Racial disparities in non-hysterectomy surgeries for endometriosis

Objective

To evaluate the self-reported prevalence of hysterectomy and non-hysterectomy surgeries for endometriosis by race/ethnicity.

Methods

This cross-sectional study used data from the National Survey of Family Growth (NSFG) 2017–2019 cycle. This study included persons ages 15–49 years who identify as female and who reported receiving a diagnosis of endometriosis from a healthcare professional. The main study outcomes were self-reported receipt of hysterectomy and non-hysterectomy surgeries for endometriosis. The main exposure was race/ethnicity. Multivariable logistic regression estimated adjusted prevalence odds ratios and 95% confidence intervals of hysterectomy and non-hysterectomy endometriosis surgery. Differences in social determinants of health (SDH) among women who did and did not receive non-hysterectomy endometriosis surgery were tested using chi-square analysis.

Results

Of 6,141 survey participants, 314 (5.11%) answered yes to ever being diagnosed with endometriosis. While there were no significant differences in the odds of having a hysterectomy for endometriosis when stratifying by race/ethnicity, Black women had a significantly lower odds of non-hysterectomy endometriosis surgery compared to White women. The analysis of SDH revealed a higher prevalence of poverty among women who did not receive non-hysterectomy endometriosis surgeries. However, including poverty in the multivariable logistic regression model did not alter racial disparity findings.

Conclusion

White women have over four times higher odds of receiving non-hysterectomy endometriosis surgery compared to Black women in a fully adjusted model, which cannot be explained by a secondary analysis of SDH. Further examination of factors that may influence decisions on surgery for endometriosis will create a better understanding of disparities in endometriosis care.