13634 Variation in Treatment Utilization after Uterine Fibroid Diagnosis By Race and Ethnicity in an Integrated Healthcare System

Evaluation of treatment utilization after first fibroid diagnosis by race and ethnicity. Retrospective cohort study. Large integrated health care system at Kaiser Permanente Northern California. From January 2009 through December 2022, a cohort of 84,206 female patients aged 18-54 (16% Black, 23% Hispanic, 32% White, 25% Asian [7% East Asian, 4% South Asian, 8% Southeast Asian, and 6% Other Asian or Pacific Islander]) was studied from first fibroid diagnosis for up to five years and treatments received were ascertained. Levonorgestrel intrauterine device (IUD) insertion, hysteroscopic myomectomy, myomectomy, uterine artery embolization, endometrial ablation, hysterectomy. 30,838 patients (37%) received 36,115 treatments within 5 years after diagnosis. Treated patients were more likely to be aged 40-49, White, multiparous, obese, and have symptoms. The most common treatments were hysterectomy (45% of treatments), levonorgestrel IUD (18%) and myomectomy (10%). Compared to White patients, Hispanic patients were about 10% (95% confidence interval (CI: 8%, 13%) less likely receive treatment, Black patients were about 12% (CI: 9%, 15%) less likely, and Asian patients were 19% - 52% less likely to receive treatment (specifically, treatments were lower for Southeast Asian 19% (CI: 16%, 23%) South Asian 37% (CI: 33%, 41%); East Asian 40% (CI: 37%, 43%); and Other Asian 52% (CI: 49%, 55%). As first treatments, Black patients were more likely than White patients to receive uterine artery embolization, and Black, East Asian, and South Asian patients were more likely to receive myomectomy. White patients were more likely to receive hysterectomy, ablation, IUDs, and hysteroscopic myomectomy. East Asian, Southeast Asian, South Asian, Black, and Hispanic patients were less likely than White patients to receive fibroid treatment within 5 years after diagnosis. Determining the causes of these differences may ensure equitable access to fibroid care.