(111) Racial and ethnic inequities in rates of diagnostic laparoscopy for evaluation of pelvic pain in adolescent patients

Background: Endometriosis is a chronic condition marked by chronic pelvic pain (CPP), dysmenorrhea, and subfertility that often presents in adolescence. Research in the adult population has demonstrated that non-White race is associated with greater delay in surgical diagnosis of endometriosis. This study aimed to identify inequities in rates of diagnostic laparoscopy among adolescents presenting with dysmenorrhea or CPP according to race, ethnicity, and socioeconomic status (SES).

Methods: A retrospective chart review was performed at a single academic medical center. IRB exemption was obtained. Subjects were aged 10-21, assigned female at birth, and seen by Pediatric and Adolescent Gynecology or Minimally Invasive Gynecologic Surgery between 2013 and 2023 for dysmenorrhea or CPP. Patients were classified as non-surgical, undergoing scheduled diagnostic laparoscopy, or undergoing emergent laparoscopy. Patients were excluded if they had an adnexal mass or cyst, prior laparoscopy identifying endometriosis, or an unrelated indication for laparoscopy. Demographic data were abstracted from an institutional database query. Data were analyzed using logistic regression. Odds ratios were calculated with White non-Hispanic as the reference category. SES was measured by the Area Deprivation Index (ADI).

Results: Of the 4,480 patients meeting inclusion criteria, 4,426 were expectantly managed, 47 underwent scheduled diagnostic laparoscopy, and 7 underwent emergent laparoscopy. Only 3.5% (n=2) of Black patients received any laparoscopy, both for emergent care. Black patients were significantly less likely to receive any laparoscopy (OR 0.20, 95% CI 0.03-0.68, p=.007) or non-emergent surgery (OR 0.005, 95% CI 0.0-0.18, p=.014) than White patients. Patients of Asian descent were less likely to undergo any laparoscopy (OR 0.001, 95% CI 0.0-0.40, p=.04) than White patients. Hispanic patients were less likely to undergo scheduled laparoscopy (OR 0.20, 95% CI 0.01-1.17, p=.04) than non-Hispanic patients. Older women were more likely to have laparoscopy (OR 1.33, 95%CI 1.19-1.50, p<.001). There was no significant difference in rate of laparoscopy according to ADI (OR 1.03, 95% CI 0.92-1.14, p=.14).

Conclusions: This study identified inequities in rates of laparoscopy among adolescent patients by race and ethnicity, with surgery performed at lower rates for Black, Asian, and Hispanic patients. These findings represent sub-specialty care at one academic medical center, and thus may not be generalizable to all adolescents. Further research is needed to identify the contributing factors leading to these differences and to guide more equitable care.