Green Michael J, Doll Kemi M, Wood Mollie E, Howard Annie G, Anderson Lauren G, Mathias Joacy G, Rivadeneira Natalie A, Carey Erin T, Carey Timothy S, Nicholson Wanda, Stürmer Til, Myers Evan R, Robinson Whitney R
Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA.
Health Equity. 2025 Jun 11;9(1):326-338. doi: 10.1089/heq.2024.0238. eCollection 2025.
Levonorgestrel-releasing intrauterine devices (LNG-IUDs) can be effective treatments for benign gynecological conditions, but there may be ethno-racial differences in how patients receive treatment.
Data were from a health care system in the U.S. South (April 2014-September 2019). We identified 783 female patients aged 18-44 years with an LNG-IUD for a benign gynecological condition (455 White, 208 Black, and 120 Hispanic patients). Abstraction of medical notes preceding insertion gave symptom severity scores for uterine bleeding, pelvic pain, and uterine bulk. Linear and negative binomial regression models assessed differences in patients' age and symptom severity scores, respectively. Covariates included insurance status, parity, prior treatments, and fibroid and endometriosis diagnoses.
White patients' mean age was 32.4 years. Black patients were similarly aged (+0.9 years [95% confidence interval: -0.4 to 2.1]), whereas Hispanic patients were older (+3.4 years [2.0-4.9]), and adjustment attenuated this difference (+0.7 [-0.7 to 2.0]). Estimated ratios indicated more severe bleeding and bulk symptoms for Black and Hispanic than White patients (bleeding: Black: 1.7[1.5-2.0], Hispanic: 1.7[1.4-2.1]; bulk: Black: 1.5[1.3-1.9], Hispanic: 1.5[1.2-1.9]). Adjustment for covariates attenuated estimates, especially for Hispanic patients (bleeding: Black: 1.4[1.2-1.6], Hispanic: 1.2[1.0-1.4]; bulk: Black: 1.3[1.1-1.6], Hispanic: 1.2[1.0-1.6]).
At the time of LNG-IUD insertion, Hispanic patients were older than White patients. Black and Hispanic patients had more severe symptoms than White patients. Differences in age and symptom severity were associated with lack of insurance coverage, higher parity, presence of fibroids, and prior medical management, potentially indicating barriers to early LNG-IUD treatment for Black and Hispanic patients.
左炔诺孕酮宫内节育器（LNG-IUD）可有效治疗良性妇科疾病，但患者接受治疗的方式可能存在种族差异。
数据来自美国南部的一个医疗保健系统（2014年4月至2019年9月）。我们确定了783名年龄在18 - 44岁之间因良性妇科疾病使用LNG-IUD的女性患者（455名白人、208名黑人、120名西班牙裔患者）。插入前医疗记录的摘要给出了子宫出血、盆腔疼痛和子宫体积的症状严重程度评分。线性回归模型和负二项回归模型分别评估了患者年龄和症状严重程度评分的差异。协变量包括保险状况、产次、既往治疗以及子宫肌瘤和子宫内膜异位症的诊断。
白人患者的平均年龄为32.4岁。黑人患者年龄相近（大0.9岁[95%置信区间：-0.4至2.1]），而西班牙裔患者年龄较大（大3.4岁[2.0 - 4.9]），调整后这种差异有所减弱（大0.7岁[-0.7至2.0]）。估计比率表明，黑人和西班牙裔患者的出血和子宫体积症状比白人患者更严重（出血：黑人：1.7[1.5 - 2.0]，西班牙裔：1.7[1.4 - 2.1]；子宫体积：黑人：1.5[1.3 - 1.9]，西班牙裔：1.5[1.2 - 1.9]）。对协变量进行调整后估计值有所减弱，尤其是西班牙裔患者（出血：黑人：1.4[1.2 - 1.6]，西班牙裔：1.2[1.0 - 1.4]；子宫体积：黑人：1.3[1.1 - 1.6]，西班牙裔：1.2[1.0 - 1.6]）。
在插入LNG-IUD时，西班牙裔患者比白人患者年龄大。黑人和西班牙裔患者的症状比白人患者更严重。年龄和症状严重程度的差异与缺乏保险覆盖、产次较高、存在子宫肌瘤以及既往医疗管理有关，这可能表明黑人和西班牙裔患者早期使用LNG-IUD治疗存在障碍。
