Abstract：
BACKGROUND: Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UFs) and experience more severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than the common alternative, open hysterectomy. To determine whether demographic disparities persist in UF treatment utilization, we reviewed patient characteristics associated with UAE versus hysterectomy for UF among studies of US clinical practices.
METHODS: A systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051), yielding 1,350 articles (January 1, 1995, to July 15, 2023) that outlined demographic characteristics of UAE compared with hysterectomy. Two readers screened for inclusion criteria, yielding 13 full-text US-based comparative studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed on the data (STATA v18.0). Egger\'s regression test was used to quantify publication bias.
RESULTS: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio = 3.35, P < .01) and young age (P < .05) were associated with UAE, whereas private insurance (relative to Medicare and/or Medicaid) was not (odds ratio = 1.06, P = .52). Between-study heterogeneity (I2 > 50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance.
CONCLUSIONS: Knowledge of demographic characteristics of patients with UFs receiving UAE versus hysterectomy is sparse (n = 13 studies). Among these studies, which seem to be racially well distributed, Black and younger women are more likely to receive UAE than their counterparts.
METHODS: A systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051), yielding 1,350 articles (January 1, 1995, to July 15, 2023) that outlined demographic characteristics of UAE compared with hysterectomy. Two readers screened for inclusion criteria, yielding 13 full-text US-based comparative studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed on the data (STATA v18.0). Egger\'s regression test was used to quantify publication bias.
RESULTS: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio = 3.35, P < .01) and young age (P < .05) were associated with UAE, whereas private insurance (relative to Medicare and/or Medicaid) was not (odds ratio = 1.06, P = .52). Between-study heterogeneity (I2 > 50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance.
CONCLUSIONS: Knowledge of demographic characteristics of patients with UFs receiving UAE versus hysterectomy is sparse (n = 13 studies). Among these studies, which seem to be racially well distributed, Black and younger women are more likely to receive UAE than their counterparts.
摘要：
背景：在美国，黑人和保险不足的女性比她们的同龄人更有可能患上子宫肌瘤（UF）并经历更严重的症状。子宫动脉栓塞术(UAE),保留子宫的治疗程序，比普通的替代方案侵入性小，开腹子宫切除术.为了确定UF治疗利用中的人口统计学差异是否持续存在，我们回顾了美国临床实践研究中UAE与UF子宫切除术相关的患者特征.
方法：通过PubMed进行了系统的文献综述，Embase,和CINAHL（PROSPEROCRD42023455051），发表了1,350篇文章（1995年1月1日至2023年7月15日），概述了与子宫切除术相比阿联酋的人口统计学特征。两名读者筛选纳入标准，产生13项全文基于美国的比较研究，规定了至少一个常见的人口统计学特征。对数据进行随机效应荟萃分析(STATAv18.0)。Egger回归检验用于量化发表偏倚。
结果：9名（138,960名患者），4名(183,643名患者)，并对7项(312,270名患者)研究进行了种族分析，保险状况,和年龄作为治疗方式的预测因素，分别。黑人种族（OR=3.35，p<0.01）和年轻年龄（p<0.05）与阿联酋有关，而私人保险(相对于医疗保险/医疗补助)则没有(OR=1.06，p=0.52)。在所有三个meta分析中都检测到研究间异质性(I2>50%)。检测到年龄而不是种族或保险的小研究偏倚。
结论：接受UAE和子宫切除术的UF患者的人口统计学特征知识很少（n=13项研究）。在这些研究中,似乎在种族上分布得很好，黑人和年轻女性比她们的同龄人更有可能接受阿联酋。
方法：通过PubMed进行了系统的文献综述，Embase,和CINAHL（PROSPEROCRD42023455051），发表了1,350篇文章（1995年1月1日至2023年7月15日），概述了与子宫切除术相比阿联酋的人口统计学特征。两名读者筛选纳入标准，产生13项全文基于美国的比较研究，规定了至少一个常见的人口统计学特征。对数据进行随机效应荟萃分析(STATAv18.0)。Egger回归检验用于量化发表偏倚。
结果：9名（138,960名患者），4名(183,643名患者)，并对7项(312,270名患者)研究进行了种族分析，保险状况,和年龄作为治疗方式的预测因素，分别。黑人种族（OR=3.35，p<0.01）和年轻年龄（p<0.05）与阿联酋有关，而私人保险(相对于医疗保险/医疗补助)则没有(OR=1.06，p=0.52)。在所有三个meta分析中都检测到研究间异质性(I2>50%)。检测到年龄而不是种族或保险的小研究偏倚。
结论：接受UAE和子宫切除术的UF患者的人口统计学特征知识很少（n=13项研究）。在这些研究中,似乎在种族上分布得很好，黑人和年轻女性比她们的同龄人更有可能接受阿联酋。
