Trends and predictors of hysterectomy prevalence among women in the United States

Harvey, Summer V; Pfeiffer, Ruth M.; Landy, Rebecca; Wentzensen, Nicolas; Clarke, Megan A.

doi:10.1016/j.ajog.2022.06.028

Cited by 19 publications

(11 citation statements)

References 40 publications

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“…Acknowledging that missing data could underestimate symptom severity, we focused on the quartile of greatest symptom severity, which we expect to be a highly specific measure of severe symptoms. 20 In one large health care system in the U.S. South, a region with high rates of premenopausal hysterectomy, 4,5,14,40 we found little evidence of overtreatment of non-Hispanic Black and Hispanic patients given their levels of symptom burden. However, there was evidence of a disproportionately high burden of severe symptoms among Black and Hispanic patients without a corresponding level of previous uterine-sparing treatments attempted.…”

Section: Discussionmentioning

confidence: 79%

“…[8][9][10] However, in the past 20 years, few quantitative studies have investigated potentially racialized overtreatment with hysterectomy. [11][12][13][14] Research has focused on clinical outcomes or surgical route rather than treatment decision making. [15][16][17] One barrier to investigating overtreatment with hysterectomy is the difficulty of defining "overtreatment."…”

Section: Discussionmentioning

confidence: 99%

“…8–10 However, in the past 20 years, few quantitative studies have investigated potentially racialized overtreatment with hysterectomy. 11–14 Research has focused on clinical outcomes or surgical route rather than treatment decision making. 15–17…”

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confidence: 99%

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Ethnoracial Differences in Premenopausal Hysterectomy

Robinson

Mathias

Wood

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate whether greater symptom severity can explain higher hysterectomy rates among premenopausal non-Hispanic Black compared with White patients in the U.S. South rather than potential overtreatment of Black patients. METHODS: Using electronic health record data from 1,703 patients who underwent hysterectomy in a large health care system in the U.S. South between 2014 and 2017, we assessed symptom severity to account for differences in hysterectomy rates for noncancerous conditions among premenopausal non-Hispanic Black, non-Hispanic White, and Hispanic patients. We used Poisson generalized linear mixed modeling to estimate symptom severity (greater than the 75th percentile on composite symptom severity scores of bleeding, bulk, or pelvic pain) as a function of race–ethnicity. We calculated prevalence ratios (PRs). We controlled for factors both contra-indicating and contributing to hysterectomy. RESULTS: The overall median age of non-Hispanic White (n=1,050), non-Hispanic Black (n=565), and Hispanic (n=158) patients was 40 years. The White and Black patients were mostly insured (insured greater than 95%), whereas the Hispanic patients were often uninsured (insured 58.9%). White and Black patients were mostly treated outside academic medical centers (nonmedical center: 63.7% and 58.4%, respectively); the opposite was true for Hispanic patients (nonmedical center: 34.2%). Black patients had higher bleeding severity scores compared with Hispanic and White patients (median 8, 7, and 4 respectively) and higher bulk scores (median 3, 1, and 0, respectively), but pain scores differed (median 3, 5, and 4, respectively). Black and Hispanic patients were disproportionately likely to have severe symptoms documented on two or more symptoms (referent: not severe on any symptoms) (adjusted PR [Black vs White] 3.02, 95% CI 2.29–3.99; adjusted PR [Hispanic vs White] 2.61, 95% CI 1.78–3.83). Although Black and Hispanic patients were more likely to experience severe symptoms, we found no racial and ethnic differences in the number of alternative treatments attempted before hysterectomy. CONCLUSION: We did not find evidence of overtreatment of Black patients. Our findings suggest potential undertreatment of Black and Hispanic patients with uterine-sparing alternatives earlier in their disease progression.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Ethnoracial Differences in Premenopausal Hysterectomy

Robinson

Mathias

Wood

et al. 2023

Obstetrics &Amp; Gynecology

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“…A majority of women who undergo surgical oophorectomy also have their uteruses removed. Indeed, hysterectomy is now believed to be the most common form of non-obstetrical surgery among US women with rates of up to 21.1%, leading to a risk of premature menopause in many of these treated women [ 10 , 11 ]. Cumulating evidence suggests that hysterectomy with or without oophorectomy has adverse health consequences, such as increased risk of cardiovascular disease, hyperlipidemia, large artery stiffening, and stroke [ 12 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Association of hysterectomy with nonalcoholic fatty liver disease among US women

