Missed Diagnosis of PCOS Tied to Race and Socioeconomic Vulnerability Factors

The probability of missed polycystic ovary syndrome (PCOS) diagnoses are higher among Black vs non-Hispanic White women, women on Medicaid vs private insurance, non-English vs English speakers, and women with lower vs higher body mass index (BMI), according to study results published in the Journal of Clinical Endocrinology & Metabolism.

Researchers sourced data from the Boston Medical Center (BMC) Clinical Data Warehouse to identify predictors of missed PCOS diagnoses. Participants were female patients aged 18 to 45 years who presented at primary care for androgen blood tests, hirsutism, evaluation of menstrual regularity, pelvic ultrasound, or PCOS.

Demographic and socioeconomic data, including race, education, insurance type, and BMI, were extracted from electronic health records.

Among the 23,786 participants (mean age, 27.4 years), 47% were Black, 25% were non-Hispanic White, and 15% Hispanic/Latino. The researchers identified 1199 physician-diagnosed and 730 algorithm-diagnosed PCOS cases. Overall, 56% of patients had charity or Medicaid insurance.

Among the algorithm-diagnosed patients, 248 had irregular menstruation and androgen excess, 436 had irregular menstruation and polycystic ovarian morphology, and 46 met all 3 criteria. Although annual PCOS diagnoses remained stable, they dropped in 2015 due to a switch from ICD-9 to ICD-10 codes.

Adjusted analyses showed that missed PCOS diagnoses were more likely among Black vs White patients (odds ratio [OR], 1.69; 95% CI, 1.28-2.24) and those with Medicaid (OR, 1.90; 95% CI, 1.47-2.46) or charity insurance (1.90; 95% CI, 1.41-2.56) vs private insurance. The effect of charity insurance on missed diagnoses was notably higher among non-Hispanic White patients compared with Black and Hispanic/Latino patients.

Moreover, patients with higher vs lower BMI had reduced odds of a missed diagnosis. The odds of a missed PCOS diagnosis were lowest among those with class III obesity (OR, 0.25; 95% CI, 0.17-0.35), followed by those with obesity (OR, 0.39; 95% CI, 0.28-0.53) and overweight (OR, 0.39; 95% CI, 0.28-0.53) compared with underweight or normal BMI (OR, 0.71; 95% CI, 0.51-0.98).

Socioeconomic Vulnerability Index (SVI) scores were linked with missed diagnoses, particularly in housing/transportation factors (OR, 1.10 per 10% SVI increase; 95% CI, 1.02-1.18). Compared with English speakers, non-English speakers also faced higher odds of a missed PCOS diagnosis (OR, 1.34; 95% CI, 1.03–1.75).

Study limitations include the absence of an estimate for diagnosed and unrecognized PCOS, potential informative presence bias in electronic health record data, and potential confounding.

The study authors concluded, “Ensuring vulnerable patients receive timely PCOS diagnoses will increase their access to information and support, reduce comorbidity risk, and improve quality-of-life.”

This article originally appeared on Endocrinology Advisor