Agarwal Sanjay K, Stokes Michael, Kung Tiffany, Tilney Rong, Lickert Cassandra
UC San Diego, La Jolla, CA, USA.
Evidera, St. Laurent, Quebec, Canada.
Int J Womens Health. 2023 Oct 16;15:1561-1575. doi: 10.2147/IJWH.S420612. eCollection 2023.
This retrospective database claims analysis describes the clinical characteristics and treatment patterns of commercially insured United States women with uterine fibroids (UF) and heavy menstrual bleeding (HMB).
Women age 18-55 years with an incident UF diagnosis (index date) between 1/1/2012 and 12/31/2019 and ≥1 claim for HMB (UF-HMB), were identified from the Optum Clinformatics database. Outcomes included clinical characteristics, pharmacologic therapy use, and surgeries/procedures. Regression models were used to identify factors associated with time to post-diagnosis hormonal therapy and hysterectomy.
A total of 85,428 women had UF-HMB (mean [SD] age, 43.7 [6.4] years). The median follow-up was 3.2 years. After HMB, the most common symptoms were pelvic pressure/pain (27.6%) and backache (17.5%). Within 6 months of UF diagnosis, 40.2% of patients had received only pharmacologic therapy; 25.5% had received no treatment; 24.3% had a hysterectomy, and 10.0% had other procedures. By the end of follow-up, 50.0% had received a hysterectomy. Multiple factors were predictive of a higher likelihood of receiving hormonal therapy (geographic region, infertility, pre-index pregnancy) or hysterectomy (older age, prior hormonal treatment, specific bulk symptoms, White race).
Within 6 months of UF diagnosis, fewer than one-half of women with UF-HMB had received hormonal therapy, one-quarter received no treatment, and one-quarter had received a hysterectomy or another gynecologic procedure. Patients who received a hysterectomy were more likely to be older, White, and to have bulk symptoms.
本回顾性数据库索赔分析描述了患有子宫肌瘤（UF）和月经过多（HMB）的美国商业保险女性的临床特征和治疗模式。
从Optum临床信息数据库中识别出年龄在18 - 55岁之间、在2012年1月1日至2019年12月31日期间首次诊断为UF（索引日期）且有≥1次HMB索赔（UF - HMB）的女性。结局包括临床特征、药物治疗使用情况以及手术/操作。使用回归模型来确定与诊断后激素治疗和子宫切除术时间相关的因素。
共有85428名女性患有UF - HMB（平均[标准差]年龄为43.7[6.4]岁）。中位随访时间为3.2年。HMB后，最常见的症状是盆腔压迫感/疼痛（27.6%）和背痛（17.5%）。在UF诊断后的6个月内，40.2%的患者仅接受了药物治疗；25.5%未接受治疗；24.3%进行了子宫切除术，10.0%进行了其他操作。到随访结束时，50.0%进行了子宫切除术。多种因素可预测接受激素治疗（地理区域、不孕不育、索引前妊娠）或子宫切除术（年龄较大、既往激素治疗、特定的肌瘤相关症状、白人种族）的可能性更高。
在UF诊断后的6个月内，患有UF - HMB的女性中不到一半接受了激素治疗，四分之一未接受治疗，四分之一进行了子宫切除术或其他妇科手术。接受子宫切除术的患者更可能年龄较大、为白人且有肌瘤相关症状。