Jin,

Li,

Fang

et al. 2024

Lipids Health Dis

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Background A postmenopausal rise in the rates of nonalcoholic fatty liver disease (NAFLD) has been reported in women. This study thus sought to further probe the association of hysterectomy with NAFLD. Methods The data utilized in this investigation were attained from the 2017-March 2020 cycle of the National Health and Nutrition Examination Survey (NHANES), reflecting a strategic utilization of comprehensive health and nutrition information in the US population, to conduct a cross-sectional examination of the relationship between self-reported hysterectomy and NAFLD. Subjects included in this study were women aged 20 years or older. The multivariable logistic regression methodologies were utilized to determine the pertinent odds ratios (ORs) and their associated 95% confidence intervals (CIs). Results Of the 2,868 subjects enrolled in this study (mean age: 51.3 years, 95%CI: 50.0-52.6 years), 22.1% (95%CI: 19.7–24.7%) reported having undergone a hysterectomy, while 31.1% (95%CI: 28.1–34.1%) exhibited elastographic evidence of NAFLD, and 3.8% (95%CI: 2.6–5.6%) exhibited clinically significant fibrosis (CSF). Relative to women with no history of hysterectomy, those that had undergone hysterectomy exhibited a higher odd of NAFLD (OR:1.66, 95%CI: 1.24–2.21) in a multivariable model fully adjusted for age, ethnicity, body mass index, female hormone use, oophorectomy, diabetes, hyperlipidemia, and smoking status. Subgroup analyses revealed a stronger association among women who were not obese (OR:2.23, 95%CI:1.61–3.11), women who were not affected by diabetes (OR:1.76, 95%CI: 1.25–2.46), and without hyperlipidemia (OR: 1.87, 95%CI: 1.10–3.16). No significant association of hysterectomy with NAFLD encompassing CSF was identified. Conclusions The results of the present nationally representative analysis suggested an association between hysterectomy and increased NAFLD prevalence among US women. Knowledge of this relationship may better aid clinical efforts to screen for and manage NAFLD.

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“…Around 65,000 hysterectomies are performed in France each year [1]. Their incidence is much higher in other countries such as the United States and Germany [2,3,4].…”

Section: Introductionmentioning

confidence: 99%

Impact on sexual functioning: total versus subtotal hysterectomy

Nadia¹

2023

Int J of Adv Stud in Sexology

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Objective To evaluate and compare postoperative sexual functioning following total (TH) versus subtotal hysterectomy (STH). Design A longitudinal, prospective and comparative study in women undergoing hysterectomy for benign diseases in Ibn El Jazzar Hospital, Kairouan in Tunisia. Sample Sixty women undergoing hysterectomy for benign disease. Main outcome measures Sexual functioning evaluation using the Arizona Sexual Experiences Scale (ASEX) and Female Sexual Function Index (FSFI) before the operation and after 6 months. Results Following surgery, significant improvement in sexual functioning according to both scales. In fact, the mean total score of the ASEX scale went from 25.14 to 21.15 and from 11,99 to 19,31 for the FSFI. The average time to resume sexuality postoperatively was 50 days. No significant difference was found in these results between total and subtotal hysterectomy. Conclusion Hysterectomy, whether total or subtotal, has a positive impact on the overall sexual satisfaction of the patients especially in those with an impaired sexuality before surgery. There were no statistically significant differences in sexual function between the two groups TH versus STH. Therefore, cervix preservation for the purpose of improving overall sexual satisfaction cannot be recommended. Keywords Hysterectomy . Sexual dysfunction . Supracervical hysterectomy . Cervix

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Trends and predictors of hysterectomy prevalence among women in the United States

Cited by 19 publications

References 40 publications

Ethnoracial Differences in Premenopausal Hysterectomy

Ethnoracial Differences in Premenopausal Hysterectomy

Association of hysterectomy with nonalcoholic fatty liver disease among US women

Impact on sexual functioning: total versus subtotal hysterectomy

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