Racial Differences in Endometriosis and Uterine Fibroid Diagnosis and Hysterectomy Treatment

Background and Purpose:
Negative reproductive health outcomes, such as fibroids and endometriosis affect nearly 10% of reproductive age women. Previous literature reports that Black women are significantly less likely be diagnoses with endometriosis, yet more likely to develop uterine fibroids, and have a hysterectomy for benign gynecological conditions when compared to White women. Reproductive issues can negatively impact the quality of life of affected women, including physical and emotional health. Current research reports that endometriosis and fibroids are the second and fifth leading causes of hysterectomies, respectively.

Racial disparities in healthcare service delivery affect entire communities. While research is consistent on the existence of health disparities, there is a lack of research that examines the specific areas of disparities so that communities can address them with accountability and specificity. The purpose of this study is to help contribute to the body of literature addressing racial disparities in healthcare by examining the role of race in reproductive health diagnoses and outcomes.

Methods:
A secondary analysis was conducted of the National Survey of Family Growth data collected from 2015-2017 by the Centers for Disease Control and Prevention’s National Center for Health Statistics. The data used is a part of a much larger data set that examines information on family matters, including contraception. For the purpose of this analysis, we examined only the responses of reproductive age women in the study. Of the 5,542 survey participants, 45% (n=2492) reported being Black or Hispanic (minority) while 49.5% (n=2742) reported being White. There were 308 participants with missing values, and those observations were dropped. Binary logistic regressions were conducted to quantify the association between race/ethnicity with having a uterine condition and having a hysterectomy.

Findings:
Diagnosis rates of uterine conditions significantly differed by race/ethnicity with 7.5% being Hispanic, 12.3% being Black, and 13.6% being White (p < .05). Rates of hysterectomies in women with uterine conditions did not differ significantly by race/ethnicity [Hispanic (25.3%), Black (27.8%), and White (28.6%)].

Conclusion and Implications:
Treatment for uterine conditions vary with hysterectomy often being a last resort. While our research identified that race/ethnicity was not a statistically significant predictor of hysterectomies in women with a diagnosed uterine condition, a large proportion of this population is receiving radical treatment that is not curative. The differences in previous literature findings are significant and further research is warranted. Specifically, we suggest a more ethnically representative sample, and a model that would take into consideration the impact of cultural values regarding contraceptive use and reproductive health. Further, we suggest that the research would be expanded to include concepts surrounding age of diagnosis and examine geographical patterns.