Ethno-Racial Differences in Age and Symptom Severity Among Pre-Menopausal Women Commencing Treatment for Benign Gynecological Conditions with a Levonorgestrel-Releasing Intrauterine Device.

Abstract

Introduction: Levonorgestrel-releasing intrauterine devices (LNG-IUDs) can be effective treatments for benign gynecological conditions, but there may be ethno-racial differences in how patients receive treatment.

Methods: Data were from a health care system in the U.S. South (April 2014-September 2019). We identified 783 female patients aged 18-44 years with an LNG-IUD for a benign gynecological condition (455 White, 208 Black, and 120 Hispanic patients). Abstraction of medical notes preceding insertion gave symptom severity scores for uterine bleeding, pelvic pain, and uterine bulk. Linear and negative binomial regression models assessed differences in patients' age and symptom severity scores, respectively. Covariates included insurance status, parity, prior treatments, and fibroid and endometriosis diagnoses.

Results: White patients' mean age was 32.4 years. Black patients were similarly aged (+0.9 years [95% confidence interval: -0.4 to 2.1]), whereas Hispanic patients were older (+3.4 years [2.0-4.9]), and adjustment attenuated this difference (+0.7 [-0.7 to 2.0]). Estimated ratios indicated more severe bleeding and bulk symptoms for Black and Hispanic than White patients (bleeding: Black: 1.7[1.5-2.0], Hispanic: 1.7[1.4-2.1]; bulk: Black: 1.5[1.3-1.9], Hispanic: 1.5[1.2-1.9]). Adjustment for covariates attenuated estimates, especially for Hispanic patients (bleeding: Black: 1.4[1.2-1.6], Hispanic: 1.2[1.0-1.4]; bulk: Black: 1.3[1.1-1.6], Hispanic: 1.2[1.0-1.6]).

Discussion: At the time of LNG-IUD insertion, Hispanic patients were older than White patients. Black and Hispanic patients had more severe symptoms than White patients. Differences in age and symptom severity were associated with lack of insurance coverage, higher parity, presence of fibroids, and prior medical management, potentially indicating barriers to early LNG-IUD treatment for Black and Hispanic patients.