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 systematically review 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 Randomized 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% CI through a random effects model. Methodological quality was assessed using the Newcastle-Ottawa risk of bias Scale (NOS). Main Results Compared to White women, Black woman were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.29-0.83), while Asian women were more likely to have this diagnosis (OR 1.63, 95% CI 1.03-2.58). Compared to 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 to White women. There is scarce literature exploring the influence of race/ethnicity on symptomatology, as well as treatment access, preference and response. This article is protected by copyright. All rights reserved.