Differences in menopausal hormone therapy use among women in Germany between 1998 and 2003.

BACKGROUND: To examine the differences in menopausal hormone therapy (MHT) use and user profiles among women in Germany before and after the communication of the Women's Health Initiative (WHI) trial and other study results concerning the risks and benefits of MHT. METHODS: Current MHT use was ascertained in two periodic German national health surveys conducted in 1997-1999 and 2003-2004. MHT prevalence and user profiles were assessed within each survey. The association of the survey period (2003-2004 vs. 1997-1999) with current MHT use was analyzed in weighted multivariable logistic regression (MLR) models, pooling data from both surveys. RESULTS: The overall prevalence of current MHT use decreased by 40.2% from 16.9% of the sample in 1997-1999 to 10.1% in 2003-2004. The difference in prevalence between surveys varied with age decade with the smallest decreases among women 60-69 years of age (20.3% vs. 18.5%), compared to women of younger and older age groups (40-49: 10.7% vs. 3.9%; 50-59: 36.3% vs. 21.3%; 70-79: 5.7% vs. 3.2%). Variables independently associated with higher current MHT use in both health surveys included age category (curvilinear relationship with highest use among women 50-59 years) and residence in West vs. East Germany. A higher social status, lower body mass index, and more health-conscious behaviour were significantly associated with higher current MHT use in the 1997-1999 survey, but these associations were not found in the later survey. MLR analyses confirmed a significant decline in MHT use between the 1997-1999 and 2003-2004 surveys, however, the effect was modified by social status and was not significant among lowest social-status women. CONCLUSION: Current MHT use considerably declined among women in Germany between the pre- and post-WHI era. A convergence of current MHT use among women of higher social status with pre-existing patterns of use among lower social-status women suggests that MHT in Germany is now less likely to be used for health promotion.

Use of oral contraceptives in Germany: prevalence, determinants and use-associated health correlates. Results of National Health Surveys from 1984 to 1999.

OBJECTIVES: To describe oral contraceptive (OC) use, its determinants and use-associated health correlates from 1984 to 1999 in Germany. STUDY DESIGN: Cross-sectional comparison was performed for socioeconomic factors, personal lifestyle and use-associated health correlates between 1862 OC users and 2625 age-matched nonusers identified from five German National Health Surveys. Regression models were used to obtain the determinants of OC use. RESULTS: While in women aged 25-49 years OC use remained nearly constant in the western part of Germany from 1984 to 1999 (17.3-20.1%), it declined greatly in the eastern part from 43.0% in 1991 to 32.3% in 1999. Cross-sectional comparison and regression analysis suggested that OC users did not differ from nonusers in most selected personal and socioeconomic factors. OC users showed generally a better health profile than age-matched nonusers with more satisfaction with health, higher quality of life and no significant difference in history of cardiovascular diseases despite slightly higher prevalence of hypertension and hyperlipidemia that are of little clinical significance. CONCLUSIONS: OC use seems to be generally safe. Whether the better health profiles found in OC users are the results of OC use or effects of healthy users, or both, should be further studied.

Hormone replacement therapy in Germany: determinants and possible health-related outcomes. Results of National Health Surveys from 1984 to 1999.

OBJECTIVES: To explore the determinants of hormone replacement therapy (HRT) use and possible health-related outcomes in Germany. METHODS: 827 current HRT users (age range 31-78 years, who had taken HRT products in the last 7 days before the medical interview) and 2371 age-matched nonusers were identified from five population-representative National Health Surveys performed from 1984 to 1999 in Germany. Cross-sectional comparisons between HRT users and nonusers were performed for socioeconomic factors and possible health-related outcomes. Regression models were used to obtain odds ratios of HRT use. RESULTS: HRT use increased dramatically from 3% in 1984/1985 to 21% in 1998/1999 among German women aged 40-69. Regression analysis and comparison between HRT users and nonusers suggested that HRT use was closely associated with socioeconomic factors and personal lifestyle that may favor better health. In HRT users, however, we did not observe any health-related benefits in satisfaction with life or health. While HRT users appeared superior to nonusers with respect to the glycemic status, histories of cardiovascular diseases, despite a favorable lipid profile, occurred not less than in the group of nonusers. CONCLUSIONS: In the settings of our cross-sectional studies in Germany HRT did not improve users' health benefits and did not show cardioprotective effects. The better glycemic status should be balanced against the higher risks of cardiovascular diseases and breast cancer.

Association of serum caffeine concentrations with blood lipids in caffeine-drug users and nonusers - results of German National Health Surveys from 1984 to 1999.

Previous studies regarding effects of caffeine on lipids focused mainly on coffee consumption, the real association of serum caffeine concentrations with blood lipids is unclear. 814 caffeine-drug users who had taken any caffeine/caffeine-containing pharmaceutical products and 623 nonusers without any drug use in the last seven days before the medical interview were identified from German National Health Surveys from 1984 to 1999. Serum caffeine concentrations were measured by using EIA for caffeine-drug users and nonusers in the same laboratory. Blood lipids were measured routinely for all survey participants. The association of caffeine concentrations with blood lipids was established by means of partial correlation analysis and regression analysis. After controlling for influence factors, caffeine concentrations were closely positively related to triglycerides in caffeine-drug users (male: r = 0.245, p < 0.001; female: r = 0.117, p = 0.018) and related to HDL-C in female nonusers (r = 0.245, p < 0.001). No associations were found between caffeine concentrations and total cholesterol and LDL-C levels in any groups of our study. Acute intake of caffeine might increase triglycerides levels especially in men while chronic intake of caffeine might be weakly but positively associated with HDL-C concentrations in women. The effects of caffeine on the pathogenesis of cardiovascular diseases should be further confirmed through epidemiological studies.

Determination of alpha-tocopherolquinone in human serum samples by liquid chromatography with fluorescence detection and on-line post-column derivatization.

A HPLC/fluorescence method with on-line post-column derivatization by a photoreactor was developed, where alpha-, beta + gamma- and delta-tocopherolquinone (TQ) are separated on a 250 mm x 4.6 mm RP-18 column. The LOD is about 250 pg for all TQs. In combination with a two-step sample preparation procedure, this method was successfully employed for measurement of alpha-TQ in human serum samples. Recovery for alpha-TQ from spiked serum was excellent (99 +/- 5%) and results of alpha-TQ determinations in 111 serum samples are reported. Additionally, possibilities for determination of other TQs in serum and alternative derivatization with a zinc reduction column are discussed.