A Decade Long Analysis of Healthcare Disparities and Uterine Artery Embolization: An Exploration of Social Determinants of Health.

Abstract

Purpose: To determine the extent that social determinants of health have on uterine artery embolization (UAE) utilization for treatment of symptomatic uterine fibroids.

Methods: In this IRB-exempt study, data from the 2011-2020 National Inpatient Sample was used to identify patients with ICD-9 and -10 codes of uterine fibroids who underwent UAE. Data collected included: patient's demographics (race/ethnicity, income, insurance status) and procedure location (geographic region, hospital setting). Results are presented in percentage (UAE procedures per variable) and analyzed using Chi-square test.

Results: UAE utilization by race/ethnicity demonstrated the following distribution: Non-Hispanic Blacks (45.6%), Non-Hispanic Whites (28.1%), Hispanics (14.2%) and Asians (5.7%). The lowest quartile for income experienced no change in utilization (27.8%), while the highest quartile gradually decreased across the decade (2011:26.7%, 2020:19.0%, p=0.01). The Northeast region of the US (49.0% in 2011) was superseded by the South (34.8% in 2020) as the dominant geographic region for UAE. The main insurance statuses were private (55.5%) and Medicaid (26.2%), with Medicaid rates increasing throughout the decade (2011:18.2%, 2020: 28.6%, p < 0.001). Urban teaching hospitals accounted for the highest rates of total UAE (82.3%), compared to urban non-teaching (16.0%) and rural hospitals (1.2%).

Conclusion: Over the past decade, UAE has been performed in a relatively equitable fashion on the basis income, with improved utilization within the Medicaid population and throughout the geographic regions of the US. When accounting for US population representation and unequal disease burden, Non-Hispanic Blacks demonstrated a greater-than-expected utilization of UAE, compared to lower-than-expected rates among Non-Hispanic Whites.