Racial Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System

Abstract

Objective: To assess disparities in medical and surgical management of endometriosis and pelvic pain disorders, focusing on Black individuals and individuals from other racial and ethnic groups within an integrated health care delivery system.

Methods: We conducted a retrospective cohort study of women aged 18 years or older with a pelvic pain disorder, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded in the electronic health record (EHR) between 2012 and 2019 within Kaiser Permanente Northern California. Demographic, clinical, and treatment characteristics were assessed overall and by patient race and Black compared with other racial and ethnic groups as coded in the EHR.

Results: Of 15,164 eligible women, 1,707 (11.3%) were Black and 13,457 (88.7%) were non-Black, including 44.4% White patients, 13.8% Asian patients, 24.8% Hispanic patients, and 5.7% patients from other or unknown racial and ethnic groups. Black compared with non-Black women were younger (median [interquartile range] age 36 years [28-44 years] vs 37 years [30-45 years], P <.001), had a higher median [interquartile range] body mass index (BMI) (29.8 [25.2-35.9] vs 26.0 [22.7-30.7], P <.001), and had similar parity. Compared with non-Black women, a higher proportion of Black women received hormonal therapy (56.2% vs 51.9%, P =.001), pain medications (55.4% vs 44.7%, P =.001), and surgery (25.5% vs 23.0%, P =.02). A smaller proportion of all non-White women were referred to a pelvic pain physician specialist compared with White women ( P =.001), with Black women referred at lower rates (14.9% vs 18.4%, P =.001).

Conclusion: Black women in this integrated health care system received more hormonal, pain, and surgical management for endometriosis than non-Black women. However, there was a lower referral rate to pelvic pain physician specialists among all non-White women compared with White women, which highlights the need to better understand care allocation.