Endometriosis Diagnosis and Management: Does Race Matter?

INTRODUCTION: Disparities exist within the diagnosis and the management of individuals with endometriosis. Early biased research reported White race as a risk factor for developing endometriosis. Recent studies demonstrate that non-White patients are less likely to be diagnosed with endometriosis compared with White patients. Disparity in management also exists, with non-White patients having higher rates of open surgery, a higher likelihood of their surgery being performed by a low-volume surgeon, and higher surgical complication rates. There is limited reported data on disparity in medical management. OBJECTIVE: To investigate the association between race and the management of endometriosis. METHODS: This study analyzed data from the 2022–2023 National Survey of Family Growth (NSFG), a nationally representative survey of the United States household population. Survey data from NSFG is collected using a multimodal design, including face-to-face and web administration, with an overall response rate for women participants of 23.8%. The data used were collected from 5,586 female respondents, aged 15–50 years. Sampling weights were applied to ensure nationally representative estimates. Descriptive statistics, ANOVA, and chi-square tests of association were performed. RESULTS: The national rate of self-reported endometriosis diagnosis was 5.3% (95% CI 4.7–5.9%). Of respondents with endometriosis, 74.5% reported limitations in daily activities due to pain. Individuals received a mean of 2.02 endometriosis treatments, with the number of treatments ranging from 0 to 7. The most frequently reported treatments were non-narcotic analgesics (60.6%), hormonal therapy, (43.7%), and fertility-sparing surgery (32.8%). Endometriosis diagnosis was significantly associated with race, with non-Hispanic White individuals overrepresented in the population of those with a diagnosis (73.9% non-Hispanic White, 8.6% Black, and 10.9% Hispanic), compared to those without a diagnosis (54.7% non-Hispanic White, 14.9% Black, and 20.7% Hispanic; p<0.0001). There was a significant association between race and mean number of treatments, with White respondents receiving more treatments (2.28 [CI 2.0–2.6], p=0.005). This difference persisted when comparing White to Black (p=0.013) and other (p=0.001), but not Hispanic women (p=0.34). There was no association between race and surgical management (p=0.38). CONCLUSIONS: Endometriosis diagnosis and management are associated with race. This study supports current literature reporting disparity in endometriosis diagnosis, characterizes management of endometriosis nationwide, and highlights that inequalities persist after diagnosis, with White women receiving more treatments for endometriosis than Black women. Further studies are needed to explore these disparities, to identify barriers, and to ensure equitable endometriosis care in the United States.Table 1Figure 1Figure 2