Racial and Socioeconomic Disparities in Approach to Treatment of Uterine Fibroids

To evaluate the association between social determinants of health and level of invasiveness of uterine fibroid treatment.

Retrospective cohort study.

De-identified administrative claims from >200 million enrollees across the United States using OptumLabs Data Warehouse.

Patients aged 15 to 55 years with newly-diagnosed symptomatic fibroids between 2010 and 2023. Individuals with prior fibroid diagnosis/treatment, gynecologic cancer, or menopause were excluded.

The primary outcome was fibroid treatment within 180 days after diagnosis, classified by invasiveness of surgery: (1) no surgery, (2) vaginal/hysteroscopic myomectomy, ablation/embolization, (3) laparoscopic myomectomy/hysterectomy, (4) open myomectomy/hysterectomy. We used Pearson chi-square tests for categorical variables, and analysis of variance and t tests for continuous variables. Multinomial logistic regression was used to assess the association between social determinants of health and type of treatment after adjusting for pertinent covariates.

Data from 133 109 individuals were analyzed. After controlling for age, year of surgery, and insurance type, race, income, education, and rurality were each significantly associated with level of treatment invasiveness. Black patients had a higher predicted probability (0.114, 95% CI 0.110-0.118) of having the most invasive treatment compared to White patients (0.095, 95% CI 0.093-0.097). The predicted probability for the most invasive treatment was greater in patients with lower household income (0.111, 95% CI 0.107-0.115 for <$40 000 vs 0.078, 95% CI 0.075-0.081 for >$124 999), lower educational attainment (0.118, 95% CI 0.087-0.148 for less than high school vs 0.082, 95% CI 0.078-0.086 for bachelor's degree plus), and patients living in a rural area (0.106, 95% CI 0.092-0.121 for rural vs 0.095, 95% CI 0.094-0.097 for metropolitan). All associations were significant, p < .05.

Race, income, education, and rurality were independently associated with invasiveness of fibroid treatment. Historically marginalized individuals with fewer socioeconomic advantages were more likely to receive the most invasive treatment.