Cross-sectionally derived hysterectomy prevalence for correcting uterine and ovarian cancer incidence rates and probabilities

PURPOSE: This paper presents a cross-sectional method for deriving age-specific hysterectomy prevalence. The influence of hysterectomy prevalence on uterine and ovarian cancer incidence rates and probabilities is illustrated.METHODS: Hysterectomy prevalence estimates are derived from cross-sectional data using a life table method. Analysis is based on hysterectomy data from the Utah Hospital Discharge Data Base and cancer cases recorded by the Utah Cancer Registry, 1995-1997.RESULTS: Correction for hysterectomy prevalence increases cancer incidence rates, more so at older ages, such that by ages 85 and older the increase is 92% for uterine cancers of the cervix and corpus, and 17% for ovarian cancer. Over the life span, correction for hysterectomy prevalence increases the estimated number per 100,000 developing these diseases by 195 (from 603 to 798) for uterine cervical cancer, 1,553 (from 2,580 to 4,133) for corpus uterine cancer, and 911 (1,674 to 2,585) for ovarian cancer.CONCLUSIONS: The utility of the cross-sectional method for deriving hysterectomy prevalence is that it does not require several years of data to obtain reasonable estimates. Correction for hysterectomy prevalence has a large effect on the cancer rates and probabilities, providing a more accurate representation of the risk and burden of these cancers.     

Risk estimates of hysterectomy and selected conditions commonly treated with hysterectomy

PURPOSE: This study presents corrected rates and probability (risk) estimates of experiencing a hysterectomy and of selected conditions commonly treated with hysterectomy. METHODS: Analyses are based on hysterectomy prevalence data from the Behavior Risk Factor Surveillance Survey (calendar years 2000-2006), hysterectomy incidence data from the National Hospital Discharge Survey (2001-2005), and population estimates from the U.S. Census Bureau (2001-2005). The correction involved removing those women without a uterus from the denominator in the rate calculation. RESULTS: Corrected hysterectomy incidence rates per 1000 women were greater than the uncorrected rates for women ages 18-44 years (6.0 vs. 5.0), 45-64 years (10.4 vs. 7.1), and 65 years and older (4.9 vs. 2.6). Correcting the rates had a comparatively larger impact in the South. Incidence rates of selected conditions associated with the female reproductive system were greater after correction for hysterectomy prevalence. For example, corrected compared with uncorrected rates of uterine fibroids per 1000 women were 2.9 vs. 2.7 for ages 18-44 and 5.0 vs. 3.4 for ages 45-64. The uncorrected and corrected 10-year risk of being diagnosed with uterine fibroids among women aged 50 who have not previously had fibroids is 3.87 (1 in 26) and 4.54 (1 in 22), respectively. CONCLUSIONS: The correction method employed produces greater incidence and age-conditional-risk estimates of hysterectomy and of conditions commonly treated with hysterectomy. Corrected rates and age-conditional risk estimates may allow women with intact uteri to better assess their probability of undergoing a hysterectomy and certain other conditions of the reproductive system.     

Correlates of hysterectomy among African-American women

Hysterectomy is the second most common surgery performed on US women. Baseline data from a large study of African-American women were used to examine correlates of premenopausal hysterectomy. Analyses were conducted on participants aged 30-49 years; 5,163 had had a hysterectomy and 29,787 were still menstruating. Multiple logistic regression was used to compute prevalence odds ratios for the association of hysterectomy with various factors. Hysterectomy was associated with region of residence: Odds ratios for living in the South, Midwest, and West relative to the Northeast were 2.63 (95% confidence interval (CI): 2.38, 2.91), 2.02 (95% CI: 1.81, 2.25), and 1.89 (95% CI: 1.68, 2.12), respectively. Hysterectomy was inversely associated with years of education and age at first birth: Odds ratios were 1.96 (95% CI: 1.74, 2.21) for < or =12 years of education relative to >16 years and 4.33 (95% CI: 3.60, 5.22) for first birth before age 20 relative to age 30 or older. Differences in the prevalence of major indications for hysterectomy did not explain the associations. This study indicates that the correlates of hysterectomy among African-American women are similar to those for White US women. The associations with geographic region and educational attainment suggest that there may be modifiable factors which could lead to reduced hysterectomy rates.     

