRT. The associations of childhood socioeconomic measures with HRT use were independent of adult SEP, behavioral risk factors, and physiological risk factors for heart disease.

Conclusions. SEP from across the life course is associated with HRT use. Because the association between early life SEP and HRT is not fully explained by adult risk factors, residual confounding (which is not captured by adjustment for adult variables only) may explain some of the disparity between observational studies and randomized controlled trials in this area.




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