Treatment Utilization after Uterine Fibroid Diagnosis by Race and Ethnicity

Abstract

Background:

Treatment utilization after the first fibroid diagnosis has not been well described for patients who are not Black or White. We studied treatment utilization by race and ethnicity in a large, diverse patient cohort.

Materials and Methods:

In the electronic health records of Kaiser Permanente Northern California, we studied 84,206 female patients aged 18–54 from first fibroid diagnosis (January 1, 2009–December 31, 2022) for up to 5 years and ascertained treatments received (levonorgestrel intrauterine device [IUD], hysteroscopic myomectomy, myomectomy, uterine artery embolization, endometrial ablation, hysterectomy). Cox proportional hazards models calculated hazard ratios for receiving any long-term treatment, uterine-preserving treatment, and hysterectomy by race and ethnicity. We assessed effect modification by body mass index (BMI), Neighborhood Deprivation Index (NDI), symptoms, and age. Finally, we calculated the hazard of receiving each treatment as the first treatment.

Results:

Overall, 30,838 of 84,206 patients (37%) received 36,115 treatments. The most common treatments were hysterectomy (45% of treatments), levonorgestrel IUD (21%), and myomectomy (15%). Compared with White patients, Black, Asian, and Hispanic patients were significantly less likely to receive any treatment, hysterectomy, or uterine-preserving treatment. This pattern was consistent across age, symptoms, BMI, and NDI. As first treatments, Black patients were more likely than White patients to receive uterine artery embolization, and Black, East Asian, and South Asian patients were more likely to receive myomectomy. White patients were more likely to receive hysteroscopic myomectomy, IUD, endometrial ablation, and hysterectomy as first treatments.

Conclusions:

Determining causes of differences in long-term treatment utilization may ensure that access to fibroid care is equitable.