Factors associated with hysterectomy among older women from Latin America and the Caribbean

ABSTRACT

To identify factors associated with hysterectomy, data collected from 1999–2000 were assessed from seven cities of the Health, Well-Being and Aging in Latin America and the Caribbean Study on 6,549 women, aged 60 years and older. Hysterectomy prevalence ranged from 12.8% in Buenos Aires (Argentina) to 30.4% in Bridgetown (Barbados). The median age for having had a hysterectomy ranged from 45 to 50 years across the cities and was 47 years in the pooled sample. Ethnic differences in hysterectomy rates were partially explained by differences across cities. Factors significantly associated with lower odds for hysterectomy included older age, household crowding conditions, and having public/military or no health insurance, compared to having private health insurance. Women who had three or more children were less likely to have had a hysterectomy, a finding that differs from most previous studies. Socioeconomic position related to rates of hysterectomy in late life rather than hysterectomies earlier in life. However, the nature of these differences varied across birth cohorts. The findings suggested that adverse socioeconomic factors were most likely related to hysterectomy risk by affecting access to health care, whereas parity was most likely acting through an effect on decision-making processes.     

Temporal and regional variation in hysterectomy rates in the United States, 1970--1975.

Regional hysterectomy rates in the United States for 1970 and 1975 have been estimated from a one per cent sample of hospital discharges. All rates have been corrected for the number of women truly at risk, that is, with uteri intact, and regional and age-specific estimates of uterine prevalence in 1975 are provided. The rates rose by one-third in 1970-1975, with the increase taking place nearly uniformly over all ages below 65 years. Rates were greatest for 40--44-year-old women, but in 1970 there was a secondary peak for women between the ages of 65 and 69 years. That peak disappeared with rising rates for younger women in 1975. For women under age 35 years, the hysterectomy rate in the South was three times higher than that in the Northeast.     

Hysterectomy fractions in New South Wales, 1971–2006

Hysterectomy fractions by age group for particular periods are of interest for: estimating proper population denominators for calculation of disease and procedure rates affecting the cervix and uterus; estimating the target population for Pap test programs, and response rates; and as a way of displaying the cumulative consequences of hysterectomies in a population. Hysterectomy fractions for populations can be determined by direct inquiry via a representative sample survey, or, as in this study, from prior hysterectomy rates of the cohorts of women which compose each age bracket. Hysterectomy data 1979–93 were obtained from the hospital In-patients Statistics Collection (ISC) which covers both public and private hospitals in NSW. Annual population denominators of women were obtained from Census data. Data were modelled by Poisson regression, using five-year age group (15-≥85 years), annual period, and five-year birth cohort (APC model). Forward- and back-projection of the period effects were undertaken. The resultant NSW hysterectomy fractions by age and period are consistent with fractions obtained from modelled hysterectomy rates for Western Australia (1980–84), and fractions from national representative sample surveys (1989/90 and 1995) for younger women, but not for women aged >70 years in 1995, which revealed higher hysterectomy fractions than modelled hysterectomy data would suggest.
Hysterectomy fractions for NSW women by five-year age group for quinquennia centred on 1971 to 2006 are provided.     

