Analysis of National Emergency Department Utilization for Endometriosis by Rac and Socioeconomic Status (2019)

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Conference Proceeding

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Publication Title

Reproductive Sciences


Introduction: Endometriosis is a disease in which endometrial glands and stroma are found outside of the uterine cavity. It is the third leading cause of infertility and afects 10% of reproductive-aged females in the United States (US). Severe pelvic pain is a common symptom and can lead patients to seek emergency care. While previous studies have characterized emergency department (ED) utilization for endometriosis, no study has examined racial and socioeconomic factors impacting ED utilization and admission rates.

Methods: Retrospective analysis was performed on the Nationwide Emergency Department Sample (NEDS). ICD-10 codes were used to identify patients 21-50 years old who were seen in EDs with a primary diagnosis of endometriosis in 2019. NEDS included data on rac for the first time in 2019, the most recent year of available data. In addition to rac; age, payer type, and income quartile by zip code were also analyzed. Linear and logistic regression models were used to estimate associations of interest.

Results: In 2019, there were 12,351 ED visits with a primary diagnosis of endometriosis among 21-50 year old patients. The majority of visits occurred in patients younger than 35 years old, with the largest proportion of visits (24.5%) in 31-35 year olds, followed by those aged 26-30 years (22.6%). White patients made up 49.3% of ED visits with primary diagnosis of endometriosis, while Black and Hispanic patients comprised 24.3% and 16.4% respectively. Patients from the lowest income quartile comprised the largest proportion of ED visits for endometriosis at 31.2%. Hospital admission rates were higher for patients with a primary diagnosis of endometriosis (13%) compared to admission rates for all other ED diagnoses (7.9%, p<0.01) and were highest for patients in the highest income quartile (17%) versus the lowest quartile (11.7%). Native American and Asian-American/Pacific Islander (AAPI) patients with endometriosis were twice as likely to be admitted than their White or Black counterparts.

Conclusion: While ED visits for endometriosis constitute a small percentage of visits overall, admission rates continue to be higher than all other ED diagnoses. White patients make up the majority of ED visits for endometriosis and are more likely to be higher-income, privately-insured patients. Although patients from the lowest income quartile comprised the largest proportion of ED visits for endometriosis, higher admission rates were seen in the highest income quartile. With regards to rac, highest admission rates were seen amongst Native American and AAPI patients possibly suggesting more severe disease at presentation and limited access to outpatient gynecologic care in these groups. Future studies are needed to identify and increase access to equitable outpatient management of endometriosis.



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