Associations between social determinants of health and clinical diagnosis time of uterine fibroids and endometriosis: a cross-sectional electronic health record-based study

Abstract

This study characterizes the association between self-reported race/ethnicity, insurance type, and preferred language with clinical diagnosis time for uterine fibroids (UF) and endometriosis patients, defined as time from first symptom consultation to diagnosis date. We extracted electronic health record data for patients of NYU Langone Health diagnosed with UF or endometriosis between 2017–2023. We utilized negative binomial regressions and a quantitative intersectionality methodology for the analysis. For UF patients, preferring Spanish (adjusted rate ratio [aRR] = 1.09, 95% confidence interval = [0.94, 1.26]) or a non-Spanish, non-English language (aRR = 1.16 [0.87, 1.55]) was associated with longer diagnosis time compared with English, albeit confidence intervals were wide. For endometriosis, non-Hispanic Black (aRR = 1.35 [0.99, 1.85]) and Hispanic/Latina patients (aRR = 1.40 [1.10, 1.78]) had longer diagnosis times compared with non-Hispanic White patients, and patients who had public insurance compared with private insurance (aRR = 1.20 [0.96, 1.50]). There was no evidence of interactions between these variables, but there was large heterogeneity in diagnosis time for NH Asian UF patients and Hispanic/Latina endometriosis patients. We found evidence that these social determinants of health are associated with diagnosis time for UF and endometriosis patients, an integral step towards delivering equitable care for UF and endometriosis patients.