Kashyap Aparajita, Aziz Maryam, Sun Tony Y, Lipsky-Gorman Sharon, Opoku-Anane Jessica, Elhadad Noémie
medRxiv. 2023 Oct 3:2023.10.02.23296435. doi: 10.1101/2023.10.02.23296435.
Endometriosis is a chronic disease with a long time to diagnosis and several known comorbidities that requires a range of treatments including of pain management and hormone-based medications. Racial disparities specific to endometriosis treatments are unknown.
We aim to investigate differences in patterns of drug prescriptions specific to endometriosis management in Black and White patients prior to diagnosis and after diagnosis of endometriosis and compare these differences to racial disparities established in the general population.
We conduct a retrospective cohort study using observational health data from the IBM MarketScan® Multi-state Medicaid dataset. We identify a cohort of endometriosis patients consisting of women between the ages of 15 and 49 with an endometriosis-related surgical procedure and a diagnosis code for endometriosis within 30 days of this procedure. Cohort is further restricted to patients with at least 3 years of continuous observation prior to diagnosis.We identify a non-endometriosis cohort of women between the ages of 15 and 49 with no endometriosis diagnosis and at least 1 year of continuous observation. We compare prevalence of prescriptions across selected drug classes for Black vs. White endometriosis patients. We further examine prevalence differences in the non-endometriosis cohort and prevalence differences pre- and post-diagnosis in the endometriosis cohort.
The endometriosis cohort comprised 16,372 endometriosis patients (23.3% Black, 66.0% White). Of the 28 drug classes examined, 17 were prescribed significantly less in Black patients compared to 21 in non-endometriosis cohort (n=3,663,904), and 4 were prescribed significantly more in Black patients compared to 6 in the non-endometriosis cohort. Of the 17 drugs prescribed more often in White patients, 16 have larger disparities pre-diagnosis than post-diagnosis.
Our analysis identified significant differences in medication prescriptions between White and Black patients with endometriosis, notably in hormonal treatments, pain management, and treatments for common endometriosis co-morbidities. Racial disparities in drug prescriptions are well established in healthcare, and better understanding these disparities in the specific context of chronic reproductive conditions and chronic pain is important for increasing equity in drug prescription practices.
子宫内膜异位症是一种慢性病，诊断时间长，且有多种已知的合并症，需要一系列治疗，包括疼痛管理和激素类药物治疗。子宫内膜异位症治疗方面的种族差异尚不清楚。
我们旨在调查黑人和白人患者在诊断子宫内膜异位症之前和之后，针对子宫内膜异位症管理的药物处方模式差异，并将这些差异与一般人群中已确定的种族差异进行比较。
我们使用来自IBM MarketScan®多州医疗补助数据集的观察性健康数据进行了一项回顾性队列研究。我们确定了一组子宫内膜异位症患者，包括年龄在15至49岁之间、接受过与子宫内膜异位症相关的外科手术且在此手术30天内有子宫内膜异位症诊断代码的女性。队列进一步限制为在诊断前至少有3年连续观察期的患者。我们确定了一组年龄在15至49岁之间、无子宫内膜异位症诊断且至少有1年连续观察期的非子宫内膜异位症女性队列。我们比较了黑人和白人子宫内膜异位症患者在选定药物类别中的处方患病率。我们进一步研究了非子宫内膜异位症队列中的患病率差异以及子宫内膜异位症队列中诊断前后的患病率差异。
子宫内膜异位症队列包括16372名子宫内膜异位症患者（23.3%为黑人，66.0%为白人）。在所检查的28种药物类别中，与非子宫内膜异位症队列（n = 3663904）中的21种相比，黑人患者中17种药物的处方量明显较少，与非子宫内膜异位症队列中的6种相比，黑人患者中4种药物的处方量明显较多。在白人患者中更常处方的17种药物中，有16种在诊断前的差异比诊断后更大。
我们的分析确定了患有子宫内膜异位症的白人和黑人患者在药物处方方面存在显著差异，尤其是在激素治疗、疼痛管理以及子宫内膜异位症常见合并症的治疗方面。药物处方中的种族差异在医疗保健中已得到充分证实，更好地了解这些差异在慢性生殖疾病和慢性疼痛的特定背景下对于提高药物处方实践的公平性很重要。
