Disparity in Uterine Leiomyomata Care in Black Women in Years Prior to and After Adoption of the Affordable Care Act

Abstract

Abstract

Objective:

This research was conducted to determine if surgical management patterns for uterine leiomyomata, specifically in black women, changed after the Affordable Care Act (ACA) was implemented.

Materials and Methods:

Data from within a public academic health system were retrospectively abstracted on 670 women who underwent hysterectomy for management of uterine leiomyomata between 2004 and 2016.

Results:

A significant change in route of hysterectomy after ACA implementation (p < 0.0001) was seen; rates of open hysterectomy increased (8% versus 13%), whereas rates of minimally invasive surgeries (MIS) decreased (92% versus 87%). After implementation of the ACA, women had increased odds of undergoing open surgery (adjusted odds ratio [aOR] = 1.81; 95% confidence interval [CI] = 0.1.03, 3.21) compared to before. In consideration of the U.S. Food and Drug Administration (FDA) Safety Communication on electromechanical morcellation in 2014, data were also stratified by specific time periods. Overall, women who had surgery after ACA implementation, but before the Communication (2012–2014) had higher odds of MIS (aOR = 0.45; 95% CI = 0.22, 0.90), compared to women who underwent surgery after the FDA Communication (post-2014), and these findings were even stronger among black women (aOR = 0.28; 95% CI = 0.09, 0.83).

Conclusions:

Despite increased access to care with implementation of the ACA, surgical management via open hysterectomy for uterine fibroids increased for all races. Open approaches still comprise a higher proportion of hysterectomies in black women, compared to white women. Although the ACA increased access to care, further research is needed to evaluate what barriers to MIS still exist, particularly for black women.