Uncovering Inequities: The Role of Social Determinants of Health in Hospitalized Adolescents and Young Adults With Heavy Menstrual Bleeding

ABSTRACT Background Heavy menstrual bleeding (HMB) is a common condition among adolescents and young adults (AYAs) and is the leading cause of iron deficiency anemia (IDA) in this population. Growing evidence suggests that social determinants of health (SDOH) influence menstrual bleeding patterns, access to care, and treatment. However, no studies have comprehensively evaluated how SDOH impacts the full clinical course of AYAs hospitalized for HMB. Objectives/Hypothesis This study aims to evaluate how factors such as race, ethnicity, geographic location, and socioeconomic status (SES) impact the severity of anemia at presentation, inpatient evaluation and management, and post‐discharge subspecialty follow‐up for AYAs hospitalized for HMB. Methods A retrospective chart review was performed for AYAs admitted to our medical center for anemia secondary to HMB from January 2008 to January 2026. SES was characterized using the Community Deprivation Index (CDI) and Child Opportunity Index (COI). Patients were categorized into three SDOH groups: Black non‐Hispanic English‐speaking (BNHES), White non‐Hispanic English‐speaking (WNHES), and other race, ethnicity, and/or language (OREL). Results A total of 271 admissions were included. BNHES individuals had lower Hgb and MCV than WNHES individuals (6.6 vs. 7.8 g/dL and 74.3 vs. 82.2 fL; p < 0.05 and <0.005, respectively); however, they did not have a higher transfusion burden, iron administration rate, or longer hospitalizations. BNHES individuals resided in neighborhoods with greater socioeconomic disadvantage and lived significantly closer to the hospital yet presented at an older age and further from menarche. CDI and COI scores did not independently correlate with admission Hgb or MCV. Conclusions BNHES AYA females hospitalized for HMB presented with more severe IDA and at a greater interval from menarche despite proximity to the hospital, suggesting that complex SDOH factors, including SES, led to progressive anemia at presentation. Standardizing laboratory testing, bleeding disorder (BDO) screening, and the use of hormonal and iron therapies in the outpatient setting could potentially reduce disparities in care among these populations.