Date of Award

January 2024

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Xiaomei Ma

Second Advisor

Xiao Xu

Abstract

Objectives: To examine the pattern of diagnostic evaluation for abnormal uterine bleeding (AUB) in a national sample of women seeking care at emergency departments (ED) and to identify potential influencing factors with a focus on race and ethnicity.

Methods: We identified 1,049 (unweighted, or 7,900,653 weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB from the National Hospital Ambulatory Medical Care Survey during 2014-2021. The primary outcomes were whether an ultrasound was provided/ordered and whether a referral/return for follow-up consultation was recommended. Multivariable logistic regressions were conducted to assess the association of race and ethnicity with diagnostic evaluations, while accounting for other characteristics of the visit.

Results: Compared to non-Hispanic White women, non-Hispanic Black women were less likely to receive or have an ultrasound ordered (42.5% vs. 34.9%, P = 0.004; adjusted odds ratio [OR] = 0.58, 95% confidence interval [CI] 0.36-0.92) nor to have a referral/return recommended (84.4% vs. 82.5%, P = 0.58; adjusted OR = 0.54, 95% CI 0.31-0.94). Hispanic women did not differ significantly from non-Hispanic White women in these measures. Other factors associated with these measures included age, obesity status, involvement of a consulting physician during the ED visit, and metropolitan/non-metropolitan area location.

Conclusions: When women presented with AUB at ED, provision or ordering of ultrasound and referral/return for follow-ups varied by their race and ethnicity as well as other characteristics. These variations should be addressed in future efforts to improve care quality and equity.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/07/2026

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