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October 2020

HRT prescribing lower in most deprived areas



A study in general practice has identified a stark association between prescribing rates for HRT at a practice level and socioeconomic deprivation.

The overall rate of HRT prescriptions for women over 40 years was 29% lower in practices from the most deprived areas compared with the most affluent.

Even after adjusting for risk factors for cardiovascular health (obesity, smoking, hypertension, diabetes, coronary heart disease and stroke) there was still an 18% lower prescribing rate in the most deprived practices compared with the least deprived.

The paper, in the British Journal of General Practice, points out that social deprivation is associated with a range of morbidities, many of which may affect a clinician’s decision to prescribe HRT.

Bone fractures and osteoporosis are more prevalent in areas of socioeconomic deprivation, and deprivation is associated with a younger age of the menopause, both of which should be considered positive reasons to prescribe HRT, yet do not appear to translate into practice. Practices with a higher prevalence of diabetes also prescribed less HRT, even though HRT has been shown to improve glycaemic control.

The study’s authors say their analysis ‘uncovers a large unmet need in terms of the menopause care and support that is provided in areas of deprivation’. But they say there needs to be further research to establish the barriers to accessing support in and around the time of the menopause before recommendations to change practice can be made.

Hillman S, et al. Br J Gen Practice. https://doi.org/10.3399/bjgp20X713045

Practice Nurse 2020;50(8):6