Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta‐analysis

Abstract

Background Understanding the impact of race/ethnicity on the prevalence and presentation of endometriosis may help improve patient care. Objective To review systematically the evidence for the influence of race/ethnicity on the prevalence of endometriosis. Search strategy CENTRAL, MEDLINE, PubMed, Embase, LILACS, SCIELO, and CINAHL databases, as well as the grey literature, were searched from date of inception until September 2017. Selection criteria Randomised control trials and observational studies reporting on prevalence and/or clinical presentation of endometriosis. Data collection and analysis Twenty studies were included in the review and 18 studies were used to calculate odds ratio (OR) with 95% confidence interval (CI) through a random effects model. Methodological quality was assessed using the Newcastle‐Ottawa risk of bias scale (NOS). Main results Compared with White women, Black woman were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.29–0.83), whereas Asian women were more likely to have this diagnosis (OR 1.63, 95% CI 1.03–2.58). Compared with White women, there was a statistically significant difference in likelihood of endometriosis diagnosis in Hispanic women (OR 0.46, 95% CI 0.14–1.50). Significant heterogeneity (I2 > 50%) was present in the analysis for all racial/ethnic groups but was partially reduced in subgroup analysis by clinical presentation, particularly when endometriosis was diagnosed as self‐reported, Conclusions Prevalence of endometriosis appears to be influenced by race/ethnicity. Most notably, Black women appear less likely to be diagnosed with endometriosis compared with White women. There is scarce literature exploring the influence of race/ethnicity on symptomatology, as well as treatment access, preference, and response. Tweetable abstract Prevalence of endometriosis may be influenced by race/ethnicity, but there is limited quality literature exploring this topic.

Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case–control study in China?

“…The incidence of endometriosis is reported to vary by ethnicity. 3 In addition, approximately 25% of women with endometriosis do not have any clinical symptoms, 4 resulting in a reduced effort to examine the clinical presentation of endometriosis in various ethnicities. Pelvic pain during an individual women's menstrual cycle may also not consider serious enough by the woman to seek medical attention.…”

“…7 In addition, although most diagnoses of endometriosis are in women aged 25-39 years, 6 8 the age distribution of diagnoses was also dependent on ethnic group, socioeconomic and cultural factors. 3 A number of epidemiological studies reported that women with endometriosis normally have a lower body mass index (BMI) 9 10 or are underweight. 11 12 However, a recent case-control study done in Australia found that women with a normal BMI were also more likely to experience endometriosis, compared with women with underweight.…”

Global, regional, and national endometriosis trends from 1990 to 2017

“…The actual percentage changes were low, which may be related to the diagnostic bias. The bias in diagnosis itself may be influenced by variation in clinical symptoms among different populations not adequately captured or appreciated by standard clinical definitions, or may represent implicit bias in healthcare leading to alternate interpretation of the same symptoms, affecting likelihood of diagnosis 30 . Therefore, due to the limited availability of burden estimates in most countries/territories, more studies on the development of screening tools for endometriosis are needed in clinical work to fully capture the number of women with endometriosis around the world.…”

Is Scientific Medical Literature Related to Endometriosis Treatment Evidence-Based? A Systematic Review on Methodological Quality of Randomized Clinical Trials

“…Furthermore, the identified studies were heterogeneous with regard to the drug (the highest number of studies evaluating the same treatment—Dienogest—is six, four DB-RCTs [38,42,48,49] and two OL-RCTs [60,61]) and the used doses. Race/ethnic differences were observed with regard to both prevalence and symptoms [71,72,73] and therapy response [74,75], so it is recommended to carefully select the studies to be combined in the results of a meta-analysis. Several meta-analyses have already been published in the scientific literature, reporting the efficacy of Levonorgestrel releasing intrauterine system as post-operative therapy [76], the effect of micronized Palmitoylethanolamide-trans-polydatin on endometriosis-related pain [77], the comparison of Dienogest (DNG) with gonadotropin-releasing hormone (GnRH) analogs [74].…”