Uterine fibroid burden based on race and ethnicity

Uterine fibroid burden based on race and ethnicity | Image Credit: © Tom - © Tom - stock.adobe.com.

Uterine fibroids disproportionately affect Black and Asian-Chinese patients, according to a recent study published in JAMA Network Open.

Uterine fibroids are the most commonly observed neoplasm in women, presenting in varying sizes, growth patterns, and locations as monoclonal smooth muscle cells and fibrous connective tissue. Symptoms include heavy menstrual bleeding often leading to anemia and pelvic bulk symptoms and pain.

Women with uterine fibroids often must undergo frequent outpatient visits, emergency department evaluations, and hospitalizations. In the United States, about 30,000 myomectomies are performed annually and fibroids cause 37% of hysterectomies for benign indications.

Fibroids also have a significant impact on reproductive health, being linked to subfertility and early pregnancy loss. Obstetric outcomes are also impacted by fibroids, with increased risks of preterm delivery, fetal malpresentation, placental abruption, abnormal placentation, and worse neonatal outcomes.

These complications make uterine fibroids a severe public health issue, but the prevalence of fibroids in various US populations is unknown. To estimate the proportion of individuals with uterine fibroids, investigators conducted a community-based cohort study.

Recruitment occurred from October 2006 to September 2012, with 996 women aged 25 to 45 years recruited. A mostly equal proportion of patients were recruited from the following racial and ethnic groups: Asian-Chinese, Black, Hispanic, and White. Age categories, including 25 to 29 years, 30 to 34 years, 35 to 39 years, and 40 to 45 years also had a mostly equal proportion of participants.

Inclusion criteria included having regular menses, not having used a progestin- or estrogen-containing medicine in the past 3 months, and not having a history of uterine or ovarian surgery.

Fibroid presence, multiplicity, and dimensions were measured as the primary outcome through transvaginal ultrasonography. Additional data collected included race and ethnicity, parity, smoking status, and highest level of educational attainment.

Of the 996 patients included in the study, 23% were Asian-Chinese, 25% Black, 23.8% Hispanic, and 28.2% White. Patients were overall aged a mean 35.1 years, while Asian-Chinese patients were aged a mean 34.8 years, Black a mean 35.4 years, Hispanic a mean 34.8 years, and White a mean 35.3 years.

Other demographic variations between racial and ethnic groups included a higher body mass index in Black patients, a greater proportion of current smoking in White patients, and being nulliparous in more White and Asian-Chinese patients. Hispanic patients saw the lowest level of complete college education at 26.2%.

Fibroids were found in 20% of overall patients, 21.8% of Asian-Chinese patients, 35.7% of Black patients, 12.7% of Hispanic patients, and 10.7% of White participants. Older age was associated with an increase in fibroid prevalence for all demographics except White. For Asian-Chinese and Black populations, increased fibroid prevalence was found in all age groups.

Black patients had the greatest mean diameter of fibroids at 3.9 cm, followed by Asian-Chinese patients at 3.2 cm, White patients at 3.2 cm, and Hispanic patients at 3 cm. Significant differences in the proportion of patients with multiple fibroids were not found between racial and demographic groups.

Uterine fibroid presence was significantly associated with Black or Asian-Chinese race and ethnicity and being aged over 35 years. Fibroid burden was similar between White and Hispanic patients. Investigators recommended further studies to determine specific fibroid characteristics associated with adverse reproductive outcomes in women.

Reference

Huang D, Magaoay B, Rosen MP, Cedars MI. Presence of fibroids on transvaginal ultrasonography in a community-based, diverse cohort of 996 reproductive-age female participants. JAMA Netw Open. 2023;6(5):e2312701.doi:10.1001/jamanetworkopen.2023.12701