Association Between Age, Race, Ethnicity, and Body Mass Index and Time to Endometriosis Diagnosis

To assess the associations of time to endometriosis diagnosis after presentation for pelvic pain between patients of different ages, races, ethnicities, and body mass index (BMI) ranges.

This retrospective study was conducted with the U.S. Collaborative Network on the TriNetX research network of health care organizations using International Classification of Diseases, Tenth Revision (ICD-10) codes. Race, ethnicity, and BMI cohorts consisted of 18- to 44-year-old female patients with diagnoses of endometriosis (ICD-10 N80) and pelvic-perineal pain (ICD-10 R10.2). Age cohorts consisted of female patients aged 18-30 years or 31-44 years, with the same two diagnoses. The BMI cohorts were categorized as lower than 19.9 (ICD-10 Z68.1), 20-29 (ICD-10 Z68.2), and higher than 30 (ICD-10 Z68.3, Z68.4). Patients were matched for race, ethnicity, and age at pelvic pain diagnosis. We assessed time to endometriosis diagnosis after an initial diagnosis of pelvic and perineal pain using Kaplan-Meier analysis and log-rank test with a value of P<.05 considered significant.

For patients aged 18-30 years (n=13,662), the median time to endometriosis diagnosis was 0.49 years; for patients aged 31-44 years (n=13,662), the median time to diagnosis was 3.10 years (χ²=3,503, P<.001). In a comparison of Black and White patients (n=12,242 patients in each group), the median time to endometriosis diagnosis for Black patients was 1.34 years compared with 0.67 years for White patients (χ²=128, P<.001). For Asian (n=2,453) and White (n=2,453) patients, the median time to endometriosis diagnosis was 0.58 years for Asian patients and 0.64 years for White patients (χ²=0.68, P=.41). For Hispanic and non-Hispanic patients (n=10,640 patients in each group), the median time to endometriosis diagnosis was 1.11 years for Hispanic patients and 0.68 years for non-Hispanic patients (χ²=27, P<.001). For BMI lower than 19.9 (n=1,448) and BMI 20-29 (n=1,448), the median time to endometriosis diagnosis was 1.15 years for BMI lower than 19.9 and 1.35 years for BMI 20-29 (χ²=2.8, P=.10). For BMI higher than 30 (n=1,719) and BMI lower than 19.9 (n=1,719), the median time to endometriosis diagnosis was 1.52 years for BMI higher than 30 compared with 1.15 years for BMI 20-29 (χ²=19.4, P<.001).

Disparities exist in the time to endometriosis diagnosis after pelvic and perineal pain diagnosis. Obesity, older age, Black race, and Hispanic ethnicity are associated with longer times from a pelvic pain diagnosis to an endometriosis diagnosis.