Abstract No. 401 Disparities in Utilization of Uterine Fibroid Embolization: A Longitudinal 5-Year Analysis of Inpatient Procedural Data in the United States

To perform a nationwide analysis of uterine fibroid embolization (UFE) compared to hysterectomy and myomectomy for uterine fibroid management, with attention to trends in utilization and disparities in access. Administrative data extracted from the National Inpatient Sample was obtained from the Healthcare Cost and Utilization Project and analyzed for the period between 2016 and 2020. After identifying the diagnosis of uterine fibroid based on ICD codes, we evaluated the utilization trends of UFE, hysterectomy, and myomectomy. The latter two were combined into one "surgical intervention" category for analysis. A multivariate logistic regression was performed to assess the influence of age, race, income, payer, and rural status to determine if any disparities exist. Of the 474,855 inpatient encounters with uterine fibroids, 374,665 (78.9%) underwent hysterectomy, 93,410 (19.7%) myomectomy, and 6,780 (1.4%) underwent UFE. There was no significant difference in the mean age of those undergoing UFE (44.75, SD= 8.08) versus those undergoing surgical interventions (45.55, SD=9.45). Compared to white patients, African American and Asian patients were more likely to undergo UFE compared to surgical interventions (Odds ratio (OR): 1.5, 95% CI: 1.3-1.8, P < 0.001 and OR: 1.3, 95% CI: 1.03-1.7, P =0.02, respectively). Compared to patients on private insurance, those on Medicaid and self-pay were more likely to have UFE than surgical interventions (OR: 1.75, 95% CI: 1.5-2.0, P < 0.001, and OR: 1.86, 95% CI: 1.46-2.36, P < 0.001, respectively). Compared to patients living in dense metropolitan regions, those living in rural regions were significantly less likely to undergo UFE than surgical interventions (OR: 0.28, 95% CI: 0.18-0.45, P < 0.001). Additionally, when compared to procedures in 2016, patients were more likely to undergo UFE than surgical interventions in 2020 (OR: 1.6, 95% CI: 1.3-1.9, P < 0.001). In this national analysis, differences in UFE utilization were observed by race, insurance type, and population density. UFE utilization, compared to other surgical interventions, increased from 2016 to 2020. Further studies are needed to better evaluate reimbursement trends and understand access to UFE.