Diagnostic Delays for Endometriosis among Rural Residents in the United States

Holly Hagstrom

MPH, Public Health Administration & Policy

Carrie Henning-Smith

Endometriosis; rural health


Endometriosis is a chronic health condition with a high prevalence and significant disease burden, including long diagnostic delays after initial symptom onset.1(p713),2 Approximately one in ten women in the United States have endometriosis,3 generating tens of billions of dollars per year in health care costs.1 Longer delays to endometriosis diagnosis after symptom onset are associated with higher health care costs and disease burden, indicating that shortening the diagnosis time may reduce overall health care costs, as well as the patient’s economic and disease burdens.4 Identifying disparities in diagnosis time of endometriosis has the potential to reduce preventable burdens on patients and the health care system by revealing areas for intervention. This is particularly important for those in rural areas, who may have greater difficulty accessing the specialized health services necessary for diagnosing, treating, and managing endometriosis than their counterparts in more suburban and urban areas.5

The following policy analysis highlights the trajectory of diagnostic delays for endometriosis among rural residents by identifying previous policies and political, social, and economic factors that played a role in the development, perpetuation, and exacerbation of these diagnostic delays. The paper evaluates two policy actions policymakers could implement in order to address the problem: (1) funding endometriosis research relating to disparities and inequities in the time to diagnosis of endometriosis and (2) requiring rural health care providers to complete additional training on screening and diagnosing gynecologic diseases and disorders.

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