Health Care Disparities in Hysterectomy for Gynecologic Cancers

Abstract

III.

Social determinants of access to minimally invasive hysterectomy: reevaluating the relationship between race and route of hysterectomy for benign disease

“…By generating multivariable models that adjusted for patient-level factors, we were able to expose the role of confounding on previously described associations between race and access to MIH. 4,[8][9][10][11] In the United States, we found that African American race, low income, and underinsurance are all associated with overweight and obesity. 13 Obesity limits the application of laparoscopic and robot-assisted surgery; obese women have greater odds of vaginal over other routes of hysterectomy.…”

“…Being in the highest income quartile (compared to the lowest) and having private insurance (compared to Medicaid) also Previous analyses have shown racial and socioeconomic disparities in laparoscopic hysterectomy overall but most have not evaluated the role of robotassisted hysterectomy specifically, as national databases rarely differentiate between laparoscopic surgeries performed with and without robot assistance. 4,[8][9][10][11] In our subgroup analyses, adjusting for confounding in multivariable analysis did eliminate many univariate associations between In contrast to trends in robot-assisted hysterectomy, the odds of undergoing vaginal hysterectomy over abdominal hysterectomy were higher among women in the lowest income quartile compared to those in the highest income quartile and among African Americans compared to whites. Individual practice patterns and patient characteristics at the 3 hospitals could explain the findings noted despite having controlled for hospital itself.…”

“…Large national databases often do not report BMI or uterine size such that previous analyses of nationwide disparities in mode of hysterectomy have not been able to account for their effect on surgical route. 3,4,[8][9][10][11] In our study population, disparities in access to MIH due to insurance and income status are less stark than in national analyses, given the ability to more comprehensively address confounding due to multiple factors. By using data from 3 hospitals within 1 urban hospital system in Philadelphia, our analysis among a relatively uniform population may have biased some socioeconomic associations towards the null.…”

“…[4][5][6][7] National investigations of disparities in MIH have found that younger age, white race, higher income, and private insurance independently predict laparoscopic over abdominal hysterectomy. [8][9][10][11] The primary aim of this study was to determine the association between race and the odds of MIH for the treatment of fibroids, adenomyosis, and abnormal bleeding. The secondary objective was to assess the relationship between indicators of socioeconomic status, ethnicity, and the odds of MIH for the above indications.…”

The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications

“…2 In the USA, women of color experience higher rates of severe maternal morbidity [3][4][5][6][7] and death during and after pregnancy. Although race/ ethnicity is known to be associated with disparate outcomes in nonobstetric hysterectomy care, 8,9 the relationship between race/ethnicity and peripartum hysterectomy 6,[10][11][12] or its related outcomes 10 is not well-explored. Recent publications focus on differences in outcomes after peripartum hysterectomy based on hospital characteristics, without examining disparities among minority groups, 13,14 or they have combined peripartum hysterectomy with other maternal morbidity outcomes.…”