Polycystic ovary syndrome (PCOS) is a complex health condition with associated risk of metabolic, reproductive and psychological complications. PCOS is more recently being recognised as a metabolic disorder concurrently being diagnosed with metabolic syndrome, a combination of diabetes, high blood pressure and obesity. It is a severely underdiagnosed condition. We also know that ethnicity has a factor to play in PCOS – in both the prevalence and its phenotype. PCOS disproportionately affects women of non-Caucasian ethnicity, however this has not been thoroughly quantified. Furthermore, literature suggests that metabolic outcomes may also be more prevalent in certain ethnic groups. Therefore, we aim to research whether there is an association with ethnicity, PCOS, and metabolic outcomes in women with PCOS – this will help us investigate the burden of PCOS among different ethnic groups to guide effective targeted prevention and treatment strategies and ultimately improve clinical outcomes for patients with PCOS.
We will look at diagnostic records to identify women with PCOS and women who develop metabolic outcomes. The metabolic outcomes we will be researching include type 2 diabetes, hypertension, and hyperthyroidism. The ethnic subgroups will be white, black Afro-Caribbean, South Asian, mixed, and other ethnicity. Patients form white ethnicity will be used as the reference standard to compare risk of metabolic outcomes between ethnic groups.
We will also look at annual trends in incidence of PCOS and metabolic outcomes among women with PCOS, stratified by ethnicity to see if there is a time trend in ethnic disparity.
Polycystic ovarian syndrome (PCOS) is a very common endocrine disorder with associated metabolic, reproductive, and psychological morbidities. Prevalence is estimated to be between 4-18%. PCOS disproportionately affects women of non-Caucasian ethnicity, and so metabolic outcomes that are commonly observed in women with PCOS may also be more prevalent in certain ethnic groups. This study aims to investigate the ethnic variation in the annual incidence and prevalence trends of PCOS and metabolic outcomes (first ever diagnosis of outcome to date), namely type 2 diabetes, hypertension, and hyperthyroidism among women with PCOS. We will also investigate the annual incidence of the metabolic outcomes.
An odds ratio will be calculated to compare the odds of development of PCOS and of each metabolic outcome among ethnic minority women compared to white women, using a regression model to account for confounders (as listed in the covariate section).
With further research in this area, we can better understand the burden of PCOS, and which ethnic groups of women are more affected. With this information, targeted and equitable treatment can be given to these women and ultimately result in better patient outcomes.
A descriptive population based retrospective cohort study between 2000 and 2021 of women within the CPRD Aurum database, aged over 18, will be conducted to find the annual incidence of PCOS, and of metabolic outcomes, stratified by ethnicity. Women are coded by Snomed CT codes into 5 broad ethnicity categories - white (reference standard), South Asian, Afro-Caribbean, mixed and other, which will be used to define their ethnicity exposure.
We will also look at trends of incidence of the metabolic outcomes among women with PCOS stratified by ethnicity.
Incidence and prevalence trends of PCOS
Incidence trends of metabolic conditions, namely (1) Type 2 Diabetes (2) hypertension and (3) hyperthyroidism.
Anuradhaa Subramanian - Chief Investigator - University of Birmingham
Anika Goel - Corresponding Applicant - University of Birmingham
Krishna Gokhale - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Patient Level Index of Multiple Deprivation