Associations between lipid profiles, body mass index, race/ethnicity, and endometriosis diagnosis in a nationally diverse U.S. cohort

Background/context Endometriosis is a chronic inflammatory gynecologic disorder associated with pelvic pain, infertility, and systemic metabolic alterations [1]. Despite growing recognition of metabolic involvement in disease pathophysiology, the combined role of metabolic and demographic factors remains incompletely defined.

This study aimed to evaluate complementary associations of body mass index (BMI), lipid profiles, and race/ethnicity with recorded endometriosis diagnosis using the All of Us Research Program database.

In this retrospective observational analysis, participants aged 18–45 years with a recorded endometriosis diagnosis were compared with participants without a recorded diagnosis using propensity score–based methods. BMI differences were assessed using Welch t-tests stratified by race, and racial associations were evaluated using chi-square testing and multivariable logistic regression. Lipid analyses — including HDL, LDL, total cholesterol, and triglycerides — utilized matched regression models and inverse probability of treatment weighting (IPTW) sensitivity analyses adjusted for age and BMI.

Endometriosis cases had modestly lower BMI than controls in the matched-design analysis (mean difference, − 1.19 kg/m²; 95% CI, − 1.97 to − 0.41; P=0.003), although formal interaction testing indicated heterogeneity across race/ethnicity (P for interaction=0.020). Race/ethnicity was associated with recorded endometriosis diagnosis, with Asian and Hispanic or Latino participants demonstrating lower odds than White participants. In the primary matched lipid analyses, triglycerides were higher among cases in the adjusted model, whereas HDL, LDL, and total cholesterol differences were not statistically significant. IPTW sensitivity analyses yielded directionally similar estimates and statistically significant differences across all four lipid outcomes.

Race/ethnicity, BMI, and lipid measures were associated with recorded endometriosis diagnosis in this EHR-based population, although the direction of BMI differences varied across demographic subgroups and lipid findings differed in statistical significance across analytic approaches. Because socioeconomic factors, healthcare access, treatment exposures, fasting status, and temporality were not fully characterized, these associations should not be interpreted as causal. Prospective studies incorporating longitudinal metabolic measurements and more comprehensive clinical and social covariates are warranted. Similar content being viewed by others Abbreviations - BMI: - Body Mass Index - CI: - Confidence Interval - EHR: - Electronic Health Record - HDL: - High–Density Lipoprotein - IPTW: - Inverse Probability of Treatment Weighting - LDL: - Low–Density Lipoprotein - NIH: - National Institutes of Health - OR: - Odds Ratio - PSM: - Propensity Score Matching - SMD: - Standardized Mean Difference - TG: - Triglycerides

The authors wish to thank Dr. Carrie Champine, Associate Dean of OMS IV and Graduate Medical Education and Associate Professor of Obstetrics and Gynecology at Edward Via College of Osteopathic Medicine, for her mentorship at the conception of this project and for her tireless advocacy on behalf of her students — who are better physicians and researchers for having had her in their corner. We also wish to acknowledge the generations of researchers in women’s health who have continued rigorous, meaningful scientific investigation on behalf of a population that has too often been underserved and underfunded. This work stands on their shoulders. We gratefully acknowledge All of Us participants for their contributions, without whom this research would not have been possible. We also thank the National Institutes of Health’s All of Us Research Program for making available the participant data examined in this study. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study was reviewed by the Edward Via College of Osteopathic Medicine Institutional Review Board and determined to be exempt from full review because it did not constitute human subjects research (VCOM IRB Record #2024 − 225). All data were obtained from the NIH All of Us Research Program. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and applicable institutional and national research standards. Participants in the All of Us Research Program provided informed consent at enrollment through the program’s institutional consent framework, which governs the use of their de-identified data for approved research purposes. No direct contact with participants was made as part of this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Onken, E., Yi, E., McGinley, K. et al. Associations between lipid profiles, body mass index, race/ethnicity, and endometriosis diagnosis in a nationally diverse U.S. cohort. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-05009-6 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-05009-6