Risk factors for and consequences of endometriosis among Black women

Endometriosis is a common and debilitating gynecologic disorder characterized by the presence of endometrial-like tissue outside of the uterus. It burdens approximately 10% of persons born with internal reproductive organs in the U.S., and incurs significant health care costs and morbidity. Prior research suggests that Black women are less likely to be diagnosed with endometriosis than White women; however, these racial/ethnic differences in endometriosis diagnosis likely reflect disparities in access to care and clinical presentation as opposed to biological differences in endometriosis incidence. To date, there has been almost no research on risk factors for or consequences of endometriosis among Black women. This is a significant gap in the literature as many established risk factors for endometriosis differ in their prevalence between Black and White women (e.g., age at menarche, parity, body mass index). Further, endometriosis is associated with higher risk of several diseases that disproportionately impact Black women (e.g., systemic lupus erythematosus). In recent work, patterns of the association between endometriosis and ovarian cancer risk differed between Black and White women, as did modifiers of the endometriosis-ovarian cancer association. These differences highlight the critical need for research into the impact of endometriosis on Black women across the life course. To address these important knowledge gaps we will utilize the Black Women’s Health Study, a prospective cohort of Black women followed to date for 27 years. This cohort represents a unique opportunity to evaluate the association between endometriosis risk factors and comorbidities among 59,000 participants, among whom over 1,600 endometriosis cases have occurred. Here we propose to further our understanding of endometriosis among Black women through the following specific aims: Aim 1. Determine whether existing risk factors that have been strongly and consistently associated with endometriosis in studies of predominantly White populations (i.e., parity, age at menarche, menstrual cycle length, body size, birth weight), are associated with endometriosis risk among Black women. Aim 2. Investigate the association between endometriosis and autoimmune diseases that have previously been associated with endometriosis and have a higher prevalence in Black women, including examining whether these associations vary by hysterectomy status. This proposed study is a unique opportunity for the first ever, large-scale prospective study on risk factors and consequences of endometriosis among Black women. The epidemiologic methods needed to examine endometriosis in a non-clinical setting are complex and the outcomes of this project will lay the groundwork for a larger scale grant where more novel risk factors and endometriosis consequences can be examined allowing for endometriosis research to expand beyond White populations.