Modified Project Summary/Abstract Section Compared with White women, Black women are 3 times more likely to develop fibroids and experience more significant symptoms, have higher hospitalization rates, and are more likely to schedule a uterine-sparing treatment. Although uterine-preserving treatment approaches can often effectively manage symptoms during the early disease experience, hysterectomy rates are 2-4 times higher among Black women compared with White women. The reasons for this difference remain unclear. Clinical considerations, such as uterine size, only partially explain the disproportionately higher rate of hysterectomy among Black women. Timely diagnosis and early treatment represent crucial steps in UF care and may contribute to observed differences between different demographic groups in treatment and outcomes. Differential delays in diagnosis or treatment initiation for Black women with UF compared with White women could result in longer duration of UF progression and growth, higher rates of care complications, and fewer treatment options. We know little about the UF care pathways, including the need for urgent services, like hospitalization, for symptoms. We also do not know to what degree community-level characteristics contribute to differences in UF care patterns and outcomes. This proposal builds on existing knowledge about differences between groups in UF treatment patterns (e.g., uterine-sparing vs. hysterectomy) by comparing UF care pathways among Black and White women living in a variety of neighborhood settings. This proposal will clarify how care timeliness is associated with differences in treatment patterns and the excess morbidity experienced by Black women. Our proposal complements the other projects in the Partnering for Engagement: An Academic and Community Alliance to Eliminate Differences throughout the Fibroid Experience (PEACE) Center examining UF etiology (Project 2) and patient experience (Project 3) and will be under the advisement of the Center’s Community Stakeholder and Advisory Board (CAB). Our experienced team will conduct the proposed study of care pathways for symptomatic UF among >27K Black and White Michigan Medicaid enrollees and will leverages data from detailed health records of >13K Black and White individuals in Southeastern Michigan between 2016 and 2024. The Aims are to 1) compare UF care intervals between Black and White Medicaid enrollees with symptomatic UF, 2) determine if the relationships between care interval duration and urgent health service use differ between Black and White individuals and 3) determine if neighborhood resources affect the relationships between the two groups and care interval duration or urgent health service use. Impact and significance. Findings from this large, longitudinal analysis of a racially and socioeconomically varying group of individuals with UF can assist efforts to target care processes to reduce these differences in UF treatment and health outcome...