Socioeconomic inequities may lead to fewer PCOS diagnoses
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Social determinants of health play a role in whether women receive a diagnosis of polycystic ovary syndrome, according to a case control study presented at the ASRM Scientific Congress & Expo.
Melinda Aldrich, PhD, MPH, associate professor at Vanderbilt University Medical Center, and colleagues identified and validated 1,297 cases of PCOS and 12,039 controls aged older than 18 years with available socioeconomic status (SES) information at a de-identified academic hospital institution.
SES information was represented by the area deprivation index (ADI), which uses census-level data to calculate a community’s socioeconomic position. The researchers used multivariable regression models with PCOS diagnosis as the outcome and ADI as the predictor variable to test the association between ADI and PCOS case status.
Also, to evaluate ADI’s effects across racial groups, the researchers fitted the logistic regression model to a sample of white patients (cases, n = 1,066; controls, n = 18,103) and a sample of Black patients (cases, n = 187; controls, n = 2,235).
The researchers found that patients with PCOS had significantly lower ADI (OR = 0.2; 95% CI, 0.12-0.33), which indicates higher SES. The lowest rate of PCOS diagnoses was found among patients in the highest ADI quartile (OR = 0.58; 95% CI, 0.49-0.69), indicating that as ADI increased, the rate of PCOS diagnoses decreased, the researchers said.
The researchers also observed this trend among white women in the top two quartiles, who had 28% to 44% lower odds for being diagnosed. Black women in the top two quartiles, however, had 42% to 48% lower odds of being diagnosed.
These differences partly may be due to the sample population’s baseline ADI, the researchers said, where Black women had statistically higher deprivation indices compared with white women regardless of their PCOS status (P < .001).
Because these inequities are a potentially unrecognized cause of the high rate of undiagnosed women, the researchers said further investigations are necessary to establish the role of social determinants of health on PCOS and its outcomes.
Perspective
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Emma Cermak, MD
This study finds that people with higher socioeconomic status are more likely to be diagnosed with PCOS. I think the author is likely correct in saying that this study indicates a difference in diagnosis, but I can make no comment on a difference in prevalence of PCOS.
The study sample is at an academic hospital, which may be a difficult place for people who experience the effects of a low socioeconomic status to navigate care. Furthermore, there is not thought to be a difference in the racial makeup of patients who have PCOS, but the large difference within this study could reflect inequitable access along race lines to academic medical center health care.
I think these findings are interesting, but they may have more to do with access to health care and timely diagnosis than social determinants of disease.
Patients who experience the effects of low socioeconomic status and those who face barriers to equitable care are less likely to have health insurance. They also are more likely to have difficulty getting transportation to visits, finding childcare during visits leaving work for appointments.
Additionally, some people are diagnosed with PCOS when they are having difficulty achieving pregnancy. , leaving many to pay out of pocket, which can be cost prohibitive.
PCOS is associated with long-term health consequences high blood pressure, high cholesterol and insulin resistance. Lack of access to quality health care can negatively impact the management of these chronic health conditions. Aside from advocating for universal health care, doctors can work hard within their office to flexib payment options, appointment scheduling and late arrival and no-show policies to improve access to care for these women.
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Aldrich M, et al. Abstract P-721. Presented at: Scientific Congress & Expo Oct. 17-20, 2021; Baltimore (hybrid meeting).
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