Association of country of birth and persistent anemia from initial follow-up to surgery in women with symptomatic uterine fibroids
To evaluate the association between preoperative anemia and country of birth among women undergoing surgery for uterine fibroids. Retrospective cohort study. Two urban hospitals in Montréal, Canada. 642 women who underwent surgical treatment for uterine fibroids between 2017 and 2022. Medical records were reviewed for hemoglobin levels at the start of follow-up and within 7 days before surgery, as well as demographic, clinical, surgical, and socioeconomic data. Statistical analysis was conducted using RStudio (version 2024.09.0 + 375). Among the 419 women with hemoglobin result available at the beginning of follow-up, those with anemia were less likely to have been born in North America compared to those without anemia (39 % vs 60 %). Mean initial hemoglobin levels varied significantly by region of birth; women born in North America had higher levels than the cohort mean (117.01 g/L vs 111.30 g/L). North American birth remained an independent protective factor against anemia, even after adjusting for age, fibroid characteristics, and comorbidities. Among the 221 women with hemoglobin measured within seven days before surgery, 71 % showed hemoglobin improvement. Although patients born in North America continued to have higher preoperative hemoglobin levels (126.39 g/L vs 123.23 g/L; p = 0.045), the difference was smaller than at baseline. Hemoglobin improvement was consistent across all region groups. Birthplace outside North America is independently associated with preoperative anemia in women undergoing fibroid surgery. While hemoglobin improved over time, regional disparities persisted. Early identification and targeted intervention are essential to optimize surgical outcomes in diverse patient populations.