Epidemiological correlates of hysterectomy, a hospital based study 1995 -1996 at Ain Shams Maternity Hospital

Hysterectomy is one of the most frequently performed major surgical procedures for women. Study the epidemiological correlates of hysterectomy and identify the different indications that lead to the operation as well as determine its frequency. SUBJECTS AND METHODS: A retrospective study was performed which included 231 women who had undergone hysterectomy during 1995-1996. Data about the various characteristics of women, indication, and type of surgery were retrieved from the medical fles of women in Ain Shams Maternity Hospital. RESULTS: The hospital incidence rate of hysterectomy during 1995-1996 was 9.8/1000 admission, while it rose to 13.8/1000 in the year 2000 (recent data from hospital statistics unit) Epidemiological data showed that the mean age of women was 45.4+/-8.9, the highest frequency of hysterectomy was in the age group 45-54 years (41.2%). Hysterectomy in those aged less than 35 years was 7.3%. Previous abortion accounted for 48.5% early age at menarche (< or =12) was 13%, multiparity (> or =5) was 54.4%. Among women aged less than 35 years, uterine leiomyoma was the commonest indication (29.4%), while dysfunctional uterine bleeding was the commonest indication among those aged 35-<45, and 45-<55 and accounted for 40.6% and 60% respectively. Those aged > or =55 years, uterine prolapse was the commonest indication (53.6%). Malignant neoplasm covered less than 5% of all hysterectomies. Among nullipara, uterine leiomyoma was the most frequent indication (66.7%), while among parous women, dysfunctional uterine bleeding was the most frequent (56%). The most common obstetric indication leading to hysterectomy was uncontrolled postpartum hemorrhage and ruptured uterus (57.2%) of all obstetric causes. The abdominal route was the commonest approach for hysterectomy (54.1%), followed by the vaginal (35.9%). CONCLUSION AND RECOMMENDATIONS: Hysterectomy rate in Ain Shams Maternity hospital showed a significant increase by the year 2000 than during the period of the study. Further studies are needed to identify the reasons for such increase and to reduce unnecessary operations. The present study draws the attention of the importance of prenatal care for early detection of high risk women, and prevent complications of bleeding specially in women under 35 years who may not have completed their families and who may prefer other alternatives to surgery.     

Regional pattern of hysterectomy among women in India: Evidence from a recent large scale survey

ABSTRACT

Hysterectomy is one of the major public health issues today. In India, women’s attitudes toward menstruation may be a significant driver in seeking hysterectomy. Therefore, we attempted to study the prevalence, associated factors and reasons for hysterectomy among 540,671 ever-married women aged 15–49 years, using data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. Univariate, bivariate and multivariate analyses were conducted. These analyses revealed that the prevalence of hysterectomy was 4.1%. The prevalence was highest in the southern region and lowest in the north-eastern regions of India. Results of multivariate models indicated that high parity (odds ratio [OR] 2.84; 95% confidence interval [CI] 2.52–3.19), high body mass index (OR-1.43; 95% CI 1.35–1.51), older age, early age at first cohabitation, and illiteracy were positively associated with hysterectomy. Excessive menstrual bleeding was the leading reason for hysterectomy in this sample. Hysterectomy has exhibited an upward trend over the years. This may exert adverse effects on the physical, socio-psychological and reproductive health of women. Therefore, it is essential to promote high-quality prevention and treatment choices for women, rather than permanent but potentially inappropriate solutions such as hysterectomy.     

Hysterectomy and socioeconomic position in Rome,Italy

STUDY OBJECTIVE: There exists conflicting evidence regarding the higher risk of hysterectomy among women of a lower educational and economic level. This study aims to assess whether in Italy socioeconomic level is related to hysterectomy undertaken for different medical reasons. DESIGN: An area based index was used to assign socieconomic status (SES; four levels defined) to 3141 women (aged 35 years or older) who underwent a hysterectomy in 1997 and were residing in Rome. Data were taken from hospital discharge records. Direct age standardised hospitalisation rates by SES level were calculated for overall hysterectomies and for those performed for either malignant or non-malignant causes. Statistical differences were detected using the ratios of standardised rates and the test for linear trend. MAIN RESULTS: The hysterectomy rate was 36.7 per 10 000 women aged 35 years or more. Hysterectomy for uterine leiomyoma accounted for 41% of all operations and was more frequent among women aged 35-49 years than for those aged 50 years or more (crude rates: 28.6 and 7.7 per 10 000, respectively). The risk of hysterectomy was 35% higher for the lowest SES group, compared with the highest group. No association was found between SES and hysterectomy rates for malignant causes, although less affluent women in age group 35-49 years had 87% higher risk of hysterectomy compared with most affluent women. The inverse association between SES and hysterectomy rates attributable to non-malignant causes was statistically significant for women aged 35-49 years but not for those aged 50 years or more. CONCLUSIONS: The inverse relation between hysterectomy and SES is largely attributable to benign disorders of the uterus, namely leiomyoma and prolapse. More affluent women may have a greater uptake of less invasive techniques for removing uterine leiomyoma compared with less affluent women, who are more likely to undergo unnecessary hysterectomies irrespective of their reproductive age.     

