Epidemiology of Hysterectomy in the United States: Demographic and Reproductive Factors in a Nationally Representative Sample

Abstract

We describe the epidemiology of hysterectomy, overall as well as for specific indications. Data were obtained from the Epidemiologic Follow-up to the First National Health and Nutrition Examination Survey, a nationally representative cohort followed prospectively from the mid-1970s through 1992. Black and white women 25-49 years of age, interviewed during follow-up, were included in the analyses. The probability of undergoing a hysterectomy was estimated by demographic and reproductive factors. Hysterectomy as confirmed by hospital records was our main outcome measure. We found that women who had completed 9-11 years of education were more likely to have undergone a hysterectomy than were women with either more or less education. Women who had completed 9-11 years of education were also more likely to have had a hysterectomy because of menstrual problems. Three or more miscarriages, especially if caused by uterine prolapse, increased the probability of hysterectomy. Having had no live births decreased the probability of hysterectomy for menstrual disorders and uterine prolapse, but women who had their first child before age 20 were at increased risk of hysterectomy because of endometriosis. Hysterectomy appears to be associated with low education, high parity, and a history of multiple miscarriages. The influence of these factors varies depending on the primary indication for the hysterectomy.

Nationwide rates of conversion from laparoscopic or vaginal hysterectomy to open abdominal hysterectomy in Germany

“…A few limitations to the study need mention. First, although we used a hierarchical algorithm similar to those that have been repeatedly used in other studies to group indications of hysterectomies (22) (2) (36) (37), this approach does not reflect the entire complexity of diagnoses for women undergoing hysterectomies (38). Second, a more detailed stratification of hysterectomy rates for benign diseases of the uterus by single indications like uterine leiomyoma, prolaps etc.…”

Prävalenz von Hysterektomien bei Frauen im Alter von 18 bis 79 Jahren

“…Ein Zusammenhang zwischen Indikatoren des sozioökonomischen Status und der Gebärmutterentfernung findet sich auch in mehreren internationalen Studien [19,32,33,34]. Unter den Indikatoren werden zum Teil Bildung [19,32] oder die (eigene) berufliche Stellung der Frauen [33] besonders hervorgehoben.…”

“…frühere, weniger invasive Interventionen) sowie eine größere Bereitschaft von ärztlicher Seite, verschiedene therapeutische Optionen aufzuzeigen bzw. alternative Therapieverfahren zu erwägen, genannt [32,34]. Ein Vergleich der Ost-West-Unterschiede bei Hysterektomien mit anderen Daten zu regionalen Unterschieden [14,15] ist nicht möglich, weil diese viel kleinräumiger sind und keine Prä-valenzen abbilden.…”

Can Hysterectomy Be Considered a Risk Factor for Cardiovascular Disease?

“…Low socioeconomic status, measured either by education or income, has been demonstrated to be associated with hysterectomy in the United States among non-Hispanic women. 4,5 Women with higher parity and younger age at first child also appear to be more likely to have hysterectomies. 4 Howard and colleagues' study, however, is one of the few epidemiological studies to have examined the relationship between hysterectomy and risk factors specific to CVD.…”

“…A body of literature suggests that at least some variables associated with the use of hysterectomy are also factors that increase the risk for CVD morbidity and mortality. 4 Most of the known factors that are associated with hysterectomy, such as reproductive history and socioeconomic status, are easily ascertained. If, however, there are other factors that determine CVD risk measured by hysterectomy that are less easily ascertained, then this knowledge may be useful to the general practitioner as a quick and easy way to identify patients at risk.…”