Eisenberg Vered H, Decter Dean H, Chodick Gabriel, Shalev Varda, Weil Clara
Sheba Medeical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2022 Feb 21;11(4):1133. doi: 10.3390/jcm11041133.
The goal of our study was to evaluate the burden of endometriosis in the community by comparing healthcare resource utilization, total direct medical costs, infertility, and comorbidity rates of women with and without a diagnosis of endometriosis. A retrospective case-control study was performed using the databases of a 2.1 million-member nationwide healthcare plan. The study population included women aged 15-55 years enrolled in the healthcare plan. Women with a diagnosis (ICD-9) of endometriosis were compared to controls without diagnosed endometriosis. Women were individually matched (1:4) on age and residence area. Patient characteristics were described, including infertility, comorbidities, and annual healthcare resource utilization. Total direct medical costs were analyzed in a generalized linear model adjusting for age. Women with endometriosis ( = 6146, mean age ± SD: 40.4 ± 8.0 y) were significantly more likely than controls ( = 24,572) to have a lower BMI and a higher socioeconomic status. After adjusting for BMI and socioeconomic status, endometriosis was significantly associated with infertility (OR = 3.3; 95% CI 3.1-3.5), chronic comorbidities, higher utilization of healthcare services (hospitalization: OR = 2.3; 95% CI 2.1-2.5), pain medications, and antidepressants. Women aged 15-19 y with endometriosis had substantially higher utilization of primary care visits (57.7% vs. 14.4%) and oral contraceptive use (76.9% vs. 9.6%). Direct medical costs associated with endometriosis were higher than those for controls (OR = 1.75; 95% CI 1.69-1.85). Endometriosis is associated with a high burden of comorbidities, increased healthcare resource utilization, and excess costs, particularly for younger patients whose healthcare needs may differ widely from the older population.
我们研究的目的是通过比较有和没有子宫内膜异位症诊断的女性的医疗资源利用情况、总直接医疗费用、不孕症和合并症发生率，来评估社区中子宫内膜异位症的负担。我们使用了一个拥有210万会员的全国性医疗保健计划的数据库进行了一项回顾性病例对照研究。研究人群包括参加该医疗保健计划的15至55岁女性。将诊断为子宫内膜异位症（ICD-9）的女性与未诊断出子宫内膜异位症的对照进行比较。女性按年龄和居住地区进行个体匹配（1:4）。描述了患者特征，包括不孕症、合并症和年度医疗资源利用情况。在调整年龄的广义线性模型中分析了总直接医疗费用。患有子宫内膜异位症的女性（n = 6146，平均年龄±标准差：40.4±8.0岁）比对照组（n = 24,572）更有可能具有较低的体重指数和较高的社会经济地位。在调整体重指数和社会经济地位后，子宫内膜异位症与不孕症（OR = 3.3；95%CI 3.1 - 3.5）、慢性合并症、更高的医疗服务利用率（住院：OR = 2.3；95%CI 2.1 - 2.5）、止痛药和抗抑郁药显著相关。15至19岁患有子宫内膜异位症的女性初级保健就诊利用率（57.7%对14.4%）和口服避孕药使用率（76.9%对9.6%）显著更高。与子宫内膜异位症相关的直接医疗费用高于对照组（OR = 1.75；95%CI 1.69 - 1.85）。子宫内膜异位症与高合并症负担、增加的医疗资源利用和额外费用相关，特别是对于医疗需求可能与老年人群有很大差异的年轻患者。
