Prevalence corrected hysterectomy rates and probabilities in Utah

PURPOSE: A life table method is used for correcting hysterectomy rates and probabilities for prevalent cases of hysterectomies in the population. Both corrected and conventional hysterectomy rates and probabilities are reported. METHODS: Hysterectomy prevalence estimates are derived from cross-sectional hysterectomy and mortality using a life table method. Analysis is based on the Utah Hospital Discharge Data Base and State death certificates. RESULTS: Hysterectomy rates are strongly influenced by age, reaching 150 per 10,000 for ages 45-49 years. The corresponding corrected hysterectomy rate is 196. Differences between the corrected and uncorrected cause-specific hysterectomy rates tend to be most pronounced at their peaks, particularly later in life where the prevalence of hysterectomy is greatest. Probability of hysterectomy approaches slightly above 35% over the life span, whereas the corrected hysterectomy probability approaches 43%. Probability of hysterectomy in the next 10 years is 12.9% for women aged 35 years and 11.7% for women aged 45 years. Corresponding corrected hysterectomy probabilities are 14.3 and 15.1. Higher prevalence of hysterectomy in later ages explains the reverse in magnitude of the rates when the correction is applied to the hysterectomy rates. CONCLUSIONS: Conventional hysterectomy rates are underestimated, particularly in older age groups. A prevalence correction of the rates and probabilities is necessary to fully understand the potential health related consequences and impact of this medical procedure in the population.     

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.     

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.     

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.     

Bilateral oophorectomy in relation to risk of postmenopausal breast cancer: confounding by nonmalignant indications for surgery?

Bilateral oophorectomy is often performed during hysterectomy for benign conditions and can reduce breast cancer risk by 20%-50% when performed at younger ages. Accuracy of estimating the decrease in breast cancer risk associated with bilateral oophorectomy could be affected by common conditions that lead to surgery, such as uterine fibroids or endometriosis. The authors examined the potential for confounding by nonmalignant indications for surgery on breast cancer risk estimates in a population-based case-control study of invasive breast cancer newly diagnosed in 1992-1995. Breast cancer cases (N = 4,935) aged 50-79 years were identified from Wisconsin, Massachusetts, and New Hampshire tumor registries; similarly aged controls (N = 5,111) were selected from driver's license and Medicare lists. Reproductive and medical history was obtained from structured telephone interviews. Odds ratios and 95% confidence intervals were estimated with multivariate logistic regression. Women who underwent bilateral oophorectomy with hysterectomy at age ≤ 40 years had significantly reduced odds of breast cancer (odds ratio = 0.74, 95% confidence interval: 0.60, 0.90) compared with women with intact ovaries and uterus. Effect estimates were virtually unchanged after adjustment for uterine fibroids or endometriosis history. Results indicate that breast cancer risk reductions conferred by bilateral oophorectomy are not strongly confounded by failure to account for nonmalignant indications for surgery.     

Impact of hysterectomy and bilateral oophorectomy on race-specific rates of corpus, cervical, and ovarian cancers in the United States

PURPOSE: Population-based cancer incidence rates of the corpus uteri, cervix uteri, and ovaries are underestimated if they fail to remove women not at risk for developing the cancers from the denominator in the race calculation. This study compares incidence rates among selected racial groups for these cancers before and after correction for prevalence of hysterectomy and bilateral oophorectomy. METHODS: The study covers 1998 through 2002 and involves Surveillance, Epidemiology, and End Results Program; Behavior Risk Factor Surveillance System; and National Health Interview Survey data. Prevalence data were obtained by using survey and life-table methods. Four racial groups are considered: whites, blacks, American Indians/Alaska Natives, and Asians/Pacific Islanders. RESULTS: Risk correction significantly increased rates of corpus uterine cancer by 73.1% for whites, 93.0% for blacks, 86.3% for American Indians/Alaska Natives, and 41.0% for Asians/Pacific Islanders. Corresponding percentages among these racial groups for cervical cancer were 37.7%, 60.2%, 45.6%, and 33.0%, and for ovarian cancer, 32.5%, 31.1%, 35.0%, and 23.6%, respectively. Risk correction had large influences on the comparison of rates among racial groups. For example, for uterine corpus cancer, Asians/Pacific Islanders had 32.9% lower rates than whites before correction, but 45.3% lower rates after correction. For cervical cancer, blacks had 27.6% higher rates than whites before correction, but 48.5% higher rates after correction; and for ovarian cancer, Asians/Pacific Islanders had 31.2% lower rates than whites before correction and 35.8% lower rates after correction. CONCLUSIONS: Corrected rates of corpus uteri, cervix uteri, and ovarian cancers have a large, but differential, impact on the racial groups considered.     

