Elsevier

Obstetrics & Gynecology

Volume 90, Issue 6, December 1997, Pages 967-973
Obstetrics & Gynecology

Original Articles
Variation in the Incidence of Uterine Leiomyoma Among Premenopausal Women by Age and Race

https://doi.org/10.1016/S0029-7844(97)00534-6Get rights and content

Abstract

Objective: To quantify the incidence of uterine leiomyoma confirmed by hysterectomy, ultrasound, or pelvic examination according to age and race among premenopausal women.

Methods: From September 1989 through May 1993, 95,061 premenopausal nurses age 25–44 with intact uteri and no history of uterine leiomyoma were followed to determine incidence rates of uterine leiomyoma. The self-reported diagnosis was confirmed in 93% of the medical records obtained for a sample of cases. Using pooled logistic regression, we estimated relative risks (RRs) of uterine leiomyoma according to race and examined whether adjustment for other potential risk factors could explain the variation in the race-specific rates.

Results: During 327,065 woman-years, 4181 new cases of uterine leiomyoma were reported. The incidence rates increased with age, and the age-standardized rates of ultrasound- or hysterectomy-confirmed diagnoses per 1000 woman-years were 8.9 among white women and 30.6 among black women. After further adjustment for marital status, body mass index, age at first birth, years since last birth, history of infertility, age at first oral contraceptive use, and current alcohol consumption, the rates among black women were significantly greater for diagnoses confirmed by ultrasound or hysterectomy (RR 3.25; 95% confidence interval [CI] 2.71, 3.88) and by hysterectomy (RR 1.82; 95% CI 1.17, 2.82) compared with rates among white women. We observed similar RRs when the cohort was restricted to participants who reported undergoing a screening physical examination within the 2 years before baseline.

Conclusion: A higher prevalence of known risk factors did not explain the excess rate of uterine leiomyoma among premenopausal black women.

Section snippets

Materials and Methods

The Nurses’ Health Study II cohort formed in September 1989 when 116,678 registered female nurses age 25–42 years from 14 states in the United States returned mailed questionnaires regarding age, race, height, weight at age 18, current weight, age at menarche, pregnancy history, history of oral contraceptive use, menopausal status, history of cigarette smoking, current alcohol consumption, and leisure-time physical activity. New questionnaires are mailed every two years to update this

Results

During 327,065 woman-years of follow-up, 4181 incident cases of uterine leiomyoma were reported. Of these, 667 (16%) were confirmed at hysterectomy, 2339 (56%) at ultrasound, and 1175 (28%) at pelvic examination only. The crude incidence rates per 1000 woman-years were 12.8 for all diagnoses of uterine leiomyoma, 9.2 for diagnoses confirmed at ultrasound or hysterectomy, and 2.0 for diagnoses confirmed at hysterectomy. Incidence rates increased with age (Table 1).

The incidence rates of uterine

Discussion

In these prospective data, we observed the incidence rates of uterine leiomyoma among premenopausal women to be associated strongly with age and approximately two to three times greater among black women than among white women. The excess rates were not attributable to a higher prevalence of risk factors among black women, nor were they attributable to differences in health screening practices, as measured by a recent physical examination or Papanicolaou smear, among the racial groups in this

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  • Cited by (0)

    Supported by Public Health Research Grant RO1-50385 from the National Institutes of Health and in part by a National Institutional Research Service Award (ES07069) from the National Institute of Environmental Health Sciences (to Dr. Marshall), Faculty Research Awards (FRA-398 and FRA-455) from the American Cancer Society (to Dr. Colditz and Dr. Hunter), and a grant from the Henry J. Kaiser Family Foundation (to Dr. Goldman).

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