Do Perceptions of Risk and Quality of Life Affect Use of Hormone Replacement Therapy by Postmenopausal Women?

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Figure 1.
Example of risk and utility estimate scales.
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Figure 2.
Risk perception and hormone replacement therapy (HRT).
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Figure 3.
Quality of life of health states considered with hormone replacement therapy (HRT).

Table 1.

Characteristics of Postmenopausal Women Participating in Osteoporosis Screening, by Use of Hormone Replacement Therapy.

Characteristic	HRT Users n = 220	HRT Nonusers n = 106	P Value^*
Age, mean years	59.2	63.3	<.001
Race or ethnic group, white, %	94.1	93.3
Education, %
High school	16.7	21.9
Some college	17.6	14.3
College graduate	20.7	26.7
Graduate school	42.8	32.4
Weight, mean pounds	150.1	156.9
Height, mean inches	64.2	64.8
Body mass index, mean	25.7	26.3
Smoking status, ever %	29.3	17.9	.028
Exercise, times per week	2.8	3.28
Overall health, %
Excellent	16.9	23.6
Good	51.1	46.2
Average	20.5	18.9
Fair	11.0	12.3
Poor	0.5	0.0
Fractures, history, %	6.2	13.5	.03
Hip	1.4	0.0
Rib	2.4	3.1
Wrist	2.4	11.4	.001
Family history of fractures in elderly, %	33.3	24.5
Rheumatoid arthritis, %	11.8	8.6
Symptoms of menopause, %	82.9	64.8	<.001
Menopausal symptoms, mean No.	3.8	2.9
Composite attitude toward preventing menopause symptoms,^† mean	22.6	21.8

Calcium supplement daily, %	71.0	65.2
Any osteoporosis treatment, %	10.8	19.4
Any nonprescription medicine, %	23.0	15.7

* P-value significance according to χ² for proportions or t test for difference between means.
† 5-point Likert scale responses for 5 symptoms were summed (total possible = 25).

Table 2.

Relation Between Hormone Replacement Therapy Use and Perceived Risk, Quality of Life, and Selected Clinical Characteristics.

Characteristic	RO^*	95% CI^†	RO_adj^‡	95% CI
Race, white vs nonwhite	1.6	0.7, 3.9	1.2	0.3, 4.7
Smoking status, ever vs never	1.9	1.1, 3.3	1.2	0.5, 2.9
Exercise, 3/wk	0.6	0.4, 1.0	0.6	0.3, 1.4
Fractures, any history	0.4	0.1, 0.9	0.5	0.1, 2.0
Symptoms of menopause, any	2.6	1.6, 4.5	6.3	2.3, 17.6
Bone density treatment, any	0.5	0.3, 1.0	0.7	0.2, 2.1
Herbal medicine, any	1.6	0.9, 2.9	1.9	0.8, 5.0
Perceived risk difference
High- vs low-risk difference^§
Osteoporosis	3.4	2.0, 5.9	4.7	2.1, 10.5
Myocardial infarction	3.3	1.9, 6.0	2.5	1.2, 5.3
Uterine cancer	0.5	0.3, 0.9	1.2	0.5, 2.8
Breast cancer	0.5	0.3, 0.9	0.5	0.2, 1.1
Quality-of-life difference^‖
High vs low QOL difference
Osteoporosis	2.0	1.2, 3.4	2.4	1.0, 6.0
Myocardial infarction	1.4	0.9, 2.3	1.7	0.7, 3.9
Uterine cancer	1.4	0.7, 2.6	1.7	0.5, 5.8
Breast cancer	2.8	1.6, 5.0	3.6	1.2, 10.7

* RO = relative odds, the odds of an HRT user having a characteristic divided by odds of an HRT nonuser having a characteristic.
† 95 percent confidence intervals.
‡ Relative odds adjusted by multivariate logistic regression, also including age (years).
§ Perceived risk difference = (lifetime probability on HRT) − (lifetime probability off HRT); the mean is used as the cutoff for the high and low group, except breast cancer for which the median is used.
‖ Quality of life (QOL) difference = QOL (current state of health) − QOL (with disease); the mean is used as the cutoff for the high and low group.