Demographic Disparities in Uterine Fibroid Incidence Are Not Reflected in Treatment Practice Patterns Among U.S. Women: A Systematic Review and Meta-analysis [ID 2683522

Abstract

INTRODUCTION: Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UF) and experience severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than hysterectomy and may improve UF outcomes. We reviewed demographic characteristics associated with UAE utilization compared to hysterectomy for symptomatic UF among U.S. women. METHODS: Systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051). 1,350 articles (January 1, 1995, to July 15, 2023) outlining demographic characteristics of UAE versus hysterectomy patients were identified. Two readers screened for inclusion criteria, yielding 11 full-text U.S.-based cohort and randomized controlled-trial studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed (STATA v18.0). Egger’s regression test was used to quantify publication bias. RESULTS: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio [OR] 3.35; p50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. CONCLUSION: Current knowledge of demographic characteristics of UF patients receiving UAE versus hysterectomy is sparse (n=11 studies). Among these studies, racial disparities in UF incidence do not appear to affect UAE utilization; rather, Black race may predict utilization of UAE compared to hysterectomy. Further research is warranted to determine the effects of clinical and demographic covariates on UF treatment outcomes.