{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:06:49Z","timestamp":1784304409212,"version":"3.55.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Access to menopausal hormone therapy (MHT) in the US remains low. Understanding whether insurance type is associated with MHT underuse and racial disparities in menopausal care is critical for designing interventions that increase evidence-based and equitable menopause care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether Medicaid compared with private insurance is associated with lower MHT use among US women. A secondary objective explored the degree that payer type is associated with observed racial differences in MHT use.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study used the 2013-2014, 2015-2016, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify a survey-weighted analytic subset of eligible respondents of a population-based survey of the US civilian, noninstitutionalized population. The study included women aged 45 to 64 years with Medicaid or private insurance coverage who were eligible for MHT. Statistical analyses were performed between March 26, 2024, and December 2, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Insurance type.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n MHT use was the primary outcome. A secondary analysis assessed whether insurance status was associated with observed racial differences in MHT use. Associations were estimated using multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The unweighted sample included 1666 National Health and Nutrition Examination Survey respondents (n\u2009=\u200922\u202f275\u202f545, weighted). Of the weighted final sample, 91.4% had private insurance, and 8.6% had Medicaid. Individuals insured by Medicaid were less likely than those with private insurance to report a history of MHT use (10.7% [95% CI, 6.9%-16.0%] vs 20.7% [95% CI, 18.1%-23.5%]). After adjustment, Medicaid-insured women had lower odds of MHT use than privately insured women (OR, 0.50 [95% CI, 0.28-0.87]). In a secondary analysis, Black participants showed lower odds of MHT than White participants (OR, 0.68 [95% CI, 0.45-0.95]), but this difference was attenuated once insurance status was included in the model (adjusted OR, 0.72 [95% CI, 0.50-1.04]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of women at typical age for menopause, Medicaid coverage was associated with significantly lower MHT use, suggesting that insurance type may play a role in menopausal care disparities. Insurance status may also partially explain previously observed racial gaps in MHT use. These findings highlight the need for policy and clinical interventions to address insurance-related barriers and to promote equitable menopausal care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.23740","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:30:27Z","timestamp":1784302227000},"page":"e2623740","source":"Crossref","is-referenced-by-count":0,"title":["Insurance Type and Menopausal Hormone Therapy Use Among US Women"],"prefix":"10.1001","volume":"9","author":[{"given":"Arina","family":"Chesnokova","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunni L.","family":"Mumford","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Schachter","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca F.","family":"Hamm","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Lorch","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia"},{"name":"Division of Neonatology, Department of Pediatrics and Center for Pediatric and Perinatal Health Disparities Research and Policy Lab, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Klebanoff","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lindley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Harness","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makeba","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn M.","family":"Schapira","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Center of Innovation in Health System Research, Philadelphia VA Medical Center, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"zoi260667r3","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s40695-016-0019-x","article-title":"The Seattle Midlife Women\u2019s Health Study: a longitudinal prospective study of women during the menopausal transition and early postmenopause.","volume":"2","author":"Woods","year":"2016","journal-title":"Womens Midlife Health"},{"key":"zoi260667r4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40695-016-0014-2","article-title":"Methods in a longitudinal cohort study of late reproductive age women: the Penn Ovarian Aging Study (POAS).","volume":"2","author":"Freeman","year":"2016","journal-title":"Womens Midlife Health"},{"key":"zoi260667r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.09.031","author":"Woods","year":"2005","journal-title":"Am J Med"},{"issue":"8","key":"zoi260667r6","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1161\/CIRCRESAHA.116.307547","article-title":"Cardiovascular disease in women: clinical perspectives.","volume":"118","author":"Garcia","year":"2016","journal-title":"Circ Res"},{"issue":"2","key":"zoi260667r7","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1080\/13697137.2018.1430131","article-title":"Vasomotor symptoms: natural history, physiology, and links with cardiovascular health.","volume":"21","author":"Thurston","year":"2018","journal-title":"Climacteric"},{"issue":"3","key":"zoi260667r8","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/13697130601181486","article-title":"Prevalence of hot flushes and night sweats around the world: a systematic review.","volume":"10","author":"Freeman","year":"2007","journal-title":"Climacteric"},{"issue":"7","key":"zoi260667r9","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1097\/GME.0000000000002028","article-title":"The 2022 hormone therapy position statement of the North American Menopause Society.","volume":"29","author":"Faubion","year":"2022","journal-title":"Menopause"},{"issue":"1","key":"zoi260667r10","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1001\/jama.291.1.47","article-title":"National use of postmenopausal hormone therapy: annual trends and response to recent evidence.","volume":"291","author":"Hersh","year":"2004","journal-title":"JAMA"},{"issue":"3","key":"zoi260667r11","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1097\/AOG.0b013e318265df42","article-title":"A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010.","volume":"120","author":"Sprague","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"5","key":"zoi260667r12","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1097\/gme.0b013e3181a02b44","article-title":"Trends in hormone therapy use before and after publication of the Women\u2019s Health Initiative trial: 10 years of