Kaiser Permanente study offers new, more detailed information about Asian subgroup rates
Women in several Asian subgroups are more likely than white women to be diagnosed with uterine fibroids, according to new Kaiser Permanente research. The study, published in JAMA Network Open, also confirmed the known, much higher fibroid rates among Black women.
Fibroid diagnosis rates were 71% higher for South Asian, 47% higher for East Asian, and 29% higher for Southeast Asian patients compared with non-Hispanic white patients. The study found Black patients with three times the likelihood of a fibroid diagnosis compared with white patients, and Hispanic patients also having elevated rates (37% higher).
“Most of the past scientific literature has focused on fibroid burden in Black patients and white patients,” said lead author Susanna Mitro, PhD, a research scientist with the Kaiser Permanente Division of Research. “Because Kaiser Permanente has such a large and diverse patient population, we had a great opportunity to better understand fibroid diagnosis rates in other racial and ethnic groups.”
Uterine fibroids are a common, non-cancerous condition that an estimated 70% to 80% of women develop by age 50. Fibroids can grow large and numerous, causing pain, interference with fertility, and other problems. They are the most common non-cancer reason women have their uterus removed through hysterectomy.
This study tallied fibroid diagnosis among 1,917,794 female members of Kaiser Permanente Northern California. None of the patients had a previous fibroid diagnosis. Patients are often diagnosed if they have symptoms or fibroids appear on abdominal imaging during treatment for some other health concern.
Medical records were examined for a 14-year period, from 2009 to 2022. Overall, those with an initial diagnosis were more likely to be older and have a higher body mass index (BMI).
The researchers also found differences in fibroid-related symptoms, such as pain or vaginal bleeding, among the diagnosed patients, suggesting variation in how people from different backgrounds might experience or report symptoms to their doctors. Asian and Pacific Islander patients were less likely to have symptoms noted in their records.
“This study is the largest and most diverse of its kind yet to be published analyzing Asians by specific geographic origin and fibroid incidence,” said senior author Eve Zaritsky, MD, a gynecological surgeon with The Permanente Medical Group. “We can see there are differences within this very diverse Asian population. The findings from this study can help to guide our counseling and practice patterns for Asian people with fibroids, contribute to the literature, and target our care.”
The study didn’t provide evidence for reasons for the differences between groups, but its results could influence medical care, Mitro said. “Understanding fibroid burden among different groups can help us ensure we are adequately counseling patients and providing care equitably across different races and ethnicities,” she said.
A number of factors could cause the differences in diagnosis, the authors wrote. These include variations in diet, environmental exposures, and health care utilization that might produce an incidental diagnosis (for instance, patients receiving infertility care at an advanced maternal age).
“There are major evidence gaps around uterine fibroids, which is concerning particularly considering how common they are,” Mitro said. Future research about risk factors, diagnosis, treatment, and other aspects of fibroids should take race and ethnicity differences into account, she said.
The study was funded by the National Institutes of Health and Kaiser Permanente Northern California Community Health.
Additional co-authors were Wendy Dyer, MS, and Monique Hedderson, PhD, with the Division of Research; Catherine Lee, PhD, formerly of DOR; Ameek Binda, MS, and Lana Wang, DO, of The Permanente Medical Group; and Miranda Ritterman Weintraub, PhD, of the Kaiser Permanente Northern California Department of Graduate Medical Education.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org or follow us @KPDOR.
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