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Patient Characteristics Associated With Embolization Versus Hysterectomy for Uterine Fibroids: A Systematic Review
Tara Srinivas1, Bethlehem Lulseged1, Mohammad Mirza Aghazadeh Attari2
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Journal of the American College of Radiology : JACR
|January 8, 2024
Summary
Black and younger women with uterine fibroids (UFs) are more likely to receive uterine artery embolization (UAE) over hysterectomy. This trend suggests demographic disparities in UF treatment persist, impacting care for these populations.
Area of Science:
- Reproductive Health
- Minimally Invasive Procedures
- Health Disparities
Background:
- Uterine fibroids (UFs) disproportionately affect Black and underinsured women in the U.S., often leading to more severe symptoms.
- Uterine artery embolization (UAE) offers a less invasive, uterine-sparing alternative to hysterectomy for UF treatment.
Purpose of the Study:
- To investigate whether demographic disparities influence the choice between UAE and hysterectomy for uterine fibroids.
- To analyze patient characteristics associated with receiving UAE versus hysterectomy in U.S. clinical practices.
Main Methods:
- A systematic literature review of PubMed, Embase, and CINAHL databases was conducted.
- Included 13 U.S.-based comparative studies published between 1995 and 2023, analyzing demographic data of patients undergoing UAE versus hysterectomy.
- Random effects meta-analysis and Egger's regression test were used to assess treatment modality predictors and publication bias.
Main Results:
- Analysis of 138,960 patients for race showed Black women were more likely to receive UAE (OR=3.35, P<.01).
- Analysis of 312,270 patients for age indicated younger women were more likely to receive UAE (P<.05).
- Insurance status (private vs. Medicare/Medicaid) did not significantly predict treatment modality (OR=1.06, P=.52).
Conclusions:
- Despite sparse data (13 studies), demographic disparities in UF treatment persist.
- Black and younger women are more likely to undergo UAE compared to hysterectomy.
- Further research is needed to understand the implications of these demographic trends in UF management.