子宫切除对女性术后生活影响的临床分析

目的:探讨子宫切除术及不同术式对女性术后生活的影响。方法:选取次全子宫切除84例及全子宫切除43例作为研究组,40例妇科门诊检查无异常的女性作为对照组。通过查阅住院病历及发放调查问卷来比较子宫切除患者术前、术后的卵巢功能及性生活情况。结果:子宫切除组与对照组同年龄段患者卵巢功能指标比较无显著差别;各组内44～45岁与≤43岁比较有显著差别。两种术式性生活评分无显著差别,52.0%患者术后无改变,20.4%有改善。两种术式的焦虑评分术前、术后比较有明显差别。结论:子宫切除对女性卵巢功能及性生活无明显影响,患者术后生活质量不同程度改善。心理因素对机体的恢复有一定作用。     

Hysterectomy-corrected incidence rates of cervical and uterine cancers in Massachusetts, 1995 to 2010

PurposeThe aim was to provide ethnicity-specific incidence trends of cervical and uterine cancers uncorrected and corrected for the prevalence of hysterectomy in Massachusetts.MethodsWe used incidence data of invasive cervical (International Classification of Diseases for Oncology, Third Edition: C53) and uterine cancer (International Classification of Diseases for Oncology, Third Edition: C54-C55) diagnosed from 1995 to 2010 from the Massachusetts Cancer Registry. Data from the Behavioral Risk Factor Surveillance Survey for Massachusetts were used to model the ethnicity-specific prevalence of hysterectomy. We standardized rates by the US 2000 population standard for the periods 1995 to 1998, 1999 to 2002, 2003 to 2006, and 2007 to 2010.ResultsDepending on the period, corrected cervical cancer rates increased by 1.2 to 2.8, 5.6 to 8.3, and 3.2 to 8.2 per 100,000 person-years, and uterine cancer rates increased by 14.3 to 16.7, 14.8 to 29.3, and 6.7 to 15.4 per 100,000 person-years among white non-Hispanic women, black non-Hispanic women, and Hispanic women, respectively. Corrected estimated annual percentage changes increased for uterine cancer among black non-Hispanic women aged 60 years and older. Ethnic disparities between white non-Hispanic women and the other groups became smaller for uterine cancer and larger for cervical cancer after correction.DiscussionCorrections of cervical and uterine cancer rates for hysterectomy prevalence are important as ethnic disparities, age patterns and time trends of cervical and uterine cancer incidence rates change.     

Prevalence of prior hysterectomy in the Seattle-Tacoma area

Hysterectomy is the most common major surgical procedure performed in the United States. The frequency of hysterectomy among women in the general population is of interest because it affects the population at risk for uterine diseases and because the procedure itself carries significant personal and socioeconomic consequences. We studied factors related to the occurrence of hysterectomy by interviewing a representative sample of women ages 35-74 (n= 1087) in two urban Washington counties during 1976-1977.

One-third of the women studied had had a hysterectomy. Later birth cohorts were at higher risk. The ageadjusted prevalence of prior hysterectomy was negatively associated with education and age at first childbirth; it was positively associated with parity, history of irregular menses, and history of a variety of other health conditions. Contrary to expectation, income was negatively associated with hysterectomy rates in one county and showed no association in the other. Part of the income effect was due to confounding by age at first childbirth, which was a surprisingly strong predictive factor.

