Observational studyJournal of minimally invasive gynecology2026
Diagnostic Disparities in Endometriosis and Adenomyosis: Investigating Social Vulnerability and Access to Care in an Ancestrally Diverse Population.
Observational study in Journal of minimally invasive gynecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
STUDY
objectiveTo evaluate differences in the likelihood of endometriosis or adenomyosis diagnosis across genetically-defined ancestry groups (African, Admixed American, East Asian, European, and South Asian), and to determine whether social vulnerability and access to surgery influence diagnostic practices in a diverse urban population.
settingPenn Medicine BioBank, a clinical and genomic biorepository. PATIENTS: Female patients aged 18 to 51 enrolled from 2008 to 2020 and followed through March 2024.
interventionsPopulation diversity was characterized using genotyping data from peripheral blood samples. Genetic ancestry was inferred through principal component analysis and clustering with reference populations. Sociocultural factors were assessed as distinct covariates rather than conflated with racial/ethnic identity. Social vulnerability indices (socioeconomic status, family/household factors, and housing/transportation access) were defined by Census tract of the patient's residence. Endometriosis and adenomyosis were identified using International Classification of Diseases-9/10 codes, validated by chart review. Logistic regressions were adjusted for age, body mass index, social vulnerability, and interaction terms. MEASUREMENTS AND MAIN
resultsAmong 9258 patients, 357 (3.9%) were diagnosed with endometriosis and 464 (5.0%) with adenomyosis. When all diagnostic routes were considered (surgical, imaging, and clinical), the likelihood of endometriosis did not differ by ancestry group. However, the odds of a surgical diagnosis by laparoscopy was significantly lower for patients of African ancestry, compared with European (adjusted OR: 0.57, 95% CI: 0.38-0.85). Socioeconomic vulnerability strongly modified this association: African-ancestry patients with the highest socioeconomic vulnerability had the lowest odds of receiving an endometriosis diagnosis (aOR: 0.29, 0.14-0.61), including surgically confirmed diagnosis (aOR: 0.31, 0.12-0.80), relative to those of European ancestry with lowest vulnerability. By contrast, patients of African ancestry had higher odds of adenomyosis (aOR: 2.88, 2.16-3.85), including cases confirmed by hysterectomy (aOR: 3.44, 2.21-5.36).
conclusionDiagnostic disparities in endometriosis and adenomyosis were most pronounced at the intersection of ancestry and socioeconomic vulnerability, highlighting the need to address social determinants and barriers to equitable care.
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