Pain Without Prejudice: Examining Disparities in Endometriosis and Pelvic Pain Management Stratified by Race in an Integrative Health Care System [ID 2683558

Abstract

INTRODUCTION: Approximately 10% of reproductive-aged women suffer from endometriosis; racial variations in prevalence and treatment are unknown. Black women are often undertreated for pain and medical conditions. This study assessed variations in pelvic pain and endometriosis management with particular emphasis on Black versus non-Black patients. METHODS: We conducted a retrospective cohort study of women 18 years and older with pelvic pain disorders, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded within the Kaiser Permanente Northern California electronic medical record between 2012 and 2019. Demographic, clinical, and treatment characteristics were assessed overall and by patient race/ethnicity. RESULTS: Of 15,164 eligible study participants, 1,707 (11.3%) were Black, 6,735 (50.1%) White, 2,097 (15.6%) Asian, 3,762 (28%) Latinx, and 863 (6%) unknown. Black compared to non-Black women were younger (36 [interquartile range (IQR) 28–44] versus 37 [IQR 30–45]; P<.001), had a higher body mass index (29.8 [IQR 25.2–35.9] versus 26 [IQR 22.7–30.7] kg/m2; P<.001) and similar parity. A higher proportion of Black women received hormonal therapy (56.2% versus 51.9%; P<.001). When stratified by all races, this was explained by White women receiving the least amount of hormonal therapy (56.2% versus 49.8%; P<.001). Black women received more pain medications (55.4% versus 44.7%; P<.001), with no racial variations in rates of laparoscopic surgery (4.4 versus 4.9; P=.21). Fewer Black women received referrals to a pelvic pain specialist (14.5% versus 17.8%; P=.001), and when stratified by all races White women received more referrals (21%; P<.001). There were no racial variations in patients who received medical followed by surgical treatment. CONCLUSION: Black women received more hormonal, pain, and similar surgical management, in contrast to that reported in prior publications. However, all races had a lower pelvic pain specialist referral rate than White patients. These findings illustrate the need to better understand the allocation of care in patients with pelvic pain disorders, including endometriosis.