Black Women Are More Likely Than White Women to Schedule a Uterine-Sparing Treatment for Leiomyomas

Abstract

Background: To evaluate differences in the proportion of uterine fibroid (UF) treatments that are uterinesparing between Black women and White women and identify factors that could explain disparities. Methods: Women at age 18-54 years who were enrolled from 10 clinical sites in the United States into the Comparing Options for Management: Patient-Centered Results for UFs (COMPARE-UF) treatment registry completed questionnaires before their UF procedure. UF symptoms and quality of life were assessed by questionnaires. Details on UF imaging and treatment (hysterectomy, myomectomy, or uterine artery embolization [UAE]) were collected from each patient's medical record. Random-effects logistic regression was used to assess the association between race and the odds of having a uterine-sparing procedure versus hysterectomy. Subgroup analyses compared each uterine-sparing procedure with hysterectomy. Results: In this cohort of 1141 White women and 1196 Black women, Black women tended to be younger (median 41.0 vs. 42.0 years) and report worse symptoms, pain, and function on every scale compared with White women. Black women were more likely to have had a prior UF treatment compared with White women (22.8% vs. 14.6%). White women had more hysterectomies (43.6% vs. 32.2%) and myomectomies (50.9% vs. 50.2%) versus Black women. Black women had more UAEs (15.1% vs. 4.7%) than White women. After adjusting for clinical site and other variables, Black women had greater odds than White women of having a myomectomy (odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.63-3.56) or a UAE versus hysterectomy (OR = 4.24, 95% CI = 2.41-7.46). Conclusion: In these participants, Black women were more likely to schedule a uterine-sparing UF treatment and a nonsurgical UF treatment than their White counterparts; this may not be true for all women. Longer

Uterine‐preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: A retrospective cohort study of long‐term outcomes

“…A significant proportion of these women may seek radiological or surgical treatment to alleviate their symptoms. Hysterectomy has been the historical mainstay of treatment but women are increasingly seeking uterine‐preserving therapy 3,4 . Myomectomy represents an option for those requiring fertility preservation.…”

“…Hysterectomy has been the historical mainstay of treatment but women are increasingly seeking uterine-preserving therapy. 3,4 Myomectomy represents an option for those requiring fertility preservation. Although UAE is uterine-preserving, national fibroid management guidelines advocate against its use in those who have pregnancy aspirations because of uncertain adverse effects on the endometrium or ovarian reserve.…”

Describing the Patient Journey of Women with Claims for Uterine Fibroids and Heavy Menstrual Bleeding Using a Commercial Database (2011–2020)

“…The role of race in treatment choice was statistically significant when evaluated using logistic regression. 31 The 2008 American College of Obstetricians and Gynecologists (ACOG) clinical management guidelines for symptomatic UF in place during this study also provide an explanation for the high frequency of hysterectomy following UF diagnosis. While these guidelines emphasized alternatives to hysterectomy, they also indicated that available medical therapies provided only short-term symptomatic relief and/or temporary fibroid size reduction, and that there was a high crossover rate to surgical approaches, including hysterectomy.…”

Comparison of Costs, Re-Intervention Rates, and Length of Hospital Stay for Three Uterus Sparing Interventions for Uterine Fibroids: A 2-Year Retrospective Claims Analysis

“… 19 Demographic disparities are also relevant, as Black patients present with a higher burden of disease earlier in life, and demonstrate different priorities, such as choosing non-surgical options. 20 In addition, the impact on healthcare resources is undeniable. In 2012, Cardozo et al conducted a study to estimate the total annual societal cost of uterine fibroid tumors in the US based on direct and indirect costs that included associated obstetric complications.…”