Disparities in Utilization of Uterine Fibroid Embolization.

IMPORTANCE

Uterine fibroid embolization (UFE) is a minimally invasive alternative to surgery. Understanding utilization patterns and disparities in access is important to ensure that patients can explore all treatment options.

OBJECTIVE

To examine trends in the use of UFE vs hysterectomy and myomectomy for uterine fibroid management, with an emphasis on sociodemographic and institutional disparities.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from the 2016 to 2022 National Inpatient Sample obtained from the Healthcare Cost and Utilization Project, a population-based, multicenter inpatient dataset representing hospitals across the US. Adult patients with a diagnosis of uterine fibroids who underwent hysterectomy, myomectomy, or UFE were identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Analysis was conducted in April 2025.

EXPOSURE

Patient age, race, ethnicity, insurance, income quartile, rurality, year of procedure, and hospital characteristics.

MAIN OUTCOMES AND MEASURES

The primary outcome was undergoing UFE, modeled using multivariable logistic regression, with hysterectomy, myomectomy, or surgery overall as reference groups. The covariate reference categories were age younger than 30 years, White race, private insurance, 76th to 100th income percentile, central metropolitan residence, the year 2016, small hospitals, rural hospitals, and hospitals in the Pacific division. Results were reported as adjusted odds ratios (aORs) with 95% CIs.

RESULTS

The sample encompassed 271 885 encounters, including 199 625 hysterectomies (73.4%), 62 675 myomectomies (23.1%), and 9585 UFEs (3.5%). The median (IQR) patient age was 47 (43-52) years for those undergoing hysterectomy, 45 (40-49) years for those undergoing UFE, and 37 (33-41) years for those undergoing myomectomy. With regard to race and ethnicity, 105 780 patients (38.9%) were African American, 16 175 (5.9%) were Asian or Pacific Islander, 48 810 (18.0%) were Hispanic, 1050 (0.4%) were Native American, 86 425 were White (31.8%), and 13 645 (5.0%) were other races. Increasing age was associated with lower odds of undergoing UFE vs hysterectomy, and higher odds of undergoing UFE vs myomectomy. African American patients were more likely to undergo UFE than hysterectomy (aOR, 1.64; 95% CI, 1.44-1.87), but less likely to undergo UFE than myomectomy (aOR, 0.84; 95% CI, 0.73-0.97). Hispanic patients were less likely to undergo UFE than both surgical procedures (aOR, 0.83; 95% CI, 0.71-0.97). Patients with Medicaid (aOR, 1.58; 95% CI, 1.41-1.77), self-pay (aOR, 1.97; 95% CI, 1.60-2.42), and no-charge (aOR, 1.97; 95% CI, 1.24-3.12) coverage had higher odds of undergoing UFE vs both surgical procedures. Among Medicare patients, UFE was more likely than myomectomy among those aged 30 to 49 years, but less likely among those aged 50 years and older. Those in the lowest income quartile (0-25th percentile) had greater odds of undergoing UFE vs myomectomy (aOR, 1.22; 95% CI, 1.04-1.43). Rural patients were less likely to undergo UFE than hysterectomy (aOR, 0.53; 95% CI, 0.34-0.83), whereas urban hospitals were more likely to perform UFE than both surgical procedures (aOR, 7.13; 95% CI, 3.43-14.80).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, UFE was underutilized with significant disparities across socioeconomic factors. Further efforts are needed to equitably expand access to UFE across the country.