How race/ethnicity influences endometriosis

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Black women are only about half as likely to be diagnosed with endometriosis compared to white women, according to a systematic review and meta-analysis. Conversely, the review in BJOG found that Asian women were more than 50% more likely to have this diagnosis than white women.

“Prevalence of endometriosis appears to be influenced by race/ethnicity,” wrote the Canadian and Filipino authors. 

The review consisted of 20 randomized controlled trials and observational studies reporting on prevalence and/or clinical presentation of endometriosis through September 2017. Of the 20 studies, 18 were used to calculate odds ratio (OR) with a 95% confidence interval (CI) via a random effects model. Eight studies were deemed high quality and the remaining 10 of low quality.

Compared to white women, black women were significantly less likely to be diagnosed with endometriosis (OR 0.49; 95% CI: 0.29 – 083).

The same held true for Hispanic women (OR 0.46; 95% CI: 0.14 – 1.50). However, Asian women were much more likely to have this diagnosis (OR 1.63; 95% CI: 1.03 – 2.58) as opposed to white women.

The investigators noted there is scant literature assessing the influence of race/ethnicity on symptomatology, treatment access, preference and response. Nonetheless, “Race/ethnicity may influence one’s ability to access healthcare and obtain appropriate management for endometriosis through a combination of socioeconomic and genetic influences,” the authors wrote.

In the included studies of women based on surgical or self-reported diagnosis of endometriosis, there was a significantly decreased odds of diagnosis of endometriosis in black women compared to white women (OR 0.58; 95% CI: 0.45 – 0.75 for self-reported and OR 0.45; 95% CI: 0.25 – 0.83 for surgical diagnosis). But in women presenting with infertility, there was no meaningful difference in endometriosis rates between the white and black women. Furthermore, the likelihood of diagnosis of endometriosis in black compared to white women was similar in studies conducted before 1990 and those after 1990.

For Asian women, there was no significant difference in endometriosis frequency when the diagnosis was self-reported, compared to white women, or made surgically or presented with infertility. However, the chances of diagnosis of endometriosis in Asian women versus white women was greater in studies published before 1990 (OR 1.88; 95% CI: 1.31 – 2.70) compared to studies published after 1990 (OR 1.57; 95% CI: 0.93 – 2.64).

Because the chief presenting symptomatology of endometriosis often includes pelvic pain and may be influenced by psychosocial factors, women of various ethnic and cultural backgrounds likely have distinct clinical presentations. “This is suggested in our results where the likelihood of endometriosis diagnosis among women of different ethnicities is partially influenced by the mode of diagnosis,” the authors wrote. External factors may also affect the diagnosis of endometriosis because it normally takes 7 to 10 years before diagnosis occurs.

A residual implicit bias among healthcare providers that diagnosis is less likely in black women may exist as well. Newer literature also indicates that race/ethnicity may influence disease severity; for example, Asian women are more likely to be diagnosed with stage III/IV endometriosis versus white women.

“Currently there is little effort in the literature to explore the diagnostic journey for women with endometriosis through a culturally sensitive lens,” the authors wrote. Meanwhile, the authors encourage clinicians to offer culturally sensitive care to the women they treat, as women of different ethnicities might present with various symptomatology.