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Ectopic pregnancy rates in California are declining, but the decline is slower among black women

Rates of ectopic pregnancy (EP), a major cause of infertility and the primary cause of maternal death during the first trimester, are declining in California for all women. Black women, however, have the highest EP rates in the State and the rate of decline is slower than that of other women, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10858 and HS14022). The continued racial disparity in EP rates, despite improved diagnostic and treatment methods, suggests that disparities in incidence of sexually transmitted disease (STD) and previous EP, two major risk factors for EP, continue to exist for black women as well.

EP occurs when the fertilized egg is implanted and begins to grow in the fallopian tube instead of the uterus. Nearly half of EPs are due to inflammation and scarring of the fallopian tubes due to STDs, especially Chlamydia trachomatis, note the researchers. They evaluated State-level multicultural trends in EP rates by analyzing California hospital discharge data for 62,829 EPs from 1991 to 2000. EP rates were highest among black women (25/1000) and lowest among Hispanic women (7.7/1000).

Black women had over twice the risk of EP relative to non-Hispanic whites. Women 35 to 44 years of age had the highest EP rates (17.6/1000) and more than twice the risk of EP compared to other age groups. The highest rate of EP was found among black women 35 to 44 years of age (43.1/1000), a rate comparable to that of women in developing African nations. What's more, the EP rate among black women declined only 24 percent from 1991 to 2000 (29.5 to 21.6/1000) compared to a 47 percent decline among white women (18.9 to 10.3/1000). Hispanic women had the smallest decline in EP rates at 20 percent (9.4 to 7.2/1000), but had the lowest EP rate for each year studied. Studies of women in other U.S. geographic regions confirm the findings of greater EP risk among black women.

See "Multi-cultural surveillance for ectopic pregnancy: California 1991-2000," by Jose L. Calderon, M.D., Magda Shaheen, M.D., Deyu Pan, M.S., and others, in the Autumn 2005 Ethnicity & Disease 15 (Suppl. 5), pp. S5-20-S5-24.

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