Comprehensive Evaluation of Disparities in Cardiometabolic and Reproductive Risk between Hispanic and White Women with Polycystic Ovary Syndrome in the United States: a Systematic Review and Meta-Analysis.

Abstract

OBJECTIVE\nWe conducted a systematic review and meta-analysis to comprehensively compare cardiometabolic and reproductive health risk between Hispanic and White women with PCOS in the United States (U.S.) in response to the call by the International Guideline for PCOS to delineate health disparities.\n\n\nDATA SOURCE\nDatabases of MEDLINE, Web of Science, and Scopus were initially searched through October 25, 2020, and confirmed on February 1, 2021.\n\n\nSTUDY ELIGIBILITY CRITERIA\nObservational studies comparing glucoregulatory, lipid profile, anthropometric, blood pressure, androgen, ovarian morphology, oligo-anovulation, and infertility status between Hispanic and White PCOS groups were included. Primary outcome was metabolic syndrome (MetS) risk. Furthermore, major cardiovascular events (stroke, coronary heart disease, heart failure) and mortality rate (cardiovascular death, total mortality) data were evaluated. Studies on adolescents (<2yrs. post-menarche), pregnant, or menopausal-aged women (>50yrs.) were excluded.\n\n\nSTUDY APPRAISAL AND SYNTHESIS METHODS\nData were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Risk of bias was assessed by Newcastle-Ottawa (NOS) scale.\n\n\nRESULTS\nEleven studies (N=2267;[589 Hispanic;1678 White]) were eligible. All studies, including both White and Hispanic groups, had high quality (NOS score≥8). Hispanic women exhibited comparable MetS prevalence (7[-1 to 14] %;P=0.06;I2=0%), yet higher modified Ferriman-Gallwey score (0.60[-0.01 to 1.21];P=0.05;I2=0%), fasting insulin (5.48[3.11 to 7.85] μIU/mL;P≤0.01;I2=40.0%) and homeostatic model assessment of insulin resistance (HOMA-IR; 1.20[0.50 to 1.89];P≤0.01;I2=43.0%) vs. White women. Groups had comparable glucose, lipid profile, waist circumference, blood pressure, and androgen status (All:P≥0.08). Findings pertaining to group differences in certain reproductive outcomes (i.e., ovarian dysmorphology, infertility) were contradictory and described only narratively as inclusion in meta-analyses was not possible. No studies reported on cardiovascular events or mortality.\n\n\nCONCLUSIONS\nHispanic women with PCOS exhibit greater impairments in glucoregulatory status vs. White women. Disparities in reproductive risks cannot be concluded at this time. The degree to which glucoregulatory aberrations translate into patient-pressing diseases (diabetes, infertility) remains a major roadblock given the paucity of available evidence. Our observations support consideration of these disparities in the diagnostic, monitoring, and management practices for PCOS. Further, they reinforce the need to elucidate mechanisms that account for the observed disparities to foster equity in PCOS care.