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Overcoming disparity in access to uterine artery embolization

Uterine fibroids are a common condition that affects up to 7 in 10 women. While some fibroid patients live with the condition without serious issues, many suffer from disruptive symptoms, such as heavy menstrual bleeding, pelvic pain, and infertility, which make it difficult for them to go about their daily lives.

Treatment options are broad and include medical management, hysterectomy, myomectomy, uterine artery embolization (UAE), endometrial ablation, and magnetic resonance-guided focused ultrasound. Uterine fibroids are the most common cause of hysterectomy in the United States. Compared to hysterectomy, UAE has a similar success rate for controlling and eliminating symptoms but preserves the uterus, decreases the risk of major complications, and carries a much shorter recovery time.

Sadly, many patients and their gynecologists are not aware of UAE, preventing women from accessing one of the most effective fibroid treatments available. This disparity of knowledge and access is harmful and unnecessary and disproportionately impacts women of color – especially Hispanic women – and rural populations.

Our team at the University of North Carolina uncovered these disparities through a study presented at the Society of Interventional Radiology’s 2024 Annual Scientific Meeting in Salt Lake City. Our research examined patient records from 2011 to 2020 in the National Inpatient Sample database. We compared records of women with symptomatic uterine fibroids who underwent UAE, hysterectomy, myomectomy, or endometrial ablation. We tabulated outcomes based on income, race, hospital type, region of the United States, and insurance status.

Black women, who suffer fibroids at a nearly three times higher rate than white women, account for 46 percent of all UAE procedures, while Hispanics account for only 14 percent. Additionally, data show that patients receiving care at an urban teaching hospital are significantly more likely to receive UAE than those in rural areas. In fact, urban teaching hospitals performed 82 percent of all UAEs, while non-teaching hospitals performed 16 percent and rural sites only 1 percent. This data dramatically demonstrates that Hispanic women and rural patients must be given more knowledge of and access to UAE to reduce this disparity.

When patients from certain ethnic groups or geographic locations experience a difference in access to treatments like UAE, our healthcare system has failed them. As medical providers, it is our job to ensure that our patients are aware of all available treatment options and can easily access the best treatment for their condition. When we are not proactive about overcoming these disparities, we contribute to the problem.

Our team is now researching the drivers of these disparities. We theorize that the language barrier and access to health insurance may be major factors for Hispanic women. Also, patients may use their social and family networks to weigh treatment options, so low knowledge of UAE may contribute to the disparities in UAE procedures among Hispanic and rural women. Furthermore, access to interventional radiologists in more rural settings can limit access to care.

Increasing the number of multidisciplinary clinics may help reduce this disparity if IRs can be co-located with OB/GYN and family medicine practitioners so that patients and providers will have better knowledge of IR options. This proximity would improve communication so providers can give patients comprehensive information about their choices of treatment.

As we gather more data, we also must proactively educate Hispanic and rural patients about IRs. We should offer in-language resources to give them the knowledge and access to this evidence-based, minimally invasive treatment that all patients deserve. By coming together as providers to address these disparities, we can ensure that Hispanic and rural patients have improved access to UAE.

Matthew Patetta is an interventional radiology resident.


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