Socioeconomic Status Differences in Hormone Therapy: Prevention or Patriarchy?

Marks, Nadine F., and Diane S. Shinberg
Working paper no. 1997-02


The relative benefits and hazards of noncontraceptive hormone therapy (HT) for aging women remain a controversial medical and social issue. This study examined the lifetime incidence of HT use, how usage varied by surgery status, and the bivariate and net associations between a large array of SES indicators and the likelihood of midlife women ever using HT by age 53-54 among N=3,612 non-Hispanic white women participants in the Wisconsin Longitudinal Study 1957- 1993. About half the sample of women had ever used HT; 79% who had ever used HT were currently using HT (38.5%). In multivariate logistic regression analyses, the most robust SES predictor of HT use was a woman’s husband’s occupational status (higher status associated with higher rates of use). This association withstood adjusting for all other measured sociological and biomedical factors (e.g., other health behaviors, menopausal symptoms, age at menopause, health insurance). The association of HT use and education differed for women who underwent hysterectomy and/or oophorectomy (where the odds of using HT were higher for less educated women) and for women with intact reproductive organs (where the odds of using HT were lower for less educated women). Only among women who had surgery was the association of education with use of HT persistent adjusting for all other measured factors. Additionally, a woman’s own earnings and household net worth showed positive net associations with HT use. Two competing explanations for the observed relationship between husband’s occupational status and women’s HT use are discussed: HT as a preventive health behavior and HT as a socially influenced behavior to help maximize femininity.