Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context

Katon, Jodie G.; Plowden, Torie C.; Marsh, Erica E.

doi:10.1016/j.fertnstert.2023.01.022

Cited by 20 publications

(12 citation statements)

References 116 publications

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“…Historically, endometriosis has been classified as a condition characterized by its prevalence among individuals of certain genders, class, and race/ethnicity 193 . Dr. J. Meigs initially proposed an etiologic role of contraception use and delayed childbearing for endometriosis 194 .…”

Section: Methodsmentioning

confidence: 99%

“…Historically, endometriosis has been classified as a condition characterized by its prevalence among individuals of certain genders, class, and race/ethnicity. 193 Dr. J. initially proposed an etiologic role of contraception use and delayed childbearing for endometriosis. 194 Therefore, middle-income, White, cis-gendered women of reproductive age have for a long time been portrayed as the focus of this disease, which leaves out many marginalized communities quite affected by the disease.…”

Section: Diagnosismentioning

confidence: 99%

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Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations

Giudice,

Oskotsky,

Falako

et al. 2023

The FASEB Journal

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Endometriosis is a common estrogen‐dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co‐morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under‐treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single‐cell omics, and population‐level data, endometriosis is well positioned to benefit from data‐driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.

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Section: Methodsmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations

Giudice,

Oskotsky,

Falako

et al. 2023

The FASEB Journal

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“…Research on fibroids and other female-specific conditions that vary by race and ethnicity have unique challenges given the impact of sex and race on access to quality health care . Huang and others note some of these challenges, including systemic racism and inequities in access to care, that result in delayed diagnosis of fibroids . This delay results in many people living with significant symptom burden without a clinical diagnosis.…”

mentioning

confidence: 92%

“…4 Huang and others note some of these challenges, including systemic racism and inequities in access to care, that result in delayed diagnosis of fibroids. 1,3 This delay results in many people living with significant symptom burden without a clinical diagnosis. Large numbers of undiagnosed cases can result in biased findings from studies based on clinical diagnosis or using electronic health records.…”

mentioning

confidence: 99%

“…The data in the study by Huang et al suggest a similarly early onset in Asian-Chinese individuals. The reasons for differences in age of onset are not well understood but may be due to variation in environmental exposures and social determinants of health . Understanding the natural history of fibroids in diverse populations will allow clinicians to appreciate that fibroids may be prevalent even in young women and appropriately assess individuals with symptoms likely caused by fibroids and will further focus research efforts.…”

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confidence: 99%

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Fibroid Prevalence—Still So Much to Learn

2023

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The report from Huang et al 1 elsewhere in JAMA Network Open used a community-based cohort with systematic ultrasonographic screening to document the high fibroid prevalence in reproductiveaged participants (20%), the 2-to 3-fold higher prevalence of fibroids in Black or Asian-Chinese individuals compared with White or Hispanic individuals, and the early age of fibroid onset in both Black and Asian-Chinese participants. In the context of fibroid research, estimates of fibroid prevalence in a diverse community sample are limited. Fibroid-focused epidemiologic research is rare, yet the scarcity of data cannot be explained by unique difficulties of studying this condition given that fibroids are not hard to diagnose. Most studies rely on suboptimal study designs, including secondary analysis of studies designed for other outcomes. The study by Huang et al 1 used ultrasonographic imaging for diagnosis, but the data were collected for a different hypothesis, which

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