We conclude that: 1) despite economic predictions based on the discretionary nature of the procedure, hysterectomies are not necessarily more common among high-income women; 2) age at first childbirth may be a more important risk factor for uterine disease than previously thought; and 3) estimates of hysterectomy frequency based on clinic populations may be misleading. (Am J Public Health 70:40-47, 1980.)

     

Effects of variations in hysterectomy status on population coverage by cervical screening

OBJECTIVES: To investigate geographic differences in hysterectomy rates and effects on estimated screening coverage in South Australia. METHODS: Hysterectomy data from South Australian hospitals for 1992-2000 were used to calculate age-specific hysterectomy rates for 20-69 year old women by residential subregion and postcode. Regional variations in rates were used to estimate variations in proportions of women with an intact uterus. Effects on estimates of screening coverage were investigated. RESULTS: About 66% of South Australian women were estimated to have an intact uterus at 70 years of age, based on hysterectomy rates for 1992-2000. The proportion was smaller in lower than upper socio-economic areas, and in country areas than the State capital (Adelaide). Estimates varied from 49% to 73% across 20 subregions. About 67% of 20-69 year olds with an intact uterus were estimated to have been screened in the 24-month period from 2000 to 2001. Similar estimates applied to Adelaide and country areas, irrespective of whether adjustments were made for differences in hysterectomy rates. A lower screening coverage applied to lower than upper socio-economic areas of Adelaide, irrespective of whether these adjustments were made. While adjusting for variations in hysterectomy rates generally had little effect on estimated screening coverage, there were notable exceptions. For example, in one subregion, coverage increased among 50-69 year olds from 53% to 66%. CONCLUSIONS: Adjustments for variations in hysterectomy rates can affect estimated screening coverage in some localities. Such adjustments should be undertaken to better define areas of under-screening for targeting in screening promotion.     

Visual disturbances in a population-based survey of 6962 subjects: the German National Health Examination Survey 1998

BACKGROUND: Available prevalence estimates of visual disturbances (excluding blindness) in Germany are based on data from highly selective populations. This report describes the prevalence of visual disturbances and potential determinants based on the German National Health Examination Survey from 1998. METHODS: A population-based cross-sectional study of the non-institutionalized population in unified Germany. People aged 18-79 years were eligible and were contacted by a multi-mode approach. The response proportion was 61%, resulting in a sample of 7124 subjects who participated in the study. Visual disturbances were assessed by a self-administered questionnaire. RESULTS: Prevalance rates are higher among women in unified as well as in East- and West Germany. The higher overall prevalence rates among women is mostly driven by higher prevalance rates at ages 18-49 years, especially for shortsightedness. The prevalence rates are higher in West Germany than East Germany. Visual disturbances are more prevalent among the middle and upper social class than the lower social class. Above the age group 40-44, the prevalence of visual disturbances considerably increases, to approximately 100% in the age group 55 years or older for both sexes and in both parts of Germany. CONCLUSIONS: Nearly 100% of German adults aged 50-79 years have some degree of visual disturbance that requires refractive correction. Prevalence rates of visual disturbances are higher among people from West Germany, people of higher social status and among women. Uncorrected visual disturbances are most prevalent in the age group 18-34 years and more often among males and subjects of lower social status.     

Years of life lived with and without dementia in Australia, 2004–2006: a population health measure

Objective: To estimate the fraction of remaining life lived with and without dementia among Australian males and females at later life. Method: Analysis was performed by applying the life table technique that integrates mortality and morbidity statistics to derive a single population health indicator. Observed prevalence rates were used to calculate life expectancy with dementia. Results: At the age of 65 years, males are expected to live an additional 18 years, of which 6% would be lived with dementia. Females surviving to 65 years, are likely to live a further 22 years, 9% of which is expected to be lived with dementia. At the age of 85 years, males live a further six years; one‐sixth of this life spent with dementia. Females surviving to this age would live an additional seven years, with one‐fourth of that life with dementia. The portion of life lived with dementia out of total remaining years of life increases with age at the rate of 20 to 30% every five years beyond the age of 65. Conclusion. The extension of life expectancy is associated with increased duration of life lived with dementia. As females live longer than males, they experience a greater impact of dementia.     