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.)

     

Uterine fibroids risk and history of selected medical conditions linked with female hormones

To understand the role of several medical conditions on the risk of uterine fibroids, we analysed the findings of a large case-control study. Cases were 843 women aged 54 or less (median age 43 years, range 21-54) with histologically confirmed uterine fibroids, whose clinical diagnosis dated back no more than 2 years. Indications for surgery were recurrent menorrhagia or ultrasound evidence of fibroids larger than 10 cm in diameter. Controls were 1557 women aged 54 years or less of comparable quinquennia of age (median age 43 years, range 21-54) who had not undergone hysterectomy and were admitted for acute, non-gynecologic, non-hormonal, non-neoplastic conditions to a network of hospitals with a similar catchment area. Clinical history of severe overweight was inversely associated with the risk of fibroids (multivariate odds ratio (OR), OR: 0.6, 95% confidence intervals (CI): 0.5-0.8). An increase in the frequency of fibroids was seen in women with a history of benign breast disease (OR: 1.2, 95% CI: 0.9-1.6) and particularly of breast biopsies (OR: 2.0, 95% CI: 1.2-3.5). The results of this large dataset indicate that medical conditions known or likely to be related to female hormones are not important determinants of the risk of fibroids.     

Age-specific hysterectomy and oophorectomy prevalence rates and the risks for cancer of the reproductive system.

A sample survey was conducted in 1982 to determine the prevalence of hysterectomy and oophorectomy among upstate New York women, ages 25-74. The effects of this surgery on age-specific estimates of the risk for cancer of the uterus, cervix, and ovary were calculated. Overall, 16.9 per cent of the women reported having had a hysterectomy and 9.9 per cent reported a bilateral oophorectomy. The adjustment for age-specific hysterectomy increased the 1977-1979 average annual incidence rate of cervical and uterine cancer by 21 per cent. In several five-year age categories, the increase reached 54 per cent. The 1977-1979 average annual incidence rate of ovarian cancer increased by 12 per cent after adjusting for age-specific bilateral oophorectomy. The increase reached 29 per cent in one five-year age group. The sample results show a lower prevalence of hysterectomy among women 25 to 40 years old and among women 70 to 74 than estimates based on the application of mathematical models to data on surgical incidence.     

The incidence of varicella: correction of a common error

BACKGROUND: Interest in the incidence of varicella (chickenpox) has increased since the discovery of an effective vaccine, but calculations to date have incorrectedly ignored the question of susceptibility. METHODS: We studied the occurrence of varicella in Italy on the basis of 33,343 children (age 0-14 years) cared for by 35 pediatricians between 1 October 1997 and 30 September 1998. The life-table technique was used to calculate the number of susceptible children. On this basis, we estimated the corrected age-specific and cumulative incidence. RESULTS: We identified 1749 cases among the estimated 21,783 susceptible children, for a crude incidence of 8.0% (95% confidence interval [CI] = 7.7-8.4). The rate age-standardized to the Italian population 0-14 years old was 6.8 (CI = 6.5-7.2). The incidence was more than 16% among children age 3-4 years and more than 4% for those age 1-10 years. Comparison of the usual method and our corrected method showed that the uncorrected method underestimates the crude annual incidence (5.2% 8.0%), shifts the peak incidence to earlier ages, and underestimates cumulative incidence (at age 14, 49% 67%). CONCLUSIONS: The use of our corrected method provides more valid estimates of the incidence of varicella than the ones that are currently available. Corrected estimates should be preferred to uncorrected ones in models to study the cost-effectiveness of universal vaccination against varicella.     

