Cited by 193Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsGenetic and Kidney Cyst Diseases

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Referral Bias in Defining the Phenotype and Prevalence of Obesity in Polycystic Ovary Syndrome

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Ezeh, Uche, Yildiz, Bulent O., Azziz, Ricardo·2013·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2013-1295PMC PMC3667270

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Abstract

BACKGROUND: The described phenotype of the polycystic ovary syndrome (PCOS) has been primarily based on findings in a referred (self or otherwise) population. It is possible that the phenotype of PCOS would be different if the disorder were to be detected and studied in its natural (unbiased) state. OBJECTIVE: Our objective was to compare the phenotype of PCOS detected in an unselected population with that identified in a referral population. PARTICIPANTS: Participants included 292 PCOS patients identified at a tertiary care outpatient facility (referral PCOS) and 64 PCOS women (unselected PCOS) identified through the screening of a population of 668 seeking a pre-employment physical. Among the women undergoing a pre-employment physical, 563 did not demonstrate features of the disorder (unselected controls). All PCOS subjects met the National Institutes of Health 1990 criteria for the disorder. MAIN OUTCOME MEASURES: We estimated prevalence of obesity and severity of disease burden. RESULTS: Referral PCOS subjects had greater mean body mass index and hirsutism score and higher degrees of hyperandrogenemia, were more likely to be non-Hispanic White (83.90%), and demonstrated a more severe PCOS subphenotype than unselected PCOS or unselected controls. The prevalence of obesity and severe obesity in referral PCOS was 2.3 and 2.5 times greater than estimates of the same in unselected PCOS and 2.2 and 3.8 times greater than estimates in unselected controls, respectively. Alternatively, unselected PCOS subjects had a prevalence of obesity and severe obesity and a mean body mass index similar to those of the general population from which they were derived. CONCLUSION: The phenotype of PCOS, including the racial/ethnic mix, severity of presentation, and rate of obesity, is affected significantly by whether the PCOS subject arises from a referral population or through unselected screening, likely reflecting the degree of patient concern and awareness and access to healthcare.

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Additional file 3 of Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA)
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Additional file 1 of Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA)
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Additional file 5 of Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA)
Kim, C., Schreiner, P. J., Siscovick, D. S., Wang, A., Wellons, M., Ebong, I., Vu, T.-H., Appiah, D., Catov, J., Schisterman, E. F., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22792667
Additional file 2 of Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA)
Kim, C., Schreiner, P. J., Siscovick, D. S., Wang, A., Wellons, M., Ebong, I., Vu, T.-H., Appiah, D., Catov, J., Schisterman, E. F., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22792658
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Kawuribi, V., Adu‐Amankwaah, J., & Yalley, S. K. (2026) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2026.106034

Authors: Ezeh, U., Yildiz, B. O., & Azziz, R.
Affiliations: Cedars-Sinai Medical Center (US)
Department of Internal Medicine, Endocrinology, and Metabolism Unit (B.O.Y.), Hacettepe University School of Medicine, Hacettepe, 06100 Ankara, Turkey
University of California, Los Angeles (US)
Corresponding author: Azziz, Ricardo
ORCID: Ezeh, Uche
Azziz, Ricardo
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2013-06-01
Volume: 98
Issue: 6
Pages: E1088-E1096
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2013-1295
PMC: PMC3667270
OpenAlex: W2040201798
Cited by: 193
References: 42
Citations by year: 2026: 9 · 2025: 13 · 2024: 19 · 2023: 22 · 2022: 14 · 2021: 13 · 2020: 13 · 2019: 10 · 2018: 19 · 2017: 10 · 2016: 16 · 2015: 15 · 2014: 14 · 2013: 6
FWCI: 20.60
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Hacettepe University Institutional Repository (hacettepe.edu.tr) (submittedVersion, other-oa)
Funders: National Institutes of Health (K24-HD01346, 1-K24-HD01346)
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK073632)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD001346, R01HD029364, 1-K24-HD01346, R01-HD29364)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Kidney Cyst Diseases
Keywords: polycystic ovary syndrome, referral bias, obesity prevalence, PCOS phenotypes, hyperandrogenemia, hirsutism, body mass index, racial and ethnic differences, disease severity
MeSH terms: Adult, Female, Humans, Obesity, Phenotype, Polycystic Ovary Syndrome, Referral and Consultation, Bias, Body Mass Index, Prevalence, Hyperandrogenism

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Referral Bias in Defining the Phenotype and Prevalence of Obesity in Polycystic Ovary Syndrome

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