Differences in Clinical Management and Outcomes of American Indian and White Women Diagnosed With Endometriosis
Objective: Endometriosis is a chronic, painful disease that can be disabling. There is a scarcity of research on the clinical management and outcomes of endometriosis in American Indian (AI) women. The aim of this study was to determine whether there are discrepancies between AI and White women in symptoms at presentation, initial diagnosis methods, clinical management, and long-term outcomes of endometriosis, in a rural state. Materials and methods: This retrospective study described and compared the clinical management and long-term outcomes of AI and White women diagnosed with endometriosis. All statistical tests were two-tailed with p-value < .05 considered to be significant.
Results: 110 women diagnosed with endometriosis were included in the study, with 50% (n = 55) AI and 50% (n = 55) White. White women were more likely to have private insurance (80% vs. 42%; p < 0.001). AI women were more likely than White women to report abdominal pain at diagnosis (20.3% vs. 9%; p = 0.010), and be diagnosed with mild endometriosis symptoms at the initial visit, (44.4% vs. 10%; p = 0.051). White women were more likely to report a reduction or cessation of pain compared to AI women (63.3% vs. 34%; p = 0.004). Conclusion: We found the majority of women continue to report pain long after endometriosis diagnosis. AI women were less likely to report a reduction or cessation of pain. Future research should investigate why pain is more persistent in AI women.
2. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68: 585-96.
3. Guo S, Wang Y. The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest 2006; 62: 121-30.
4. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod
2005; 20: 2698-704.
5. Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centers. Hum Reprod 2012; 27: 1292-9.
6. American College of Obstetricians and Gynecologists. Practice Bulletin No. 114: Management of endometriosis. Obstet Gynecol 2010; 116: 223-36.
7. Zhao SZ, Wong JM, Davis MB, Gersh GE, Johnson KE. The cost of inpatient endometriosis treatment: an analysis based on the Healthcare cost and utilization project Nationwide Inpatient sample. Am J Manag Care 1998; 4: 1127-34.
8. Scott RB, TeLinde RW. External endometriosis-the scourge of the private patient. Ann Surg 1950; 131: 697-720.
9. Cavanagh WV. Fertility in the etiology of endometriosis. Am J Obstet Gynecol 1951; 61: 539-47.
10. Hasson HM. Incidence of endometriosis in diagnostic laparoscopy. J Reprod Med 1976; 16: 135-8.
11. Miyazawa K. Incidence of endometriosis among Japanese women. Obstet Gynecol 1976; 48: 407-9.
12. Peres LC, Risch H, Terry KL, Webb PM, Goodman MT, Wu AH, et al. Racial/ethnic differences in the epidemiology of ovarian cancer: a pooled analysis of 12 case-control studies. Int J Epidemiol 2018; 47: 460-72.
13. Arumugam K, Templeton AA. Endometriosis and race. Aust N Z J Obstet Gynaecol 1992; 32: 164-5.
14. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 2004; 160: 784-96.
15. Kirshon B, Poindexter AN 3rd, Fast J. Endometriosis in multiparous women. J Reprod Med 1989; 34: 215-7.
16. Matalliotakis IM, Cakmak H, Fragouli YG, Goumenou AG, Mahutte NG, Arici A. Epidemiological characteristics in women with and without endometriosis in the Yale series. Arch Gynecol Obstet 2008; 277: 389-93.
17. D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med 2003; 21: 243-54.
18. United States Census Bureau. The American Indian and Alaskan Native Population: Census brief 2010.
19. Mendenhall TJ, Berge JM, Harper P, GreenCrow B, LittleWalker N, WhiteEagle S, et al. The Family Education Diabetes Series (FEDS): Community-based participatory research with a Midwestern American Indian community. Nurs Inq 2010; 17: 359-72.
20. Roberts H, Jiles R, Mokdad A, Beckles G, Rios-
Burrows N. Trend analysis of diagnosed diabetes prevalence among American Indian/Alaska native young adults--United States, 1994-2007. Ethn Dis 2009; 19: 276-9.
21. U.S. Census Bureau, American Community Survey Five-Year Estimates, 2011-2015.
22. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997; 67: 817-21.
23. Grossman D, Krieger J, Sugarman JR, Forquera RA. Health status of urban American Indians and Alaska Natives. A population-based study. JAMA 1994; 271: 845-50.
24. Zuckerman S, Haley J, Roubideaux Y, Lillie-Blanton M. Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play? Am
J Public Health 2004; 94: 53-9.
25. Amparo P, Farr SL, Dietz PM. Chronic disease risk factors among American-Indian/Alaska-Native women of reproductive age. Prev Chronic Dis 2011; 8: A118.
26. Guo S-W. Recurrence of endometriosis and its control. Hum Reprod Update 2009; 15: 441-61.
27. Yudell M, Roberts D, DeSalle R, Tishkoff S. Taking race out of human genetics. Science 2016; 351: 564-5.
28. Leyland N, Casper R, Laberge P, Singh SS, SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can 2010; 32: S1-32.
29. Marciani RD, Humphries LL, Maxwell EN Jr, Costich JF, Wiegert T, Engelberg J. Chronic pain: economic, psychosocial, ethical, preventive, and medical aspects. South Med J 1985; 78: 719-24.
30. Khachikyan I, Ortiz R, Sinaii N, Shah J, Segars J, Stratton P. All chronic pelvic pain is not the same: quality of life symptoms in women with endometriosis-associated pain differs from symptoms in chronic pelvic pain due to other causes. Reprod Sci 2011; 1: 193A.
31. Fry RP, Crisp AH, Beard RW, McGuigan S. Psychosocial aspects of chronic pelvic pain, with special reference to sexual abuse. A study of 164 women. Postgrad Med J 1993; 69: 566-74.
32. Apostolopoulos NV, Alexandraki KI, Gorry A, Coker A. Association between chronic pelvic pain symptoms and the presence of endometriosis. Arch Gynecol Obstet 2016; 293: 439-45.
33. Burney R, Giudice L. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012; 98: 511-9.
34. Schrager S, Falleroni J, Edgoose J. Evaluation and treatment of endometriosis. Am Fam Physician 2013; 87: 107-13.
35. Soliman AM, Fuldeore M, Snabes MC. Factors Associated with Time to Endometriosis Diagnosis in the United States. J Womens Health 2017; 26: 788-97.
36. Mehedintu C, Plotogea MN, Ionescu S, Antonovici M. Endometriosis still a challenge. J Med Life 2014; 7: 349-57.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.