产科急症子宫切除术相关因素的分析

目的讨论产科急症子宫切除术患者相关危险因素的分析,探讨子宫切除的时机和指征降低子宫切除率的可行方法。方法回顾性分析了2001年1月到2010年12月期间,某院收治的产科急症子宫切除的患者70例作为观察组,并且选择同期收治的68例剖宫产产后出血子宫未切除患者作为对照组。自行设计调查表,观察组和对照组分别从前置胎盘、胎盘早剥、子宫收缩乏力、子宫破裂、弥散性血管内凝血(DIC)、晚期产后出血、子宫肌瘤、疤痕子宫、宫腔感染、羊水过多、巨大儿等方面进行调查,分别采用单变量(χ2检验)进行对比,筛选出与子宫切除术有关因素。以及多变量(条件Logistic回归)方法筛选出主要危险因素。结果单因素分析显示病例组与对照组之间在前置胎盘(P﹤0.05)、胎盘早剥(P﹤0.05)、胎盘植入(P﹤0.05)、子宫破裂(P﹤0.05)、DIC(P﹤0.05)、出血量多(P﹤0.05)、子宫肌瘤(P﹤0.05)这7个方面差异有统计学意义;多因素条件Logistic回归显示只有前置胎盘(P﹤0.05)、胎盘早剥(P﹤0.05)、胎盘植入(P﹤0.05)、子宫破裂(P﹤0.05)、DIC(P﹤0.05)5个因素显示是危险因素,与子宫切除密切相关。结论子宫切除术与多种因素有关,加强对妇女患者的监测、提高警惕、减少子宫切除术的发生     

Prevalence-corrected prostate cancer incidence rates and trends.

A correction is made of prostate cancer incidence rates based on data from the Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute. Unlike conventional incidence rates reported by the Program, corrected rates remove from the population the estimated number already diagnosed with the disease. The corrected rates reflect the average prostate cancer risk for men in the at-risk population. Because of the high incidence of and relatively good survival for prostate cancer, the prevalence of this disease is high. Corrected prostate cancer incidence rates were higher in magnitude, particularly in older age groups and among Black men. For example, in 1997 for Whites, the corrected rates were 3.8 percent higher in cases aged 60-69 years, 9.3 percent higher in cases aged 70-79, and 13.1 percent higher in cases aged 80 or more. Corresponding percentages for Blacks were 5.9, 18.9, and 16.9 percent, respectively. Percent changes over calendar time were very similar between corrected and uncorrected prostate cancer incidence rates according to age and race (White and Black). Failure to account for high levels of prostate cancer prevalence in conventional incidence rates of the disease results in underestimation of the rates but little temporal difference in the trends.     

A prospective study of hypertension and risk of uterine leiomyomata

Although uterine leiomyomata (also known as fibroids or myomas) affect the reproductive health and well-being of approximately 25% of premenopausal women, risk factors are poorly understood. Elevated diastolic blood pressure may increase fibroid risk through uterine smooth muscle injury, not unlike atherosclerosis. The authors prospectively examined the relation between diastolic blood pressure and incidence of clinically detected leiomyomata. The sample included 104,233 premenopausal nurses from 14 US states enrolled in the Nurses' Health Study II. Participants, aged 25-42 years, had intact uteri and no history of cancer or fibroids at enrollment in 1989. During the 827,348 woman-years of follow-up (1989-1999), 7,466 incident diagnoses of uterine leiomyomata, confirmed by ultrasound or hysterectomy, were reported. With a multivariable Cox proportional hazards model, the relative risk of self-reported ultrasound- or hysterectomy-confirmed uterine leiomyomata according to diastolic blood pressure in 1989 and time-varying antihypertensive use was estimated. With adjustment for age, race/ethnicity, body mass index, and reproductive history covariates, for every 10-mmHg increase in diastolic blood pressure, the risk of fibroids rose 8% (5-11%) and 10% (7-13%) among nonusers and users of antihypertensive medications, respectively. Elevated blood pressure has an independent, positive association with risk for clinically detected uterine leiomyomata among premenopausal women. Investigating this association may suggest possible pathways to prevent fibroids.     

