PCOS incidence remains stable, but age at diagnosis shifts younger

Key takeaways :

• From 2006 to 2019, PCOS incidence increased among women aged 16 to 20 years and decreased among those aged 26 to 30 years.
• Highest PCOS prevalence was 7.6% among Hawaiian or Pacific Islander women.

U.S. polycystic ovary syndrome incidence remained stable from 2006 to 2019, but prevalence was almost double prior estimates, according to data published in the American Journal of Obstetrics and Gynecology.

“We found that the prevalence of this condition in the general population in Washington state in 2019 was 5.2%,” Susan D. Reed, MD, MPH, MS, professor emeritus in the department of obstetrics and gynecology at the University of Washington Medical Center, Seattle, told Healio. “Incident or new diagnoses increased over time in younger and decreased in older age groups, perhaps related to greater awareness among practitioners of the impact of PCOS on long-term health outcomes and known prevention strategies. Increasing obesity rates may also be a factor driving earlier ages at diagnosis.”

In this U.S. population-based retrospective cohort study, researchers evaluated data on 177,527 women (mean age, 26.9 years) aged 16 to 40 years who were enrolled in Kaiser Permanente Washington for at least 3 years between 2006 and 2019 with at least one health care encounter during this time. Researchers age-adjusted PCOS incidence by direct standardization to the 2010 U.S. census data and assessed PCOS incidence over time. PCOS prevalence cases were defined as women with a PCOS diagnosis any time before the end of 2019.

Included women contributed 586,470 person-years, with 2,491 incident PCOS cases. Of women with incident PCOS, 69.3% were white, 12.1% were Asian, 6.4% were Black, 2% were Hawaiian or Pacific Islander, 1.9% were Native American and 1.4% were of other race and ethnicity. In addition, mean BMI was 31.6 kg/m² among women with an incident PCOS diagnosis and 26.3 kg/m² among women without a diagnosis.

Overall PCOS incidence was 42.5 per 10,000 person-years, with similar rates over time. However, from 2006 to 2019, researchers noted that women aged 16 to 20 years had increased PCOS incidence, from 31 to 51.9 per 10,000 person-years (P = .01), and women aged 26 to 30 years had decreased incidence, from 82.8 to 45 per 10,000 person-years (P = .02).

There was a small decreasing temporal trend in PCOS incidence rates observed among only non-Hispanic white women (P = .01). PCOS incidence rates by diagnosing provider type had little variation during the study period.

Of the 58,241 women included in 2019 data, 5.2% had a PCOS ICD diagnosis code, with the highest PCOS prevalence of 7.6% among Hawaiian or Pacific Islander women, followed by 6.9% among Native American and 6.8% among Hispanic women.

In a chart review of 700 women with incident PCOS who were enrolled in the Group Practice Division, researchers classified 60% of PCOS cases as definite or probable incident, 14% as possible incident and 17% as prevalent. Positive predictive value of PCOS ICD diagnosis code for identifying all types of PCOS was 76%.

According to Reed, despite no FDA-approved therapies targeting the cause of PCOS, lifestyle modifications, including weight loss and exercise, and medical interventions remain the standard of care in PCOS management.

“The etiology of PCOS has yet to be fully understood and will be best studied using translational research methods so that new medications targeting the cause of PCOS can be developed,” Reed said. “Health care systems should develop guidelines and clinical pathways to help in the prevention and management of patients with PCOS. The various types of prevention and management strategies should be systematically evaluated so that care can be optimized, and outcomes improved.”

For more information:

Susan D. Reed, MD, MPH, MS, can be reached at reeds@uw.edu.