What is the prevalence of chronic pelvic pain amongst the various ethnicities in Hawaiʻi?

Abstract

Objective: The primary objective of this study was to examine the prevalence of chronic pelvic pain (CPP) amongst various ethnic groups in the state of Hawaiʻi. A second objective was a secondary analysis of the data to identify any factors that may increase the risk of chronic pelvic pain. Methods: From 2005-2006, the annual Hawaiʻi Health Survey was administered to residents of the state of Hawaiʻi, by a third party vendor contracted with the Hawaiʻi Department of Health, to households with landline phones. Survey data were gathered on 24,642 people in 8503 households statewide. Questions about pelvic pain were added to the annual Hawaii Health Survey. Non-pregnant women household responders, over the ages of 18, were surveyed to assess the 3 month cross-sectional prevalence of chronic pelvic pain. Chronic pelvic pain is defined as pain below the belly button or in the female organs for more than 6 months. Those who reported chronic pelvic pain were surveyed on severity, frequency, diagnosis, and treatment. The data were weighted to account for age, gender, island location, and ethnicity. Results: All data is reported weighted to represent the general population. The survey data were weighted to represent 957,540 household members, reflecting the general population of Hawaiʻi. Forty-nine percent were male and 51.1% were female. The mean age of non-pregnant female adult respondents was 49.7 years old (SD 18.0). Of the 488,833 adult women, 10,404 (2.1%) were pregnant and 477,996 (97.8%) were not pregnant. In the last 3 months, 34,210 (7.2%) of the non-pregnant adult women surveyed responded yes to having pelvic pain. Of these, 13,449 of women responded yes to having the pain for more than 6 months. The prevalence of chronic pelvic pain was 2.8%. The mean pain score was 5.95 out of 10 (SD 2.50). Most women were not given a diagnosis, but the most common pathological diagnosis cited was endometriosis (11.3%). Though most women 10,553 (79.9%) did not miss any work, 9.1% missed less than 5 days of work, and 10.7% missed from 5 days to more than 15 days of work due to pelvic pain the previous 3 months. Twenty percent (2,580) rated themselves as fully productive, but 21% rated themselves with very low productivity, when having pelvic pain. African-American/Black (10.4%), Hawaiian (5.0%), and Caucasian/white (3.4%) were the ethnicities with the highest prevalence of chronic pelvic pain. And Chinese (1.7%), Japanese (1.1%), Other (1.3%), Asian (0.6%), and Samoan (0.4%) were below the mean prevalence of CPP. Vietnamese, Other Pacific Islander, Korean, and Asian Indian had no primary respondents who had CPP. When adjusting for age, marital status, weight, and menopausal status, African Americans (332% increased risk) and Hawaiians (27.5% increased risk) had the highest increased risk of CPP compared to Caucasians. Being in an unmarried relationship or divorced increased a woman's risk of having CPP by 8% and 10%, respectively. Being menopausal had a variable impact on risk of CPP depending on other confounding factors, and educational status was not significant for CPP. Conclusions: Chronic pelvic pain has a lower rate of prevalence at 2.8% than found nationally. African Americans and Hawaiians are at a greater risk of having CPP in the state of Hawaii. CPP results in missed days from work and adversely impacts work productivity. Hawaiians appear to be at greater risk of using more health care resources when having CPP. Additional investigations are needed to develop management approaches for this health disparity.