Adenomyosis: Pathologies associated in a set of patients underwent hysterectomy

ObjectiveTo determine if a relationship exists between the histopathological diagnosis of adenomyosis and the clinical conditions and pathologies that are more commonly related to it in patients undergoing hysterectomy.MethodsRetrospective, comparative, case-control study was conducted. With previous approval by ethics committee, we included 794 patients undergoing hysterectomy at a University Hospital. The Medical records and pathology reports of patients undergoing hysterectomy over a two-year period were reviwed. Clinical conditions and associated pathologies, in patients with and without adenomyosis, were reviewed and compared. Statistical analysis was done using the Chi-square test.ResultsAdenomyosis was reported in 140 out of 794 patients, 17.6% (95% CI: 15.1–20.4). No differences in adenomyosis prevalence were found among patients with or without uterine fibroids, 20.2% (75/371) vs. 15.5% (65/423); endometrial polyps, 9.7% (6/62) vs. 18.3% (134/732); and the presence or lack of endometrial hyperplasia 13.9% (5/36) vs. 17.4% (135/758). The prevalence of adenomyosis among patients with endometriosis was 40.7% (11/27), and among those without this diagnosis, 16.8% (129/767). This difference was significant (P=0.001). A history of two or more curettages was also positively related to adenomyosis.ConclusionsThere was a statistically significant difference in the prevalence of adenomyosis in women with endometriosis when compared to women without endometriosis. A higher incidence of adenomyosis was found in patients with a history of two or more curettages. Trauma to the endometrium could explain the higher incidence of adenomyosis in both conditions.     

Risk of myocardial infarction after oophorectomy and hysterectomy

To determine the risk of developing a first myocardial infarction after a hysterectomy and/or oophorectomy. Case-cohort analysis performed among 17,126 women in the Uppsala Health Care Region of Sweden, who had undergone a hysterectomy and/or oophorectomy in 1965 to 1983. Record linkage was used for follow-up and medical records to ascertain the actual history of oophorectomy. Risk estimates were calculated by relating the observed number of cases in the cohort to that expected on the basis of incidence rates in the population. Overall, 214 cases of myocardial infarction were observed. In premenopausal women a bilateral oophorectomy alone tended to increase the relative risk 1.6; 95% CI 0.8-3.1, but this operation combined with hysterectomy increased the risk only among those aged 50 and over at surgery. Hysterectomy at premenopausal age or unilateral oophorectomy did not alter the risk of myocardial infarction. In naturally menopausal women, hysterectomy-mainly for uterine myoma-was associated with a four-fold increase in relative risk (3.8; 95% CI 1.9-7.8). Hysterectomy for treatment of myoma performed after a natural menopause is linked to an excess risk for myocardial infarction. Bilateral oophorectomy before menopause may increase the risk of myocardial infarction.     

