# Associations of social determinants of health on likelihood of systemic hormone therapy use in midlife women

## TL;DR

This study found that social factors like education, relationship status, and diet influence whether midlife women use hormone therapy for menopause.

## Contribution

The study identifies specific social determinants of health associated with hormone therapy use in midlife women.

## Key findings

- Higher BMI, being unpartnered, lower education, and smoking were linked to lower HT use.
- Using extra virgin olive oil was associated with increased HT use.
- Protective SDOH factors correlate with better access to menopause care.

## Abstract

Social determinants of health (SDOH) can have a significant impact on women’s health and quality of life. Little is known about the impact of SDOH during menopause, and whether certain SDOH impact the likelihood of using systemic hormone therapy (HT). Our objective was to evaluate the impact of SDOH on the likelihood of HT utilization among midlife women.

Midlife women between the ages of 45–60 years were surveyed about their menopause experience between March and June of 2021. The questionnaire included information on medications used to treat menopause symptoms. From the electronic medical record demographic information and self-reported SDOH data were obtained, including the amount of exercise/physical activity, whether the participants felt stressed, social interactions, abuse in the last year, ability to pay for basics, diet, alcohol intake, smoking status, and whether participants had regular dentist visits. SDOH were compared between using/not using HT currently.

One thousand nine hundred and eighty-eight women aged 45–60 years who received primary care at one of four geographic Mayo Clinic sites completed the survey and filled out SDOH questions within 2 years. Women were 54.4 years of age on average (SD 4.2), with a mean BMI of 30.2 (SD 7.5), and a majority White (97%). 258 (13.0%) women were currently using HT. In univariate analysis, women were less likely to be using HT if they had higher BMI (per 1 kg/m2 increase, OR = 0.97, 95% 0.95–0.99, p = 0.002) were unpartnered (OR = 0.66, 95% CI 0.45–0.99, p = 0.04) had lower education (compared to post graduate studies, high school graduate/GED or less: OR = 0.45, 95% CI 0.24–0.85, p = 0.01; some college/2 year degree: OR = 0.69, 95% CI 0.49–0.96,p = 0.03), or were a smoker (compared to those who never smoked, current smoker: OR = 0.38, 95% CI 0.18–0.83, p = 0.02; former smoker: OR = 0.71, 95% CI 0.52–0.96, p = 0.03). Women who used extra virgin olive oil as main fat in diet were more likely to be using HT (OR = 1.46, 95% CI 1.10–1.94, p = 0.009). No other SDOH were associated with HT.

Certain SDOH were associated with HT use for menopause treatment. Favorable SDOH likely correlate with better access to menopause care. To assure equitable menopause treatment for all women, clinicians should evaluate and address SDOH with their midlife women patients.

Social determinants of health (SDOH) are known to have significant impacts on women’s health. However, little is known about the impact of SDOH on menopause. This study evaluates the impact of SDOH on the likelihood of menopausal hormone therapy (HT) use in midlife women. Women 45–60 years old were surveyed about their menopause experience, including medications used to treat their menopause symptoms. Self-reported SDOH data were extracted from the electronic medical record, and SDOH were compared between those who were currently using HT and those who were not using HT. The results of this study demonstrate that several protective SDOH factors are associated with a higher likelihood of HT use. These findings are important because they indicate that in order to ensure equitable access to menopause care, clinicians should be evaluating for and addressing SDOH with their midlife women patients.

In this study of a predominately White population, several SDOH factors were associated with increased menopausal hormone therapy use.

Protective SDOH such as, being partnered, having higher education, and using extra virgin olive oil, correlated with higher likelihood of menopausal hormone therapy use.

To assure equitable menopause treatment for all women, clinicians should evaluate and address SDOH with their midlife women patients in a culturally responsive manner.