Significant Racial Disparities Found in VA Uterine Fibroid Treatment
BACKGROUND:
Uterine fibroids (UF) are common, benign tumors that disproportionately affect Black women in terms of incidence and severity. UF are the leading cause of hysterectomy among women Veterans in VA and recent data suggest substantial Black/White disparities in UF treatment. As one-third of women Veterans who use VA healthcare are Black, it is critically important to understand the underlying drivers of these disparities. This study examined differences in UF treatment among Black and White Veterans in VA, including variation by UF severity as indicated by anemia. Researchers used VA data to identify Black (n=5,041) and White (n=3,206) Veterans with symptomatic UF between FY 2010 and FY 2012 with follow up through FY 2018 for outcomes, which included receipt of any treatment, and hysterectomy or fertility-sparing treatment as first treatment. Analyses were stratified by age.
FINDINGS:
- There were significant Black-White disparities in receipt of any treatment for symptomatic UF.
- Across age and UF severity subgroups, Black Veterans were less likely than White Veterans to receive any treatment.
- Racial disparities were most pronounced among Veterans with severe UF as indicated by anemia (<45 years: 60% of Black Veterans vs 71% of White Veterans received any treatment; >45 years: 46% of Black Veterans vs 67% of White Veterans received any treatment).
- Across age groups, among those who received any treatment, Black Veterans were less likely than White Veterans to have hysterectomy and more likely to have a fertility-sparing treatment as their first treatment.
IMPLICATIONS:
- These disparities may indicate delays in care among Black Veterans, differential ability to access desired treatments, and/or differential or biased care.
- Addressing disparities in UF care in VA will require building trust with patients, developing systems of accountability, and assessing VA’s regional- and site-level capacity to provide fertility-sparing treatments.
- Additional research on the experiences of Black Veterans with UF including qualitative studies is needed to inform strategies to eliminate racial disparities in UF care.
LIMITATIONS:
- This study relied solely on administrative data and lacked patient perspectives.
- Researchers were able to include only a single unidimensional measure of disease severity.
- Researchers were unable to capture any data on treatments that were not provided or paid for by VA, potentially leading to misclassification of first treatments.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 19-154). Dr. Katon is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy; Dr. Bossick and Ms. Carey are part of HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care.
Katon J, Bossick A, Carey C, et al. Racial Disparities in Uterine Fibroid Treatment among Veterans Using VA Healthcare. Women’s Health Issues. 2023 Jul-Aug;33(4):405-413.