Risk factors for uterine fibroids among women undergoing tubal sterilization

Uterine leiomyomas are reported to be the most common benign gynecologic tumors affecting premenopausal women, and they are often associated with considerable morbidity. The purpose of this study was to identify risk factors for uterine fibroids among women undergoing tubal sterilization. Cases comprised women aged 17-44 years whose uterine fibroids were first visualized at the time of tubal sterilization (1978-1979 or 1985-1987) or who reported a history of uterine fibroids (n = 317). Controls were randomly selected from women with no laparoscopic evidence of or history of fibroids (n = 1,268). Adjusted odds ratios were estimated using unconditional logistic regression separately for White (n = 1,235) and African-American (n = 350) women. Risk factors for White women included: age 40-44 years (odds ratio (OR) = 6.3; 95% confidence interval (CI): 3.5, 11.6), > or =5 years since last delivery (OR = 1.9; 95% CI: 1.1, 3.1), lifetime cigarette smoking of > or =1 pack/day (OR = 1.6; 95% CI: 1.1, 2.3), menstrual cycle length of >30 days (OR = 1.6; 95% CI: 1.1, 3.3), and menstrual bleeding for > or =6 days (OR = 1.4; 95% CI: 1.0, 2.0). Parous women were at reduced risk compared with nulliparous women (OR = 0.2; 95% CI: 0.1, 0.3). Advancing age was the only significant risk factor for African-American women (ages 40-44 years, OR = 27.5; 95% CI: 5.6, 83.6). Current oral contraceptive use and elective abortion were not associated with fibroids.     

贵州省30～79岁世居侗族妇女子宫肌瘤流行现况及影响因素分析

目的 了解贵州省30～79岁侗族妇女子宫肌瘤的流行特征及影响因素。方法 采用分层多阶段抽样的方法,用χ2及趋势χ2 分别检验因素与子宫肌瘤检出情况的差异及变化趋势;对具有统计学意义的单因素变量进行多因素非条件二分类logistic逐步回归分析。结果 非农业和统一居民户口、BMI为超重、40～49岁的妇女更容检出子宫肌瘤,OR（95%CI）分别为3.004(1.759～5.132)、1.863(1.156～3.002)、1.559(1.070～2.271)、24.316(7.683～7.759),均P＜0.05;月经状况为绝经的妇女检出子宫肌瘤的风险较低,OR(95%CI）0.294(0.155～0.556),P＜0.05。结论 加强侗族农村妇女的健康教育;在30～59岁期间适当提高子宫肌瘤检查的频率;适当控制体重,谨慎流产以降低子宫肌瘤患病风险。     

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.     

The impact of endometrial ablation on hysterectomy rates in women with benign uterine conditions in the United States

OBJECTIVE: To assess the impact of endometrial ablation on the utilization of hysterectomy in U.S. women with benign uterine conditions. METHODS: Data are from the State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for six states, 1990-97. Women who underwent hysterectomy (ICD-9-CM codes 68.3, 68.4, 68.5, 68.51, 68.59, 68.9) and endometrial ablation (68.23, 69.29) and had benign uterine conditions (ICD-9-CM code 218.0 and CCS groupings 47, 171, 173, 175, 176, 215) were extracted. Comparative rates, length of stay, total charges, age, payer, hospital, and teaching status of the hospital are reported. RESULTS: The rates of hysterectomy decreased in three states: Colorado (37% decrease; 33 per 10,000 women in 1990 to 21 per 10,000 in 1997), Maryland (18% decrease; 17/10,000 in 1990 to 14/10,000 in 1997), and New Jersey (11% decrease; 9/10,000 to 8/10,000); were static in two states (Connecticut and New York) and increased in one state, Wisconsin (11% increase; 19/10,000 in 1994 to 21/10,000 in 1997). The rates for endometrial ablation increased in all states. The ratio of hysterectomy rates to endometrial ablation rates fell in each state across the 7 years. In two states (New York and New Jersey) the rate of endometrial ablation was equivalent to the rate of hysterectomies by 1997. The total combined rate for hysterectomy and endometrial ablation for women with benign uterine conditions for each state increased by more than 10%, with the exception of Maryland, which had an increase of only 5%, and Colorado, which had a decline of 23%. CONCLUSIONS: In the six states studied, the diffusion of endometrial ablation has had a varying impact on hysterectomy rates among women with benign uterine conditions. However, endometrial ablation is used as an additive medical technology rather than a substitute.     

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.