Hysterectomy, or removal of the uterus, is the second most common surgical procedure for non-elderly women. It is one of several treatments for common and debilitating gynecologic conditions. While effective at reducing symptoms to improve quality of life, the procedure is not without risks for premenopausal women, including those for emotional distress, long-term cardiac risk, and the end of fertility.

Historically, this tension between benefits and risks has led to questions about its appropriateness as an intervention, particularly for non-cancerous gynecologic conditions such as uterine fibroids or endometriosis. While hysterectomy rates over time have declined, the procedure itself is not inherently problematic, nor is some variation in its use.

In a new study published in HSR, Danielle Gartner, Ph.D.,  Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, and colleagues wanted to understand the ways in which race, geography and socioeconomic status affect disparities in the use of hysterectomy in North Carolina. The team used county-level rate estimation, spatial analysis, and data on each county’s economic tier in their analysis.

They find rates of hysterectomy are higher in counties with lower socioeconomic status regardless of race. Rates are also higher in general among Black women than white women, but when you also consider geography and socioeconomic status, the disparity becomes more apparent. That is, the racial disparity is biggest in the higher socioeconomic counties and smallest in lower ones.  The authors note that the use of race as a classification does not indicate biological differences, but rather the groupings are used “because of differing social, historical and political realities that have long disadvantaged the Black population in North Carolina and the United States.”

Because new or state-of-the-art treatments tend to be adopted earlier among those with social advantage, the disparity in more affluent areas may indicate that measures to reduce hysterectomy were not rolled out equitably. In other words, the benefits of living in a resource-rich environment do not equally apply to Black and white women. It could also indicate differential levels of access to health care providers with a propensity to perform alternative treatments, or reveal implicit or explicit biases within the health system.  

The research highlights the importance of considering spatial and socioeconomic context in the study of hysterectomy patterns, as well as the need for more evidence to inform appropriate use of hysterectomy and understand which subpopulations may benefit from the development of uterus sparing treatments.

For more information on this study, please contact

Whitney R. Robinson, PhD MSPH, Faculty Epidemiologist, Associate Professor, Department of Women’s Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, 200 Trent Drive, 203 Baker House, DUMC 3084, Durham, NC  27710

As part of our mission to advance evidence to inform policy and practice, AcademyHealth works with HSR, one of our official journals, to develop and publish plain language summaries of selected articles from each issue. Articles are selected by HSR Editor-in-Chief Austin Frakt, Ph.D., and the summaries are prepared by AcademyHealth staff in partnership with article authors.

 

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Kristin Rosengren

Vice President and Co-Director - AcademyHealth

Kristin Rosengren is Vice President, Strategic Communications, and co-director of the AcademyHealth Translatio... Read Bio

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