follow-up.","volume":"16","author":"Barbaglia","year":"2009","journal-title":"Menopause"},{"issue":"7","key":"zoi260667r13","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.2105\/AJPH.2005.066936","article-title":"Longitudinal analysis of the association between vasomotor symptoms and race\/ethnicity across the menopausal transition: study of women\u2019s health across the nation.","volume":"96","author":"Gold","year":"2006","journal-title":"Am J Public Health"},{"issue":"5","key":"zoi260667r14","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1097\/gme.0b013e3181a3cdaf","article-title":"Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women\u2019s Health Across the Nation.","volume":"16","author":"Avis","year":"2009","journal-title":"Menopause"},{"issue":"1","key":"zoi260667r15","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s40695-022-00073-y","article-title":"Disparities in reproductive aging and midlife health between Black and White women: the Study of Women\u2019s Health Across the Nation (SWAN).","volume":"8","author":"Harlow","year":"2022","journal-title":"Womens Midlife Health"},{"issue":"11","key":"zoi260667r16","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1097\/GME.0000000000002060","article-title":"A review of African American women\u2019s experiences in menopause.","volume":"29","author":"Williams","year":"2022","journal-title":"Menopause"},{"issue":"1","key":"zoi260667r17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.004971","article-title":"In-hospital management and outcomes after ST-segment\u2013elevation myocardial infarction in Medicaid beneficiaries compared with privately insured individuals.","volume":"12","author":"Patel","year":"2019","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"3","key":"zoi260667r18","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1097\/SLA.0b013e3181e8fd75","article-title":"Primary payer status affects mortality for major surgical operations.","volume":"252","author":"LaPar","year":"2010","journal-title":"Ann Surg"},{"issue":"8","key":"zoi260667r19","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.2105\/AJPH.2016.303156","article-title":"Access and quality of care by insurance type for low-income adults before the affordable care act.","volume":"106","author":"Nguyen","year":"2016","journal-title":"Am J Public Health"},{"issue":"8","key":"zoi260667r22","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"1","key":"zoi260667r25","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1186\/s12905-024-03329-z","article-title":"Experiences of menopausal transition among populations exposed to chronic psychosocial stress in the United States: a scoping review.","volume":"24","author":"Blackson","year":"2024","journal-title":"BMC Womens Health"},{"issue":"2","key":"zoi260667r26","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1370\/afm.2792","article-title":"Conceptualizing, contextualizing, and operationalizing race in quantitative health sciences research.","volume":"20","author":"Lett","year":"2022","journal-title":"Ann Fam Med"},{"issue":"7624","key":"zoi260667r27","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"issue":"6","key":"zoi260667r28","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1097\/GME.0000000000001282","article-title":"Menopausal hormone therapy trends before versus after 2002: impact of the Women\u2019s Health Initiative Study Results.","volume":"26","author":"Crawford","year":"2018","journal-title":"Menopause"},{"issue":"6","key":"zoi260667r29","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1097\/gme.0b013e31824bb039","article-title":"A decade of postmenopausal hormone therapy prescribing in the United States: long-term effects of the Women\u2019s Health Initiative.","volume":"19","author":"Steinkellner","year":"2012","journal-title":"Menopause"},{"issue":"4","key":"zoi260667r30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.5503","article-title":"Assessment of potentially preventable hospital readmissions after major surgery and association with public vs private health insurance and comorbidities.","volume":"4","author":"Brown","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi260667r31","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.ygyno.2019.08.013","article-title":"Medicaid and Medicare payer status are associated with worse surgical outcomes in gynecologic oncology.","volume":"155","author":"Ahmad","year":"2019","journal-title":"Gynecol Oncol"},{"issue":"1","key":"zoi260667r32","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.32669","article-title":"Comparison of utilization, costs, and quality of Medicaid vs subsidized private health insurance for low-income adults.","volume":"4","author":"Allen","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi260667r33","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1377\/hlthaff.2014.0907","article-title":"Primary care providers ordered fewer preventive services for women with Medicaid than for women with private coverage.","volume":"34","author":"McMorrow","year":"2015","journal-title":"Health Aff (Millwood)"},{"key":"zoi260667r34","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000002437","author":"Rodriguez","year":"2024","journal-title":"Menopause"},{"key":"zoi260667r2","author":"Sowers","year":"2000"},{"key":"zoi260667r24","volume-title":"Stata Statistical Software: Release 17","author":"StataCorp","year":"2021"},{"key":"zoi260667r1","unstructured":"Peacock? K, Carlson? K, Ketvertis? KM. Menopause. In: StatPearls [Internet]. StatPearls Publishing; 2026. Accessed January 15, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507826\/"},{"key":"zoi260667r20","unstructured":"U.S. Census Bureau. 2023 American Community Survey 1-Year Estimates. Table B270002: Health Insurance Coverage Status by Age (Universe: Civilian noninstitutionalized population); Table B27007: Medicaid\/Means-Tested Public Coverage by Sex by Age. Accessed February 1, 2024. https:\/\/data.census.gov"},{"key":"zoi260667r21","unstructured":"Kaiser Family Foundation. (2024). Medicaid efforts to address racial health disparities. Accessed February 1, 2024. https:\/\/www.kff.org\/medicaid\/medicaid-efforts-to-address-racial-health-disparities\/"},{"key":"zoi260667r23","unstructured":"National Center for Health Statistics. National Health and Nutrition Examination Survey: sample design, 2015-2018. Vital and Health Statistics, Series 2, Number 184 (2020). Accessed February 1, 2024. https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02-184-508.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2851741\/chesnokova_2026_oi_260667_1783701526.49503.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:30:28Z","timestamp":1784302228000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2851741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.23740","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}