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Quantifying disparities in HRT prescribing

Status

Ongoing

Title

Quantifying disparities in HRT prescribing

What is the aim of the study and why is it important?

Objective a
To determine the overall uptake of HRT in women of menopausal age and describe uptake of different types of HRT, duration of use and demographics of women taking HRT and those who are not over a 10-year period.

Objective b
To identify predictors of HRT uptake

To describe the population with severe or problematic menopause symptoms, identify people with risk factors for problematic symptoms of menopause (identified from a parallel systematic review and meta-analysis) who may not have consulted and estimate the numbers of women with problematic menopause symptoms who may have benefitted from HRT treatment.

Chief Investigator

Dr Jennifer Hirst

Lead Applicant Organisation Name

Sponsor

Oxford

Location of research

Oxford

Date on which research approved

30-Oct-2023

Project reference ID

OX322

Generic ethics approval reference

18/EM/0400

Are all data accessed are in anonymised form?

Yes

Brief summary of the dataset to be released (including any sensitive data)

QResearch database 1500 general practices in England, including data on demographics, diagnoses, medication, laboratory investigations, pregnancy information, referrals.
In 2020 there were 4.6 million women in the 50-60 age category in the UK.(43) QResearch represents 15% of GP practices, suggesting that we will have a cohort of around 700,000 women meeting our inclusion criteria in 2020.
Extending back over 10 years, we would expect an additional 300,000 to be within this age range during the follow-up period, giving a total cohort size of approximately 1 million.

Breast cancer, osteoporosis & thrombosis outcomes

What were the main findings?

This large population-based cohort study of nearly two million women aged 40–60 across England revealed substantial inequalities in hormone replacement therapy (HRT) prescribing. Overall, 19.2% of women received at least two HRT prescriptions, with combination formulations being the most commonly prescribed in 62.4% of users.
Marked disparities were evident by ethnicity and socioeconomic status. White women were significantly more likely to receive HRT (23%) than women from minority ethnic groups, with uptake as low as 4% among Black African and 9% among Caribbean women. Women living in the most deprived areas were about half as likely to be prescribed HRT compared with those in the most affluent regions (11% vs 24%). London had the lowest prescription rate (11.7%), with all other English regions significantly higher after adjustment for age, ethnicity and deprivation. Multivariable Cox regression confirmed these differences persisted even after accounting for age, deprivation, and region, with adjusted hazard ratios for non-white ethnic groups ranging from 0.85 to 0.91. Although inequalities have narrowed slightly since publication of the first NICE menopause guidance [1] in 2015, they remain substantial.

1. NICE Menopause: identification and management. NICE guideline [NG23]. 2024.

Implications and Impact

These findings show that the women who may need HRT most such as those with higher cardiovascular risk, are often the least likely to receive appropriate treatment. The findings come at a crucial time, as tackling health inequalities in women's health has been made a key government priority for 2024-2025, with ministers acknowledging the £11 billion annual cost of women's health conditions to the UK economy. The study provides the first national, individual-level evidence across nine ethnic groups of who receives HRT in England – giving commissioners the granular data needed to target support and reduce unwarranted variation. This Oxford-led research has been published in BMJ Medicine [1].

1. Hirst, J.A., et al., Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study. BMJ Med, 2025. 4(1): p. e001349.

Funding Source

National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (NIHR206836).

Public Benefit Statement

Research Team

Dr Jennifer Hirst (University of Oxford)

Prof Julia Hippisley-Cox (University of Oxford)

Dr Sharon Dixon (University of Oxford)

Professor Carol Coupland (University of Nottingham)

Dr Sarah Hillman (University of Warwick)

Ms Lynn Tatnell

Ms Wema Mtika (University of Oxford)

Publications

  • Association of comorbidities with Hormone Replacement Therapy uptake: a systematic review and meta-analysis
    Authors: Allen D, Tranter E, Glover G, Mtika W, Hoang J, Hillman S, Hippisley-Cox J, Hirst J
    Ref:
  • Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study
    Authors: Jennifer A Hirst ,Wema Meranda Mtika ,Carol Coupland, Sharon Dixon, Julia Hippisley-Cox, Sarah Hillman
    Ref: Hirst JA, Mtika WM, Coupland C, Dixon S, Hippisley-Cox J, Hillman S. Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study. BMJ Medicine. 2025;4:e001349. https://doi.org/10.1136/bmjmed-2025-001349
    https://bmjmedicine.bmj.com/content/4/1/e001349

Press Releases

Access Type

Trusted Research Environment (TRE)

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