Disparities in Treatment Decisions for Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) affects similar to 1.4 million women in the United States each year. This study sought to identify differences in treatment decisions for managing noncancer-related AUB. Materials and Methods: IRB approval was obtained. This retrospective study analyzed data for all women 21-60 years old, diagnosed with AUB from July 1, 2013 through June 30, 2017, in an Obstetrics and Gynecology residents' clinic serving mostly underinsured patients. Patients with a diagnosis of postmenopausal bleeding or any gynecologic cancer were excluded. Two multivariable logistic regression models were used to identify variables independently associated with receiving surgical (vs. medical) treatment and any (vs. no) treatment. Results: Of 2,154 patients with AUB, 1,705 women met all inclusion criteria and had complete data for analysis. In the model examining receipt of surgical (vs. medical) treatment, women ages 41-60 were 4.8 times more likely than women 21-40 years old to receive surgical treatment. Women designated as "Other" (non-White) race/ethnicity were 80.8% less likely than Black/African American patients to receive surgery. Body mass index (BMI) and insurance type were not independently associated with receiving surgical treatment. In the model examining any (vs. no) treatment, women ages 41-60 (vs. 21-40) and of unknown (vs. Black/African American) race/ethnicity were 69.6% and 50.8% less likely to receive any treatment, respectively. BMI and insurance status were not independently associated with receiving any treatment. Conclusion: Management of AUB differed significantly by age and race/ethnicity, but not BMI or insurance. Further investigation among larger diverse populations is warranted to test the generalizability of these findings.