Original Article

Contemporary Geographic Variation and Sociodemographic Correlates of Hysterectomy Rates Among Reproductive-Age Women

Authors: Danielle R. Gartner, MS, Kemi M. Doll, MD, MSCR, Robert A. Hummer, PhD, MS, Whitney R. Robinson, PhD, MSPH

Abstract

Objective: For decades hysterectomy rates have famously demonstrated unexplained geographic variation. The aim of this study was to identify county-level correlates of hysterectomy rates among reproductive-age women.

Methods: Using county-level data from multiple sources, linked with claims-based surveillance data of every hysterectomy performed among women ages 20 to 44 in North Carolina from 2011 to 2013 (N = 7180), we explored social, economic, and healthcare factors associated with county-level rates.

Results: After accounting for spatial autocorrelation, county-level hysterectomy rates were negatively associated with county-level median household income, positively associated with the proportion married, and not associated with measures of healthcare capacity or access.

Conclusions: This analysis provides preliminary evidence that contemporary hysterectomy use in North Carolina occurs along socioeconomic lines.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. National Center for Health Statistics. Discharges with at least one procedure in nonfederal short-stay hospitals, by sex, age, and selected procedures: United States, selected years 1990 through 2009-2010. Table 90. http://www.cdc.gov/nchs/hus/contents2014.htm#090. Accessed July 30, 2018.
 
2. Edozien LC. Hysterectomy for benign conditions: patients and doctors will benefit from evidence based guidelines. BMJ 2005;330:1457-1458.
 
3. Corona LE, Swenson CW, Sheetz KH, et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol 2015;212:304.e1-304.e7.
 
4. Lawson EH, Gibbons MM, Ingraham AM, et al. Appropriateness criteria to assess variations in surgical procedure use in the United States. Arch Surg 2011;146:1433-1440.
 
5. Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science 1973;182:1102-1108.
 
6. Arndt M, Bradbury RC, Golec J. Indications for hysterectomy: variation within and across hospitals. Med Care Res Rev 1995;52:342-363.
 
7. Carlisle DM, Valdez RB, Shapiro MF, et al. Geographic variation in rates of selected surgical procedures within Los Angeles County. Health Serv Res 1995;30:27-42.
 
8. Haas S, Acker D, Donahue C, et al. Variation in hysterectomy rates across small geographic areas of Massachusetts. Am J Obstet Gynecol 1993;169:150-154.
 
9. McPherson K, Strong PM, Epstein A, et al. Regional variations in the use of common surgical procedures: Within and between England and Wales, Canada and the United States of America. Soc Sci Med A 1981;15(3 Part 1):273-288.
 
10. McPherson K, Wennberg JE, Hovind OB, et al. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med 1982;307:1310-1314.
 
11. Palmer JR, Rao RS, Adams-Campbell LL, et al. Correlates of hysterectomy among African-American women. Am J Epidemiol 1999;150:1309-1315.
 
12. Paul-Shaheen P, Clark JD, Williams D. Small area analysis: a review and analysis of the North American literature. J Health Polit Policy Law 1987;12:741-809.
 
13. Wennberg J, Gittelsohn A. Variations in medical care among small areas. Sci Am 1982;246:120-134.
 
14. Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol 2008;198:34.e1-34.e7.
 
15. Wu JM, Wechter ME, Geller EJ, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol 2007;110:1091-1095.
 
16. Geller SE, Burns LR, Brailer DJ. The impact of nonclinical factors on practice variations: the case of hysterectomies. Health Serv Res 1996;30:729-750.
 
17. Schoen J. Between choice and coercion: women and the politics of sterilization in North Carolina, 1929-1975. J Womens Hist 2001;13:132-156.
 
18. Price GN, Darity WA, Jr. The economics of race and eugenic sterilization in North Carolina: 1958-1968. Econ Hum Biol 2010;8:261-272.
 
19. Rosner B, Colditz GA. Age at menopause: imputing age at menopause for women with a hysterectomy with application to risk of postmenopausal breast cancer. Ann Epidemiol 2011;21:450-460.
 
20. National Cancer Institute, Surveillance, Epidemiology, and End Results Program. U.S. population data-1969-2016. www.seer.cancer.gov/popdata. Published December 2017. Accessed July 30, 2018.
 
21. US Census Bureau. American FactFinder. 2009-2013 American Community Survey. http://factfinder2.census.gov. Accessed January 3, 2016.
 
22. US Department of Health and Human Services, Health Resources and Services Administration. Area Health Resources Files, 2015. https://datawarehouse.hrsa.gov/topics/ahrf.aspx. Accessed July 30, 2018.
 
23. University of North Carolina, The Cecil G. Sheps Center for Health Services Research. North Carolina Health Professions Data System (HPDS). 2014. http://www.shepscenter.unc.edu/workforce_product/2014-north-carolina-health-professions-data-book/. Accessed November 13, 2016.
 
24. Anselin L, Bera AK, Florax R, et al. Simple diagnostic tests for spatial dependence. Reg Sci Urban Econ 1996;26:77-104.
 
25. Erekson EA, Weitzen S, Sung VW, et al. Socioeconomic indicators and hysterectomy status in the United States, 2004. J Reprod Med 2009;54:553-558.
 
26. Harlow BL, Barbieri RL. Influence of education on risk of hysterectomy before age 45 years. Am J Epidemiol 1999;150:843-847.
 
27. Kjerulff K, Langenberg P, Guzinski G. The socioeconomic correlates of hysterectomies in the United States. Am J Public Health 1993;83:106-108.
 
28. Richter DL, Kenzig MJ, Greaney ML, et al. Physician-patient interaction and hysterectomy decision making: the ENDOW study. Ethnicity, Needs, and Decisions of Women. Am J Health Behav 2002;26:431-441.
 
29. Christian CK, Niland J, Edge SB, et al. A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network. Ann Surg 2006;243:241-249.
 
30. Quon BS, Psoter K, Mayer-Hamblett N, et al. Disparities in access to lung transplantation for patients with cystic fibrosis by socioeconomic status. Am J Respir Crit Care Med 2012;186:1008-1013.
 
31. Schwartz A, Schiano T, Kim-Schluger L, et al. Geographic disparity: the dilemma of lower socioeconomic status, multiple listing, and death on the liver transplant waiting list. Clin Transplant 2014;28:1075-1079.
 
32. Daniels K, Daugherty J, Jones J, Mosher W. Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. http://www.cdc.gov/nchs/data/nhsr/nhsr086.pdf. Published November 10, 2015. Accessed November 8, 2016.
 
33. Jamison PM, Noone AM, Ries LA, et al. Trends in endometrial cancer incidence by race and histology with a correction for the prevalence of hysterectomy, SEER 1992 to 2008. Cancer Epidemiol Biomarkers Prev 2013;22:233-241.
 
34. Kwan M-P. The uncertain geographic context problem. Ann Assoc Am Geographers 2012;102:958-968.
 
35. Cummins S, Curtis S, Diez-Roux AV, et al. Understanding and representing ‘’ in health research: a relational approach. Soc Sci Med 2007;65:1825-1838.
 
36. Tomoaia-Cotisel A, Scammon DL, Waitzman NJ, et al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med 2013;11(suppl 1):S115-S123.