Race, Ethnicity and Geographical Variables in the Study of Polycystic Ovarian Syndrome

Abstract

Introduction Polycystic Ovarian Syndrome (PCOS), the most common endocrine disorder in women, is diagnosed based on a pattern of signs/symptoms including obesity, infertility, androgen excess, hirsutism, oligomenorrhea/amenorrhea, metabolic syndrome, and polycystic ovaries on ultrasound. Yet, there is little information on the variation in its presentation or response to treatment based on race or ethnicity. Many metabolic and cardiovascular disease (CVD) factors vary depending on race and/or ethnicity; stratifying PCOS patients in this way allows for a more detailed, individualized treatment. Our aim was to evaluate published primary source studies and describe the PCOS participants based on their race, ethnicity or geographical region. We hypothesized that there is an underrepresentation of minority populations in PCOS studies related to race and/or ethnicity. Methods A PubMed search was done in May 2020 for keywords ‘PCOS’ or ‘Polycystic Ovarian Syndrome’ or ‘Polycystic Ovarian Disease’ combined with keywords ‘Race’ or ‘Ethnicity.’ The resultant studies were limited to randomized control trials (RCT) or clinical trials. Studies were reviewed for classification of race: US Census criteria (white, Black, Native American/Alaskan Native, Asian/ Pacific Islander) or other, and details of Hispanic or non-Hispanic ethnicity. For non-US studies, geographic region was used as a variable for race or ethnicity. Results Our search strategy with chosen keywords yielded 19,756 studies. Limiting to keywords Race or Ethnicity resulted in 804 studies from which 28 were RCT or clinical trials. Of these, 23 studies from years 1994 to 2019 were available for review. Total subjects reported were 8,658, of those 7,451 were patients with PCOS. Race information was available in 10 studies; 3,853 subjects classified as per US census. Hispanic ethnicity information was available in 7 studies; total of 3,484 subjects. Remaining studies were based on geographical region of origin. Most studies did not differentiate Black or white Hispanic groups. There were 10 studies from Southeast Asia, China, and the Middle East that did not report race or ethnicity information. Among those that reported racial data, black people were 15% of participants (579/3,853) in US based studies. Asians were a highly studied group (22%) because of the quantity of publications from that geographical region. Of the symptoms/signs associated with PCOS, the most frequently reported were menstrual disturbances (18/23) and androgen excess (21/23). Less frequently reported were polycystic ovaries on ultrasound (14/23). Only studies based outside the US used infertility or hirsutism as PCOS diagnostic criteria. Conclusions Published reports on PCOS show an under-representation of black women, both as a race and as an ethnic sub-group among Hispanics. Racial/ethnic data has been significant in the management of PCOS comorbidities such as CVD, yet there is a paucity in this information on PCOS. Our future plan is to perform a systematic review of the interaction of race and ethnicity on the presentation and management of PCOS.