Racial and ethnic disparities in benign gynecologic conditions and associated surgeries

Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 06/2010; 202(6):514-21. DOI: 10.1016/j.ajog.2010.02.039
Source: PubMed


Common gynecologic conditions and surgeries may vary significantly by race or ethnicity. Uterine fibroid tumors are more prevalent in black women, and black women may have larger, more numerous fibroid tumors that cause worse symptoms and greater myomectomy complications. Some, but not all, studies have found a higher prevalence of endometriosis among Asian women. Race and ethnicity are also associated with hysterectomy rate, route, and complications. Overall, the current literature has significant deficits in the identification of racial and ethnic disparities in the incidence of fibroid tumors, endometriosis, and hysterectomy. Further research is needed to better define racial and ethnic differences in these conditions and to examine the complex mechanisms that may result in associated health disparities.

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    • "Health care is free in the UK, but ethnic minority groups are more likely to access maternity services late in pregnancy and less likely to have a scan at 20 weeks than are their white British counterparts [15]. Health problems which might underlie the present findings include higher rates of uterine fibroids [16] and systemic lupus erythematosus [17] in black women—disorders that are known risk factors for spontaneous abortion and preterm birth [18] [19]—and higher rates of polycystic ovarian syndrome in South Asian women. Symptoms of polycystic ovarian syndrome present at a younger age in South Asian women than in white women [20]. "
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    ABSTRACT: To assess the relationship between race and spontaneous abortion, whether the relationship varies by risk factors, and the effect of spontaneous abortions on subsequent pregnancies. A retrospective study was undertaken using data collected in London, UK, between 1988 and 2000. Logistic regression evaluated histories of spontaneous abortion and associations with small-for-gestational-age and preterm births in black African, black Caribbean, and South Asian women relative to white European women. Interactions with risk factors were assessed. Overall, 196 040 women were included. Compared with white Europeans, the odds of a previous spontaneous abortion were increased in black African (adjusted odds ratio [aOR] 1.20; 95% confidence interval [CI] 1.12-1.29) and black Caribbean women (aOR 1.31; 95% CI 1.21-1.41). The strength of the association with black African race increased with age (P=0.002), and the association with South Asian race increased with age and body mass index (P<0.001 for both). Spontaneous abortion was associated with preterm birth in all races, but was strongest in black African women (aOR 1.47; 95% CI 1.29-1.67). The greater incidence of spontaneous abortion in black African and black Caribbean women should prompt further study of risk factors in relation to race. The interaction with age in black African and South Asian women could be important for counseling in relation to timing of pregnancy. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · International Journal of Gynecology & Obstetrics
    • "Uterine fibroids, or leiomyomas, are benign hormone-sensitive tumours that consist of smooth muscle cells and affect approximately 20–40% of women of reproductive age [1] [2]. Uterine fibroids are a benign disease, but this condition may have serious pathological consequences. "
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    ABSTRACT: Objectives Ulipristal acetate is a selective progesterone receptor modulator that has been demonstrated to be an effective 3-month pre-operative treatment for moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The aim of this analysis was to assess the cost-effectiveness of 5 mg ulipristal as an add-on therapy to standard pre-surgical observation and treatment in Hungary. Study design A Markov model was developed using a 10-year time horizon. Ulipristal was compared with pre-surgical observation and immediate hysterectomy. The model comprised the following mutually exclusive health states: mild, moderate, severe, or persistent severe excessive bleeding disorder; myomectomy; post-myomectomy with mildly to moderately excessive bleeding disorder; post-myomectomy with severely excessive bleeding disorder; hysterectomy; post-hysterectomy; post-menopause; and death. Transition probabilities and utility values were obtained from clinical trials and the scientific literature. Resource utilisation and unit costs were derived from a consensus panel of clinical experts, National Health Insurance Fund tariffs, and publications. Results Adding a 3-month course of ulipristal to pre-operative observation was predicted to achieve an additional 0.021 quality-adjusted life years (QALYs) at an estimated incremental cost of €397, which would result in an incremental cost of €19,200/QALY. When 3 months of ulipristal therapy was compared with immediate hysterectomy, the incremental cost-effectiveness ratio was reduced to €3,575/QALY. The results were most sensitive to the utility value of the post-hysterectomy health state but responsive to changes in other model parameters. Conclusions The results of this analysis suggest that adding ulipristal treatment to standard pre-surgical therapy represents a good value for money in Hungary. The inclusion of societal benefits may considerably reduce the cost-effectiveness ratio.
    No preview · Article · Apr 2014 · European journal of obstetrics, gynecology, and reproductive biology
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    ABSTRACT: Myomas are the most common benign tumors of the genital organs in women of childbearing age, causing significant morbidity and impairing their quality of life. In our investigation, we have reviewed the epidemiological data related to the development of myomas in order to homogenize the current data. Therefore, a MEDLINE and PubMed search, for the years 1990-2013, was conducted using a combination of keywords, such as "myoma," "leiomyoma," "fibroids," "myomectomy," "lifestyle," "cigarette," "alcohol," "vitamins," "diet," and "hysterectomy". Randomized controlled studies were selected based upon the authors’ estimation. Peer-reviewed articles examining myomas were sorted by their relevance and included in this research. Additional articles were also identified from the references of the retrieved papers and included according to authors’ estimation. Many epidemiologic factors are linked to the development of myomas; however, many are not yet fully understood. These factors include age, race, heritage, reproductive factors, sex hormones, obesity, lifestyle (diet, caffeine and alcohol consumption, smoking, physical activity and stress), environmental and other influences, such as hypertension and infection. Some of the epidemiological data is conflicting. Thus, more research is needed to understand all the risk factors that contribute to myoma formation and how they exactly influence their onset and growth.
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