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.