Tubal sterilization in Manitoba

The author used data from the universal health insurance plan in Manitoba to determine the corrected incidence and cumulative prevalence of surgical sterilization. In 1982, by the age of 45, 61% of Manitoba women had undergone either a hysterectomy or a tubal ligation. Rates for Manitoba were higher than those reported for the US. This is likely due to underreporting in the US of tubal ligations done as day surgery and with other more major procedures. Tubal sterilizations were most likely performed in Manitoba by gynecologists in urban, nonteaching hospitals. Interval tubal ligation was the most frequently performed procedure (45% vs 34% for postpartum tubal ligations). The number of surgeons performing sterilizations fell from 380 in 1972 to 230 in 1982, due to a decline in general practitioners and general surgeons offering the procedure. Across small areas in the province, regions with high tubal ligation rates also had high hysterectomy rates suggesting that the 2 procedures have not been used as substitutes for one another. (author's)     

Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey

OBJECTIVES: We investigated hysterectomy prevalence among Hispanic women. METHODS: We obtained data from 4684 Hispanic women and 20 604 non-Hispanic White women from the 1998-1999 National Health Interview Survey. We calculated nationally representative odds ratios of previous hysterectomy, controlling for confounders. RESULTS: Compared with non-Hispanic White women, the odds ratio for hysterectomy was 0.36 (95% confidence interval [CI] = 0.30, 0.44) for Hispanic women with no high school diploma, 0.57 (95% CI = 0.44, 0.74) for high school graduates, and 0.67 (95% CI = 0.42, 0.87) for college attenders. Country of origin had little influence on hysterectomy prevalence. Hysterectomy was positively associated with acculturation. CONCLUSIONS: Hispanic women undergo fewer hysterectomies than do non-Hispanic White women. The reasons for this, as well as information on ethnicity-specific appropriateness of hysterectomy, should be explored.     

The new old epidemic of coronary heart disease

OBJECTIVES: This study quantified the consequences for prevalence of increased survival of coronary heart disease (CHD) in the Netherlands from 1980 to 1993. METHODS: A multistage life table fitted observed mortality and registration rates from the nationwide hospital register. The outcome was prevalence by age, sex, period, and disease state. RESULTS: The prevalence of CHD from 1980 to 1993 was 4.4% (men, aged 25 to 84 years) and 1.4% (women, aged 25 to 84 years). Between 1980-1983 and 1990-1993, the incidence changed little, but age-adjusted prevalence increased by 19% (men) and 59% (women). CONCLUSIONS: Sharply decreasing mortality but near-constant attack rates of CHD caused distinct increases in prevalence, particularly among the elderly.     

Ethnic differences in past hysterectomy for benign conditions.

BACKGROUND: Hysterectomy for a benign condition is common, particularly in the underserved. The objective was to determine if ethnic differences could be explained by known risk factors. METHODS: A phone survey was conducted at random on 15,160 women, ages 40-55, from seven US cities. Subjects were 49.9% Caucasian, 28.1% African American, 12.3% Hispanic, and 9.8% Asian American. RESULTS: Ethnicity was associated with past hysterectomy (odds ratio [OR]: Caucasian = 1.0, African American = 1.66; confidence interval [CI] = 1.46-1.88, Hispanic = 1.64, CI = 1.29-2.07; Asian American = 0.44, CI = 0.34-0.56), after adjustment for age, education, fibroids, body mass index, marital status, smoking, geographic site, and country of education. CONCLUSION: Because the highest rates occurred in the disadvantaged African American and Hispanic subgroups, and could not be explained by known risk factors, disparity in the form of overuse in these disadvantaged groups may exist.