Racial Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System

Eve F Zaritsky, Zaritsky EF, Lue-Yen Tucker, Tucker LY, Hen E, Eden Hen, Childs AJ, Aliyya J Childs, Ritterman Weintraub ML, Miranda L Ritterman Weintraub, Carla Wicks, Wicks C
Obstetrics and gynecology · 2025 · vol. 146(6) , pp. 888–897 · doi:10.1097/AOG.0000000000006045 · PMID:40839882
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Black women received more hormonal, pain, and surgical treatments for endometriosis and pelvic pain, but all non-White women had lower referral rates to specialists compared to White women.

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This retrospective cohort study analyzed electronic health record data from 15,164 women with pelvic pain disorders, including endometriosis, within an integrated healthcare system to evaluate treatment disparities by race. The findings revealed that Black women received higher rates of hormonal therapy, pain medication, and surgical interventions for endometriosis compared to non-Black women, indicating equitable access to these specific treatments. However, the study identified a significant disparity in specialist care, as non-White patients, particularly Black women, were referred to pelvic pain specialists at lower rates than White patients. This paper is centrally about endometriosis — specifically examining racial disparities in the medical and surgical management of the condition within a large healthcare network.

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Abstract

OBJECTIVE: To assess disparities in medical and surgical management of endometriosis and pelvic pain disorders, focusing on Black individuals and individuals from other racial and ethnic groups within an integrated health care delivery system. METHODS: We conducted a retrospective cohort study of women aged 18 years or older with a pelvic pain disorder, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded in the electronic health record (EHR) between 2012 and 2019 within Kaiser Permanente Northern California. Demographic, clinical, and treatment characteristics were assessed overall and by patient race and Black compared with other racial and ethnic groups as coded in the EHR. RESULTS: Of 15,164 eligible women, 1,707 (11.3%) were Black and 13,457 (88.7%) were non-Black, including 44.4% White patients, 13.8% Asian patients, 24.8% Hispanic patients, and 5.7% patients from other or unknown racial and ethnic groups. Black compared with non-Black women were younger (median [interquartile range] age 36 years [28-44 years] vs 37 years [30-45 years], P <.001), had a higher median [interquartile range] body mass index (BMI) (29.8 [25.2-35.9] vs 26.0 [22.7-30.7], P <.001), and had similar parity. Compared with non-Black women, a higher proportion of Black women received hormonal therapy (56.2% vs 51.9%, P =.001), pain medications (55.4% vs 44.7%, P =.001), and surgery (25.5% vs 23.0%, P =.02). A smaller proportion of all non-White women were referred to a pelvic pain physician specialist compared with White women ( P =.001), with Black women referred at lower rates (14.9% vs 18.4%, P =.001). CONCLUSION: Black women in this integrated health care system received more hormonal, pain, and surgical management for endometriosis than non-Black women. However, there was a lower referral rate to pelvic pain physician specialists among all non-White women compared with White women, which highlights the need to better understand care allocation.
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Objective

To assess disparities in medical and surgical management of endometriosis and pelvic pain disorders, focusing on Black individuals and individuals from other racial and ethnic groups within an integrated health care delivery system.

Methods

We conducted a retrospective cohort study of women aged 18 years or older with a pelvic pain disorder, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded in the electronic health record (EHR) between 2012 and 2019 within Kaiser Permanente Northern California. Demographic, clinical, and treatment characteristics were assessed overall and by patient race and Black compared with other racial and ethnic groups as coded in the EHR.

Results

Of 15,164 eligible women, 1,707 (11.3%) were Black and 13,457 (88.7%) were non-Black, including 44.4% White patients, 13.8% Asian patients, 24.8% Hispanic patients, and 5.7% patients from other or unknown racial and ethnic groups. Black compared with non-Black women were younger (median [interquartile range] age 36 years [28–44 years] vs 37 years [30–45 years], P<.001), had a higher median [interquartile range] body mass index (BMI) (29.8 [25.2–35.9] vs 26.0 [22.7–30.7], P<.001), and had similar parity. Compared with non-Black women, a higher proportion of Black women received hormonal therapy (56.2% vs 51.9%, P=.001), pain medications (55.4% vs 44.7%, P=.001), and surgery (25.5% vs 23.0%, P=.02). A smaller proportion of all non-White women were referred to a pelvic pain physician specialist compared with White women (P=.001), with Black women referred at lower rates (14.9% vs 18.4%, P=.001).

Conclusion

Black women in this integrated health care system received more hormonal, pain, and surgical management for endometriosis than non-Black women. However, there was a lower referral rate to pelvic pain physician specialists among all non-White women compared with White women, which highlights the need to better understand care allocation. Black women received equitable endometriosis treatment compared with non-Black women; however, non-White women had lower referral rates to pelvic pain specialists.

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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated Delivery of Health Care, Integrated

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