Racial Disparities in Route of Hysterectomy for Benign Indications Within an Integrated Health Care System

Zaritsky, Eve; Ojo, Anthonia; Tucker, Lue-Yen; Raine‐Bennett, Tina

doi:10.1001/jamanetworkopen.2019.17004

Cited by 23 publications

(12 citation statements)

References 6 publications

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“…We also realize that racial bias exists in hysterectomy route in the United States [19][20][21][22] and evidenced based algorithms and guidelines are needed. Within our institution, we have previously demonstrated how quality improvement initiatives to improve training on MIH was associated with reduced racial disparities in route of MIH 17 .Schmitt et al proposed a decisionmaking algorithm to determine appropriate route of hysterectomy with the goal of optimizing healthcare costs. The execution of the algorithm demonstrated no difference in major complications between LH and VH, however, their study population had limited generalizability with mostly smaller uterine weights.…”

Section: Discussionmentioning

confidence: 99%

“…KPNC serves over 40% of the insured population in Northern California and over one million reproductive-aged women annually, a broad sample of the population of insured adults in Northern California and Kaiser Permanente membership is generally representative of the broader community, primarily differing from the general population by having lower percentages of adults at the low and high income extremes. 17 This study was approved by the KPNC Institutional Review Board with waiver of consent.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Variation in Vaginal Hysterectomy Rates in an Integrated Healthcare System

Zaritsky¹,

Tucker

Kandahari

et al. 2022

Journal of Minimally Invasive Gynecology

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Variation in Vaginal Hysterectomy Rates in an Integrated Healthcare System

Zaritsky¹,

Tucker

Kandahari

et al. 2022

Journal of Minimally Invasive Gynecology

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“…Fifteen studies with multivariable analyses reported on health care disparity risk markers associated with access to MIS hysterectomy from 2008 to 2020. 4,5,[17][18][19][20][21][22][23][24][25][26][27][28][29] Three controlled for uterine weight, 4,24,28 seven controlled for myoma, 5,[17][18][19][20][21]26,29 and one performed a sensitivity analysis including myomas. 23 The Unauthorized reproduction of this article is prohibited.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies (20 models) showed consistent, weak or strong, decreased associations between having a Black racial identity (vs having a White racial identity) and the likelihood of having access to MIS hysterectomy. 4,5,[17][18][19][20][21][22][23][24][26][27][28][29] Similarly, seven studies (nine Unauthorized reproduction of this article is prohibited.…”

Section: Resultsmentioning

confidence: 99%

Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications

Wieslander,

Grimes,

Balk

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications. DATA SOURCES: PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022. METHODS OF STUDY SELECTION: The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies. TABULATION, INTEGRATION, AND RESULTS: Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy. CONCLUSION: Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021234511.

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“…Barriers to adequate screening in racially, ethnically, and socioeconomically disadvantaged populations are commonly reported, and in those residing in rural environments with difficult access to health care 8 . Given that many of these barriers are overcome by the standardized screening and equal access to care in an MCO, 9,10 disparities by race were not further investigated for this cohort, but it is an area of future interest at a multicenter level, specifically in this age group population.…”

Section: Discussionmentioning

confidence: 99%

Opportunities Missed: Cervix Cancer Screening Failures in Women Aged 65 and Older

Ing

Scott

Lentz

2023

J Low Genit Tract Dis

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Objectives This study aimed to determine the screening history and associated outcomes of women diagnosed with cervical cancer after age 65. Methods All patients from 2012 to 2021 diagnosed with squamous, adenocarcinoma, neuroendocrine, or adenosquamous cervical cancer after age 65 in a single managed care organization (MCO) were included in this retrospective cohort study. Demographic, medical, screening, pathologic, follow-up, and treatment data were extracted. Statistical analysis was done using chi-square test and logistic regression. Cancer-specific survival was estimated using the Kaplan-Meier method. Results Of 2,175 patients screened, 209 met inclusion criteria. Only 26.3% of patients had appropriate cervical cancer screening and 41% of patients died of their disease. Managed care organization membership duration of more than 5 years positively correlated with proper cervical cancer screening (p < .001); however, 64% of the long-term members still did not meet criteria to end screening at age 65, with 42.6% of these patients having more than 25 physician visit opportunities to address screening. Increased physician visits correlated with earlier stage at diagnosis of cervical cancer (p = .012). Median cancer-specific survival was significantly better in properly screened patients at 68 vs 30 months, respectively (p = .03). Conclusions Most patients diagnosed with cervical cancer after age 65 did not have adequate previous screening, including those who were MCO members for more than 5 years. There were many missed opportunities for screening, despite multiple provider touchpoints. Our data suggest that adequate screening confers a survival benefit secondary to earlier stage at diagnosis. Further study in this age group is needed to redefine the criteria to end cervix cancer screening.

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Racial Disparities in Route of Hysterectomy for Benign Indications Within an Integrated Health Care System

Abstract: This cross-sectional study examines racial disparities in the route of hysterectomy for benign indications within an integrated health care system in the United States.

Cited by 23 publications

References 6 publications

Variation in Vaginal Hysterectomy Rates in an Integrated Healthcare System

Variation in Vaginal Hysterectomy Rates in an Integrated Healthcare System

Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications

Opportunities Missed: Cervix Cancer Screening Failures in Women Aged 65 and Older

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