title: Association Between Patient Characteristics and Treatment Procedure Among Patients With Uterine Leiomyomas.
abstract: OBJECTIVE
  To analyze the association between patient characteristics and the probability of undergoing any uterine-sparing procedure (endometrial ablation, myomectomy, and uterine artery embolization) compared with hysterectomy as the first uterine leiomyoma (index) procedure and the probability of undergoing a specific uterine-sparing procedure.
  
  
  METHODS
  We conducted a retrospective analysis using a commercial insurance claims database containing more than 13 million enrollees annually. Based on the index procedure performed 2004-2009, women were classified into one of the four procedure cohorts. Eligible women were aged 25-54 years on the index date, continuously insured through 1-year baseline and 1-year follow-up, and had a baseline uterine leiomyoma diagnosis. Logistic regression was used to assess the association between patient characteristics and leiomyoma procedure.
  
  
  RESULTS
  The study sample comprised 96,852 patients (endometrial ablation=12,169; myomectomy=7,039; uterine artery embolization=3,835; and hysterectomy=73,809). Patient characteristics associated with undergoing any uterine-sparing procedure compared with hysterectomy included health maintenance organization health plan enrollment, Northeast region residence, the highest income and education quintiles based on zip code, an age-race interaction, and baseline diagnoses including menstrual disorders, pelvic pain, anemia, endometriosis, genital prolapse, and infertility. Among those who had a uterine-sparing procedure, characteristics associated with undergoing uterine artery embolization or endometrial ablation compared with myomectomy included increasing age, being from the Midwest relative to the Northeast, and certain baseline conditions including menstrual disorder, pelvic pain, endometriosis, and infertility.
  
  
  CONCLUSIONS
  Both clinical and nonclinical factors were associated with the receipt of alternatives to hysterectomy for uterine leiomyomas in commercially insured women.
authors.affiliation: Departments of Health Sciences Research, Obstetrics and Gynecology, and Surgery, Mayo Clinic College of Medicine, and the Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; and the Division of Clinical and Epidemiologic Research, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Laughlin-Tommaso
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Yao
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stewart
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D004522:Educational Status; D004715:Endometriosis / Q000150:complications; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007182:Income / Q000706:statistics & numerical data; D007247:Infertility, Female / Q000150:complications; D007889:Leiomyoma / Q000150:complications / Q000601:surgery*; D008599:Menstruation Disturbances / Q000150:complications; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D017699:Pelvic Pain / Q000150:complications; D011336:Probability; D012189:Retrospective Studies; D014481:United States; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data*; D063186:Uterine Myomectomy / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000150:complications / Q000601:surgery*; D014596:Uterine Prolapse / Q000150:complications