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 review systematically 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: Randomised 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% confidence interval (CI) through a random effects model. Methodological quality was assessed using the Newcastle-Ottawa risk of bias scale (NOS).

Main results: Compared with White women, Black woman were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.29-0.83), whereas Asian women were more likely to have this diagnosis (OR 1.63, 95% CI 1.03-2.58). Compared with 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 with White women. There is scarce literature exploring the influence of race/ethnicity on symptomatology, as well as treatment access, preference, and response.

Tweetable abstract: Prevalence of endometriosis may be influenced by race/ethnicity, but there is limited quality literature exploring this topic.

Keywords: Endometriosis; ethnicity; meta-analysis; race; systematic review.