Disparities in Utilization of Uterine Fibroid Embolization

Area of Science:

• Gynecology
• Interventional Radiology
• Health Services Research

Background:

• Uterine fibroid embolization (UFE) offers a minimally invasive alternative to surgical treatments like hysterectomy and myomectomy.
• Understanding utilization patterns and access disparities for UFE is crucial for informed patient choice and equitable healthcare.

Purpose of the Study:

• To analyze trends in the utilization of UFE compared to hysterectomy and myomectomy for uterine fibroid management.
• To identify sociodemographic and institutional disparities in access to UFE.

Main Methods:

• A cross-sectional analysis of the 2016-2022 National Inpatient Sample (NIS) data.
• Identification of adult patients with uterine fibroids undergoing hysterectomy, myomectomy, or UFE using ICD-10-CM codes.
• Multivariable logistic regression modeling to assess factors associated with UFE utilization, controlling for patient and hospital characteristics.

Main Results:

• UFE accounted for only 3.5% of procedures (9,585/271,885), with hysterectomy being the most common (73.4%).
• Significant disparities in UFE utilization were observed across race, ethnicity, insurance status, income, and geographic location (rural vs. urban).
• For example, African American patients had higher odds of UFE vs. hysterectomy, while Hispanic patients had lower odds for both surgical comparisons. Patients with Medicaid or self-pay insurance had higher odds of UFE.

Conclusions:

• Uterine fibroid embolization (UFE) is significantly underutilized in the United States.
• Substantial socioeconomic and demographic disparities exist in UFE access, highlighting the need for targeted interventions.
• Equitable expansion of access to UFE is necessary to ensure patients can consider all effective treatment options for uterine fibroids.