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Epidemiology and comorbidities of polycystic ovary syndrome in an indigent population
Susan M Sirmans1, Roy C Parish, Sandra Blake
1From the *School of Pharmacy, The University of Louisiana at Monroe, Baton Rouge; †Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center, Shreveport; and ‡Office of Outcomes Research, College of Pharmacy, The University of Louisiana at Monroe, Baton Rouge, LA.
Background:
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The aims of this study were to provide an estimate of the prevalence of PCOS in clinical practice; compare the risk of established cardiovascular risk factors, cardiovascular disease, and other comorbid conditions in women with PCOS to that of age- and race-matched controls; and explore the total costs of care that can be attributed to PCOS.
Methods:
Louisiana Medicaid claims data were used to identify women with PCOS or its defining features and a control group in a ratio of 1:3. The prevalence of PCOS, cardiovascular risk factors (diabetes, dyslipidemia, dysmetabolic syndrome, glucose intolerance, hypertension, and obesity), key comorbidities (anxiety, bipolar disorders, depression, eating disorders, infertility, obstructive sleep apnea), and diagnosed cardiovascular disease were measured.
Results:
During 2010, the prevalence of PCOS was 0.88%. Women with PCOS were more likely to have a diagnosis of diabetes (odds ratio [OR], 4.35; 95% confidence interval [CI], 3.63-5.21), dyslipidemia (OR, 3.56; 95% CI, 3.04-4.19), dysmetabolic syndrome (OR, 23.46; 95% CI, 13.64-40.36), glucose intolerance (OR, 5.46; 95% CI, 3.10-9.60), hypertension (OR, 2.76; 95% CI, 2.41-3.18), obesity (OR, 5.79; 95% CI, 5.07-6.62), infertility (OR, 23.42; 95% CI, 10.63-51.61), obstructive sleep apnea (OR, 6.47; 95% CI, 3.62-11.55), anxiety (OR, 1.76; 95% CI, 1.53-2.04), bipolar disorders (OR, 1.94; 95% CI, 1.55-2.44), and depression (OR, 2.22; 95% CI, 1.94-2.54) than did controls. Average total costs of care for the year was $5551 in the PCOS group and $3496 in the control group. After controlling for the effects of other variables, the average total cost of care for PCOS was $637 higher than that of the control group. Other variables that contributed significantly to the total costs of care included race, age, acute myocardial infarction, transient ischemic attack, peripheral artery disease, anxiety, depression, bipolar disorders, hypertension, diabetes, and dyslipidemia.
Conclusions:
Although the clinical burden of PCOS is high, it is diagnosed less frequently in clinical practice compared with systematic screening studies. This is concerning considering that PCOS is associated with cardiovascular risk factors and other comorbidities. Mean total costs of care for the PCOS group was higher than the mean total costs of care for the control group. Polycystic ovary syndrome is independently associated with an increase in mean total costs of care.