Metabolic and Structural Inequities in Endometriosis: Associations Between Lipid Profiles, Body Mass Index, and Race/Ethnicity in a Nationally Diverse Cohort (Metabolic and Structural Inequities of Endometriosis in a Diverse U.S. Cohort)

Metabolic and Structural Inequities in Endometriosis: Associations Between Lipid Profiles, Body Mass Index, and Race/Ethnicity in a Nationally Diverse Cohort (Metabolic and Structural Inequities of Endometriosis in a Diverse U.S. Cohort) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Metabolic and Structural Inequities in Endometriosis: Associations Between Lipid Profiles, Body Mass Index, and Race/Ethnicity in a Nationally Diverse Cohort (Metabolic and Structural Inequities of Endometriosis in a Diverse U.S. Cohort) Erin Onken, Elizabeth Yi, Kaitlyn McGinley, Cara Satoskar, Maryam Zahid, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-10297197/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 21 You are reading this latest preprint version Abstract Background/Context : Endometriosis is a chronic inflammatory gynecologic disorder associated with pelvic pain, infertility, and systemic metabolic alterations. 1 Despite growing recognition of metabolic involvement in disease pathophysiology, the combined role of metabolic and demographic factors remains incompletely defined. Objective This study aimed to evaluate associations between body mass index (BMI), lipid profiles, and race/ethnicity in individuals with endometriosis using the All of Us Research Program database. Methods In this retrospective cohort study, endometriosis cases (ages 18–45 years) were compared to controls using propensity score matching to adjust for confounders. BMI differences were assessed using Welch t-tests stratified by race, and racial associations were evaluated using chi-square testing and multivariable logistic regression. Lipid analyses — including HDL, LDL, total cholesterol, and triglycerides — utilized matched regression models and inverse probability of treatment weighting (IPTW) sensitivity analyses adjusted for age and BMI. Results Endometriosis cases had significantly lower BMI compared to controls (28.97 vs. 30.16, p = 0.004). Stratified analyses showed higher BMI among cases in White (p = 0.010) and Hispanic/Latino (p = 0.034) participants, with no significant differences in Asian or Black groups. Race/ethnicity was significantly associated with endometriosis (χ² p = 0.008); Asian and Hispanic/Latino individuals demonstrated lower odds of diagnosis compared to White individuals. In lipid analyses, matched models showed a significant elevation in triglycerides among cases (β = 10.56 mg/dL, p = 0.049), with non-significant trends toward lower HDL and higher LDL and total cholesterol. IPTW analyses — which achieved improved covariate balance and larger effective sample sizes — demonstrated statistically significant differences across all lipid outcomes: endometriosis was associated with lower HDL (− 1.96 mg/dL, p < 0.001) and higher LDL (+ 5.01 mg/dL, p < 0.001), total cholesterol (+ 5.99 mg/dL, p < 0.001), and triglycerides (+ 8.24 mg/dL, p < 0.001), independent of BMI. Conclusion These findings support a multifactorial model of endometriosis integrating metabolic and social determinants. Race/ethnicity was significantly associated with endometriosis diagnosis, with Asian and Hispanic/Latino individuals showing notably lower odds of diagnosis than White individuals, consistent with well-documented inequities in access to care. These disparities underscore the role of structural and social determinants of health in shaping diagnostic outcomes. Additionally, these findings highlight lipid dysregulation as a potentially important component of disease pathophysiology and long-term cardiometabolic risk. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 21 Aug, 2026 Reviewers agreed at journal 19 Aug, 2026 Reviews received at journal 17 Aug, 2026 Reviews received at journal 16 Aug, 2026 Reviewers agreed at journal 16 Aug, 2026 Reviews received at journal 16 Aug, 2026 Reviews received at journal 16 Aug, 2026 Reviewers agreed at journal 16 Aug, 2026 Reviews received at journal 14 Aug, 2026 Reviewers agreed at journal 14 Aug, 2026 Reviews received at journal 14 Aug, 2026 Reviewers agreed at journal 14 Aug, 2026 Reviewers agreed at journal 14 Aug, 2026 Reviews received at journal 14 Aug, 2026 Reviewers agreed at journal 14 Aug, 2026 Reviewers agreed at journal 13 Aug, 2026 Reviewers invited by journal 13 Aug, 2026 Editor assigned by journal 13 Aug, 2026 Editor invited by journal 27 Jul, 2026 Submission checks completed at journal 23 Jul, 2026 First submitted to journal 23 Jul, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-10297197","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":700875249,"identity":"277252f7-361e-428c-b189-615c6ecf7165","order_by":0,"name":"Erin 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database.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this retrospective cohort study, endometriosis cases (ages 18\u0026ndash;45 years) were compared to controls using propensity score matching to adjust for confounders. BMI differences were assessed using Welch t-tests stratified by race, and racial associations were evaluated using chi-square testing and multivariable logistic regression. Lipid analyses \u0026mdash; including HDL, LDL, total cholesterol, and triglycerides \u0026mdash; utilized matched regression models and inverse probability of treatment weighting (IPTW) sensitivity analyses adjusted for age and BMI.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEndometriosis cases had significantly lower BMI compared to controls (28.97 vs. 30.16, p\u0026thinsp;=\u0026thinsp;0.004). Stratified analyses showed higher BMI among cases in White (p\u0026thinsp;=\u0026thinsp;0.010) and Hispanic/Latino (p\u0026thinsp;=\u0026thinsp;0.034) participants, with no significant differences in Asian or Black groups. Race/ethnicity was significantly associated with endometriosis (χ\u0026sup2; p\u0026thinsp;=\u0026thinsp;0.008); Asian and Hispanic/Latino individuals demonstrated lower odds of diagnosis compared to White individuals. In lipid analyses, matched models showed a significant elevation in triglycerides among cases (β\u0026thinsp;=\u0026thinsp;10.56 mg/dL, p\u0026thinsp;=\u0026thinsp;0.049), with non-significant trends toward lower HDL and higher LDL and total cholesterol. IPTW analyses \u0026mdash; which achieved improved covariate balance and larger effective sample sizes \u0026mdash; demonstrated statistically significant differences across all lipid outcomes: endometriosis was associated with lower HDL (\u0026minus;\u0026thinsp;1.96 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and higher LDL (+\u0026thinsp;5.01 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), total cholesterol (+\u0026thinsp;5.99 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and triglycerides (+\u0026thinsp;8.24 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), independent of BMI.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings support a multifactorial model of endometriosis integrating metabolic and social determinants. Race/ethnicity was significantly associated with endometriosis diagnosis, with Asian and Hispanic/Latino individuals showing notably lower odds of diagnosis than White individuals, consistent with well-documented inequities in access to care. These disparities underscore the role of structural and social determinants of health in shaping diagnostic outcomes. Additionally, these findings highlight lipid dysregulation as a potentially important component of disease pathophysiology and long-term cardiometabolic risk.\u003c/p\u003e","manuscriptTitle":"Metabolic and Structural Inequities in Endometriosis: Associations Between Lipid Profiles, Body Mass Index, and Race/Ethnicity in a Nationally Diverse Cohort (Metabolic and Structural Inequities of Endometriosis in a Diverse U.S. Cohort)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-08-20 08:25:24","doi":"10.21203/rs.3.rs-10297197/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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