RESULTS
A total of 1278 women were identified by the BMC Clinical Data Warehouse
database with ICD9 codes for infertility from 2005 to 2015. Among these
women, 662 met inclusion criteria, and their charts were reviewed.
Infertility was confirmed in 99 Black American, 110 Black Haitian, 61
Black African, and 88 White American women (Figure 1). Black women were
on average of similar age to White Americans at the time of their
diagnosis (33 and 32 years old respectively, p=0.064) (Table 1).
However, after stratification into Black ethnic subgroups, this
similarity was not retained, and Black Haitians and Black Africans were
on average older (35 years old) at the time of diagnosis compared to
Black Americans and White Americans (31 and 32 years old respectively,
p<0.001). Body mass index (BMI) was higher among Black
compared to White American women (p=0.008), and this difference was
maintained after a subgroup analysis of Black ethnic groups, with the
highest BMI seen among Black American women (p=0.004).
There was no significant difference in parity or marital status between
all Black women combined compared to White American women. However,
subgroup analysis of Black ethnic subgroups showed differences in both
parity and marital status between groups. In terms of parity, 41% of
African women were multiparous compared to 25% of Haitian, 17% of
Black American, and 18% of White American women (p<0.001).
African women (62%) were more likely to be married than Black American
(19%), Haitian (41%), and White American (48%) women (p=0.007). A
greater proportion of Black women (32%) were unemployed compared to
White American women (10%, p=0.003). Subgroup analysis comparing White
women and Black ethnic subgroups continued to show this difference, with
Black Africans having the highest rate of unemployment (43%), followed
by Black Haitians (35%, p<0.001). In addition, Black women
were more likely to be uninsured or on Medicaid compared to White
American women (55% and 14% respectively, p<0.001). This
difference was maintained when Black ethnic groups were stratified with
the highest uninsured rate seen among Black Haitians (61%) and Black
Africans (61%, p<0.001).
Infertility diagnoses fell into 6
categories: anovulation/polycystic ovary syndrome (PCOS), tubal Factor,
uterine Factor, male Factor, premature ovarian failure (POF), and
unexplained. Table 2 and Figure 2 summarize the prevalence of the
various infertility diagnoses in the racial/ethnic groups. As above, an
initial analysis was performed comparing all Black women (i.e., by
combining ethnicities) with White American women. A significantly higher
proportion of Black women (19.6%) had infertility secondary to tubal
factor compared to White American women (6.8%, p=0.03). In addition,
White American women (29.5%) had a significantly higher frequency of
unexplained infertility compared to Black women (13.3%, p=0.006).
With regard to comparisons with racial/ethnic subgroups, Black American
women had a higher frequency of infertility secondary to
anovulation/PCOS (56.5%, p=0.001) compared to White American (39.8%),
Black Haitian (25.5%) and Black African women (21.3%). Black African
women had a higher percentage of infertility secondary to POF (18.0%)
compared to the other groups that ranged between 2.7 and 3.4%
(p=0.0004). A comparison of day 3 FSH) levels, showed no difference in
rates of elevated day 3 FSH level ≥10 mIU/ml among all Black women
(10%) compared to White women (4.5%, p=0.09). However, the stratified
analysis of Black ethnic subgroups showed a greater percentage of
African (16%) and Haitian (16%) women with elevated day 3 FSH compared
to Black (1.0%) and White (4.5%) American women (p=0.001, Table 1).
White American women had a lower frequency of infertility secondary to
tubal factor (6.8%) than the other groups of women, especially in
comparison to Black Americans (18.2%) and Black Haitians (25.5%,
p=0.03). Black Haitians (20.9%) and Black Africans (16.4%) had a
higher frequency of infertility secondary to Uterine Factor than either
Black (7.1%) or White Americans (9.1%, p=0.03). There were no
differences in the frequency of male factor infertility among the
groups. In Black Haitian and Black African women, infertility diagnoses
were more evenly distributed compared to the other two groups, with
anovulation/PCOS (25.5% and 21.3%), tubal factor (25.5% and 11.5%)
and uterine factor (20.9% and 16.4%) contributing to the majority of
infertility diagnoses (Table 2).
Tables 3 and 4 present the final unadjusted and adjusted multivariate
logistic regression analyses. The regression analyses were adjusted for
factors known to influence fertility, including age, BMI, parity, and
SES. There were no differences in prevalence of male factor infertility
among the groups, so only infertility factors affecting females were
included in the analysis. Table 3 summarizes the prevalence of the
various infertility diagnoses in the White/overall Black groups and
shows the adjusted and unadjusted analyses between racial groups. Tubal
factor infertility was more common in Black compared to White women
(19.6% and 6.8% respectively, p=0.04), but this difference was not
retained in the adjusted analysis (p=0.15). There were no other
significant differences in infertility etiologies between Black and
White races after adjusting for potential confounders. In the
multivariate model comparing infertility diagnoses between the White and
individual Black ethnic groups (Table 4), Black American women had five
times the odds of having PCOS/anovulation compared to Black African
women (95% CI 1.4, 17.0). In addition, compared to Black African women,
higher odds of tubal factor infertility were observed in Black American
(aOR=4.7, 95% CI=1.2, 18.7) and Black Haitian women (aOR=4.0, 95%
CI=1.4, 14.0). No other significant differences were seen among specific
ethnic groups for the diagnoses of premature ovarian failure, uterine
factor, and unexplained infertility.