7563 Association between Race and Utilization of Hysterectomy and Non-Hysterectomy Surgeries for Endometriosis

Abstract

<h3>Study Objective</h3> To evaluate the association between race and self-reported prevalence of hysterectomy and non-hysterectomy surgeries for endometriosis treatment. <h3>Design</h3> This cross-sectional study used data from the National Survey of Family Growth (NSFG). The main study outcome was self-reported receipt of hysterectomy and non-hysterectomy surgeries for endometriosis. Multivariable logistic regression estimated adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI). Differences in social determinants of health (SDH) among women who did and did not receive non-hysterectomy endometriosis surgery were tested using Rao-Scott chi-square analysis. <h3>Setting</h3> Data from the 2017-2019 NSFG cycle was collected from participants throughout the United States via in-person interviews and self-administered questionnaires. <h3>Patients or Participants</h3> This study included persons who identify as female, ages 15-49 years, who reported receiving a diagnosis of endometriosis by a healthcare provider. <h3>Interventions</h3> The main exposure was race, stratified by Non-Hispanic White, Non-Hispanic Black, Hispanic and other. <h3>Measurements and Main Results</h3> Of 6,141 survey participants, 314 (5.11%) answered yes to ever being diagnosed with endometriosis. Among women with endometriosis, there was no statistically significant difference in age, parity, history of PID and insurance status by race. Although there were no statistically significant differences in the odds of having a hysterectomy for endometriosis when stratified by race, Black women had a significantly lower odds of having non-hysterectomy endometriosis surgery compared to White women (aPOR=0.22, 95% CI 0.06, 0.77). The analysis of SDH revealed a lower prevalence of poverty among women who received non-hysterectomy endometriosis surgery (p=0.0041). However, including this variable in the logistic regression model did not change the findings. <h3>Conclusion</h3> White women have over four times higher odds of receiving non-hysterectomy endometriosis surgery compared to Black women in our full adjusted model, which cannot be explained by a secondary analysis of SDH. Further examination of factors that may influence decisions for non-hysterectomy surgery for endometriosis is warranted to better understand disparities in care.