Women’s Race, Income Linked to Treatment for Uterine Fibroids Says JNMA Study
WASHINGTON, Oct. 3 -- Black women, whom studies have shown to be more likely than white women to have uterine fibroids, are also more likely than white women to undergo a uterus- sparing surgical procedure for fibroids, according to an article in the October issue of the Journal of the National Medical Association (JNMA).
In “Inpatient Surgical Treatment Patterns for Patients with Uterine Fibroids in the United States, 1998–2002,” Edmund R. Becker, PhD, and colleagues report that race plays an important role in the kinds of surgical treatments women receive for uterine fibroids nationwide.
Additionally, the study found that women with an annual income of more than $45,000 were more likely than lower-income patients to be treated with myomectomies and less likely to have hysterectomies. Furthermore, patients with private insurance or an HMO were more likely than Medicaid patients to receive treatments other than hysterectomies. Medicaid patients were commonly Hispanic. Both Hispanic women and Asian/Pacific Islanders experienced higher rates of total hysterectomies than white women.
Among women hospitalized with a primary diagnosis of uterine fibroids, white women were most likely to be treated with a hysterectomy, the surgical removal of the uterus. Women of other races were more likely to be treated with a uterine myomectomy, the surgical removal of fibroids from the uterus, which, unlike a hysterectomy, does not render a patient sterile. Black women were 62 percent more likely than white women to receive a myomectomy; Hispanics, 5 percent more likely; and Asian/Pacific Islanders, 91 percent more likely.
White women were also more likely to have laparoscopically- assisted vaginal hysterectomies, which are less invasive than total abdominal hysterectomies, than other ethnic groups. Black women, in particular, were 69.5 percent less likely than white women to have such procedures. Black patients were also younger and experienced a longer hospital stay than other racial groups. Compared with white patients, the African-American patients had significantly higher rates of supracervical hysterectomies, hysterectomies that retain the cervix. The study seemed to confirm earlier research suggesting that black women, for cultural or other reasons, may prefer procedures that maintain fertility and/or the cervix.
The majority of the patients studied were white, followed by blacks, Hispanics, Asian/Pacific Islanders, Native Americans, and other races. To assess the impact of race and other socioeconomic factors on treatments for women with uterine fibroids, the researchers analyzed five years of national hospital data. Their results showed wide variations in fibroid treatment patterns across race.
Dr. Becker said, “In light of the growing prevalence of inpatient treatment of uterine fibroids and the substantial variation across different uterine fibroid treatment patterns, more research is needed to understand which surgeries are most appropriate and when women can benefit from more conservative treatment strategies.”
The full text of this article, J. Nat. Med. Assoc. 2005; 97:1136- 1142 can be viewed on the NMA Web site at http://www.nmanet.org and directly http://www.nmanet.org/JMNA_Journal_Articles/oct-05_jnma/OC1336.pdf.
The Journal of the National Medical Association was established in 1909 and is published monthly by the National Medical Association (NMA). The NMA is the nation’s oldest and largest medical association representing the interests of African American physicians and their patients.
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