DIFFERENT FACTORS ASSOCIATED WITH HYSTERECTOMY BASED ON ETHNICITY

A.A. Romero, M.G. Jamison, C.L. Amundsen and A.C. Weidner 

Duke University Medical Center, Durham, NC

OBJECTIVE:  To investigate the differences in factors relating to hysterectomy among four different ethnic groups.

MATERIALS AND METHODS:  Hospital discharge summary data from the Nationwide Inpatient Sample for four states, California, Texas, Florida and New York were analyzed for 85,733 hysterectomies for years 2000 and 2001. Hysterectomy rates by age group and race were estimated.  Principal diagnosis was classified as adnexal, cancer, endometriosis, fibroids, menstrual disorders, non-infectious, pelvic inflammatory disease, pregnancy, prolapse and other.  Proportion of women and mean age of hysterectomy were computed and tested for significant differences by ethnicity and primary diagnosis.  Logistic regression was used to measure the effect of race on the route of hysterectomy (abdominal or vaginal), rate of surgical complications and length of hospital stay more than 3 days after adjustment for age, diagnosis, surgery type and source of payment. 

RESULTS: Caucasian women (C) had 56,966 hysterectomies performed.  There were 10,972 performed in African-American women (AA), 12,427 in Hispanic women (H) and 2,653 in Asian women (A).  Maximum rate of hysterectomy was highest for AA women at 190 per 10,000 (40-44 years of age) with C, H and A women having rates of 120, 111, and 85 per 10,000 (45-49 years of age), respectively.  The most common principal diagnosis was fibroids 31% (C), 66% (AA) 38% (H) and 49% (A).  Mean age at hysterectomy for fibroids was 46 (C), 44 (AA), 44 (H), and 46 (A) years. Among C and H women the second most common principal diagnosis was prolapse 14% (mean age 55) and 15% (mean age 52), respectively.   Menstrual disorders were the second most common principal diagnosis among AA women (7%) with mean age at hysterectomy of 41 years.  Cancer was the second most common principal diagnosis among A women (12%) with mean age at hysterectomy of 54 years.  The relative risk of an abdominal versus vaginal approach was increased compared to Caucasian women in all ethnic groups  [OR = 2.2, 1.3, 1.8] AA, H and A women, respectively.  The relative risk of surgical complications was increased in AA and A women [OR = 1.3 and 1.1 respectively], while in H women it was decreased [OR = 0.82] as compared to Caucasian women.  Length of hospital stay >3 days for all ethnic groups was increased as compared to Caucasian women [OR = 2.1, 1.2, 1.3, respectively].

CONCLUSIONS: The four most common principal diagnoses among the ethnic groups were fibroids, prolapse, menstrual disorders and cancer.  Caucasian women were more likely than any other ethnic group to have a vaginal hysterectomy and decreased length of stay.  The risk of surgical complications and length of hospital stay may be related to the route of surgery.

Key Words:  hysterectomy, ethnicity

Disclosure – Nothing to disclose.