Patterns of black and white hysterectomy incidence among reproductive aged women

Abstract

Objective To investigate the intersection of race and economic context in treatment with hysterectomy among reproductive aged women with noncancerous gynecologic conditions. Data Sources We combined administrative billing records of inpatient and outpatient hysterectomy procedures (N = 28 301) occurring in North Carolina between 2011 and 2014 with census data to calculate county‐level hysterectomy rates. Study Design Spatial analysis techniques examined the distribution of black and white hysterectomy rates across counties, and county‐level black and white rate differences were compared across economic contexts. Data Collection/Extraction We restricted to those of premenopausal age identifying as non‐Hispanic black or white, undergoing hysterectomy for nonemergent causes (N = 28 301 procedures). Principal Findings County‐level hysterectomy rates were spatially patterned (Moran's I, P < .05) and similarly so for black and white women (LISA, P < .005). The black‐white difference in hysterectomy rates was the largest in the high economic tier counties (22/10 000 person‐years [PY], P < .05) and smallest in the mid and low economic tier counties (11/10 000 PY, P > .05 and 10/10 000 PY, P > .05, respectively). Conclusion Socioeconomic context is important to understand, particularly for black‐white disparities in hysterectomy. Efforts should be made to understand the causes of higher rates of hysterectomy among blacks than whites, especially in counties in the highest economic tier.

Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN)

“…Age at the time of the final [12,[40][41][42][43][44] and were all associated with an earlier age at FMP [34,45]. The occurrence of ovarian and uterine surgery prior to natural menopause is an impediment to determining the age at which FMP occurs; germane to this review, Black-White differences exist in the experience of these surgeries [46,47]. In the cross-sectional survey Black women were twice as likely as White women to have undergone hysterectomy/oophorectomy (30% vs 15%) [48], with Black women's elevated risk continuing throughout cohort follow-up [49].…”

Ethnoracial Differences in Premenopausal Hysterectomy

“…(Obstet Gynecol 2023;142:350-9) DOI: 10.1097/AOG.0000000000005225 R ates of hysterectomy before menopause remain disproportionately high among U.S. Black populations and in U.S. territories such as Puerto Rico. [1][2][3][4][5][6] Hysterectomy, an effective treatment for gynecologic conditions such as uterine leiomyomas (fibroids) and dysmenorrhea, 7 is also sterilizing. Overtreatment with sterilizing procedures remains a concern among marginalized communities, given state-sponsored eugenics programs in the 20 th century and the even longer history of gynecologic abuse of Black women.…”

“…We scored each patient on severity of their gynecologic symptoms on three domains: bulk, vaginal bleeding, and pelvic pain. [2][3][4][5][6] The construction and validation of the severity scores are described in detail elsewhere. 20 Our dichotomous outcomes were Yes/No to being in the top 25 th percentile of bulk, pelvic pain, or bleeding symptom severity scores.…”

The predictive impact of socioeconomic status on the pattern of reproductive health in 35-70-year-old women in Ardabil: A Persian cohort study

“…Furthermore, Vincent et al (2021) demonstrated in their qualitative study that socioeconomic status is still one of the most important factors affecting women's reproductive health in Nigeria, where the process of reducing maternal and child mortality is slow and factors such as age, education, material and human capital, economic-nancial inequality, and men's participation in reproductive health activities were deemed effective in the reproductive health of women [17]. Gartner et al (2021) discovered that the rate of hysterectomy was higher in areas with higher socioeconomic levels, the main cause of which is unknown, but may be due to the higher proportion of blacks in these cities than whites Stable employment and a steady income are two bene ts that can ease a woman's menopause by reducing nancial stress [21]. Poor socioeconomic status, in general, is related to poor health outcomes in women of all ages [22].…”