Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta-analysis

Background Understanding the impact of race/ethnicity on the prevalence and presentation of endometriosis may help improve patient care. Objective To review systematically the evidence for the influence of race/ethnicity on the prevalence of endometriosis. Search strategy CENTRAL, MEDLINE, PubMed, Embase, LILACS, SCIELO, and CINAHL databases, as well as the grey literature, were searched from date of inception until September 2017. Selection criteria Randomised control trials and observational studies reporting on prevalence and/or clinical presentation of endometriosis. Data collection and analysis Twenty studies were included in the review and 18 studies were used to calculate odds ratio (OR) with 95% confidence interval (CI) through a random effects model. Methodological quality was assessed using the Newcastle-Ottawa risk of bias scale (NOS). Main results Compared with White women, Black woman were less likely to be diagnosed with endometriosis (OR 0.49, 95% CI 0.29-0.83), whereas Asian women were more likely to have this diagnosis (OR 1.63, 95% CI 1.03-2.58). Compared with White women, there was a statistically significant difference in likelihood of endometriosis diagnosis in Hispanic women (OR 0.46, 95% CI 0.14-1.50). Significant heterogeneity (I-2 > 50%) was present in the analysis for all racial/ethnic groups but was partially reduced in subgroup analysis by clinical presentation, particularly when endometriosis was diagnosed as self-reported, Conclusions Prevalence of endometriosis appears to be influenced by race/ethnicity. Most notably, Black women appear less likely to be diagnosed with endometriosis compared with White women. There is scarce literature exploring the influence of race/ethnicity on symptomatology, as well as treatment access, preference, and response. Tweetable abstract Prevalence of endometriosis may be influenced by race/ethnicity, but there is limited quality literature exploring this topic.