LBMON236 Investigating The Effect Of Social Vulnerability Index On Fibroid Recurrence And Metabolic Dysfunction
Authors: Allen Antoinette , Nadgauda Ashni , Koepler Nathanael , Meeker Jessica , Shah Divya , Boland Mary Regina , Butts Samantha , Senapati Suneeta 
Published: November 2022

Abstract
Fibroids and metabolic dysfunction disproportionately affect women of color. We have previously shown that recurrent fibroids and metabolic dysfunction lead to increased healthcare utilization. The impact of socioeconomic factors on access to care for these women is poorly understood. Our objective was to evaluate the social vulnerability indices of women with fibroids with and without metabolic dysfunction, and determine the association of social vulnerability with fibroid recurrence. We conducted a retrospective cohort study of 918 geocoded patients who underwent myomectomy at a tertiary health care system. The primary exposure was the Social Vulnerability Index (SVI), a measure of socioeconomic disadvantage developed by the CDC with four thematic subgroups (socioeconomic status, household composition, Race/Ethnicity/Language, and Housing/Transportation). The primary outcome was clinically significant fibroid recurrence after initial myomectomy, defined as symptomatic fibroids requiring re-imaging or surgery. SVI was analyzed as an overall score and by quartiles. Models were adjusted for age, race, and insurance status, with metabolic dysfunction analyzed separately as a covariate. Patients were classified as having metabolic dysfunction (MD) if they met any 2 of 5 WHO or NCEP ATP III criteria for metabolic syndrome with BMI as proxy for waist circumference. Appropriate parametric and non-parametric tests and logistic regression were used to determine the association of SVI with fibroid recurrence. The mean SVI score for the cohort was 0.58 (SD 0.31). Mean SVI scores for patients with and without clinically significant fibroid recurrence were similar at 0.56 (SD 0.30) and 0.57 (SD 0.30), respectively. There remained no association between mean SVI score and odds of fibroid recurrence in adjusted models (OR 0.35, CI 0.10-1.24, p 0.11). Notably, there was a decreased rate of radiologic fibroid recurrence in the highest quartile of SVI (p=0. 011) and an increased rate in the third quartile (p=0. 015). When isolating the individual themes of the SVI index, there was a significant decrease in surgical and radiologic fibroid recurrence in individuals with the highest quartile of minority and language vulnerability (p=0. 03). The odds of metabolic dysfunction increased by 2.9 with each unit increase in SVI (OR 2.85, CI 1.34-6. 07, p 0. 006) after adjusting for age, race, and insurance status. We report that while patients with a higher SVI have increased risk of metabolic dysfunction, this does not translate to higher rates of clinical significant fibroid recurrence. Higher SVI is associated with lower resourced settings and reduced access to care and can therefore be used as a starting point for public health policy. SVI should be considered when studying fibroids, and may illuminate potential barriers in access to care for fibroid recurrence in patients with a history of myomectomy.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.