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.     

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.     

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.     

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.     

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.     

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.     

子宫腺肌症286例临床分析

目的 通过分析子宫腺肌症临床资料,以总结临床经验.方法 回顾分析20011年1月～2005年12月收治的286例子宫腺肌症患者临床资料.结果 286例子宫腺肌症患者占同期妇科手术的7.3%,术前诊断为子宫腺肌症195例,诊断符合率68.2%.随访1～5年,经腹及经腹腔镜子宫切除术后患者痛经缓解率100%,腹腔镜筋膜内子宫切除术患者痛经缓解率95.3%.保守性手术配合药物治疗术后1年痛经缓解率91.4%,术后2年缓解率81.0%.有生育要求者共58例,术后妊娠22人次,足月妊娠14例,自然流产7例,孕6个月子宫破裂1例.结论 子宫腺肌症治疗目前仍以手术为主,子宫切除可达根治目的.对于年轻的患者,应制定个体化治疗方案.     

Hysterectomy, tubal sterilization, and the risk of breast cancer

Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could alter breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20-54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7, 95% confidence interval (CI) = 0.6-0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past. Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95% CI = 0.7-0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% CI = 1.0-1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.     

Fatal occupational injury rates: Quebec, 1981 through 1988.

OBJECTIVES. The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. METHODS. Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. RESULTS. From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100,000); women's rates were stable (< or = 1.0 per 100,000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100,000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100,000). CONCLUSIONS. Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death.     

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.     

Health status of users of hormone replacement therapy by hysterectomy status in Western Australia

STUDY OBJECTIVES: To compare the demographic, behavioural, and biological correlates of use of hormone replacement therapy (HRT) in women with an intact uterus and women who have undergone hysterectomy. DESIGN: Cross sectional analysis of data from the Busselton Health Study and the 1994 Healthway-National Heart Foundation Risk Factor Survey. SETTING: Busselton and Perth, Western Australia, 1994. PARTICIPANTS: 2540 women aged 35-79 years. MAIN OUTCOME MEASURES: Demographic, behavioural, and biological correlates of use of HRT by hysterectomy status. RESULTS: In women with an intact uterus, after adjustment for age and place of residence, current use of HRT was significantly associated with having a professional level of occupation, ever use of alcohol, having a history of smoking, and a lower body mass index. Current users of HRT had significantly lower levels of total cholesterol and higher levels of triglycerides than non-users. In women who had undergone hysterectomy, the only non-biological characteristic associated with use of HRT was having a history of smoking. Current users of HRT had lower levels of systolic blood pressure, lower levels of LDL cholesterol, higher levels of HDL cholesterol, and higher levels of triglycerides. The association between use of HRT and participation in exercise, level of systolic blood pressure, level of HDL cholesterol, and total/HDL cholesterol ratio varied significantly by hysterectomy status. After adjustment for age and place of residence, the mean levels of systolic and diastolic blood pressure, body mass index, waist/hip ratio, LDL cholesterol, and total/HDL cholesterol ratio were highest in women who had undergone hysterectomy and were not using HRT. CONCLUSIONS: Demographic/behavioural and biological correlates of use of HRT varied depending on hysterectomy status. Demographic and behavioural characteristics were more important as selection factors for use of HRT in women with an intact uterus than in women who had undergone hysterectomy. Women who had undergone hysterectomy and were not using HRT had a significantly worse profile for CHD than did women with an intact uterus. These results indicate that any bias in estimates of the protective effect of HRT on risk of CHD in observational studies is likely to depend on the prevalence of hysterectomy within the study population. Hysterectomy status needs to be taken into account in any studies that investigate the effect of HRT on risk of CHD.     

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.     

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.     

Socioeconomic variations in hysterectomy: evidence from a linkage study of the Finnish hospital discharge register and population census.

STUDY OBJECTIVE: To explore variations in rates for hysterectomy in relation to social class, education, and family income. DESIGN: Retrospective analysis of the 1988 Finnish hospital discharge register linked individually to the 1987 population census. SETTING: Finland. PARTICIPANTS: All women living in Finland aged 35 and over were the denominator population. The numerators were the 8663 women who underwent hysterectomy in 1988. MAIN RESULTS: The overall rate for hysterectomy was 63.5/10,000 women aged 35 and over. There was a marked positive correlation between disposable family income and hysterectomy rates even after age, hospital catchment area, education, and occupational status were adjusted for. However, no linear trend for overall hysterectomy rates was observed in relation to social class or education. Procedures due to myomas, accounting for 48% of all hysterectomies, were more frequent among women of high socioeconomic status according to all socioeconomic indicators. Larger proportions of hysterectomies for myoma were also performed in patients in private hospitals and in pay beds in public hospitals than in women in worse off groups. CONCLUSIONS: Unlike the findings in earlier studies from other countries, there was a positive correlation between income and hysterectomy rates as a result of the high numbers of hysterectomies performed to treat myoma in the well off women. The findings are discussed in terms of socioeconomic differences in the use of private gynaecological services, and factors, such as parity and use of hormonal replacement therapy, that affect the growth of myomas.     

Biosocial determinants of hysterectomy in New Zealand

OBJECTIVES: This study examined the prevalence and biosocial correlates of hysterectomy. METHODS: Data were from a 1995 national survey of women aged 20 to 59 years. We applied piecewise nonparametric exponential hazards models to a subsample aged 25 to 59 to estimate the effects of biosocial correlates on hysterectomy likelihood. RESULTS: Risks of hysterectomy for 1991 through 1995 were lower than those before 1981. University-educated and professional women were less likely to undergo hysterectomy. Higher parity and intrauterine device side effects increased the risk. CONCLUSIONS: This study confirms international results, especially those on education and occupation, but also points to ethnicity's mediating role. Education and occupation covary independently with hysterectomy. Analysis of time variance and periodicity showed declines in likelihood from 1981.     

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.     

Long-term risk of hysterectomy after tubal sterilization

Previous studies with only short-term follow-up have produced conflicting results on whether a tubal ligation increases a woman's risk for having a hysterectomy. By use of population-based data from the province of Manitoba's universal health insurance plan, all women aged 25-44 years who had a tubal ligation in 1974 (n = 4,374) were identified. As a comparison group, a random sample of 10,000 Manitoba women who were registered with the insurance plan on July 1, 1974 was chosen. Women undergoing hysterectomy prior to July 1, 1974 or a tubal ligation from 1970-1982 were excluded, leaving 6,835 in the comparison group. All health care utilization for two years before tubal ligation or July 1, 1974 (comparison group) was recorded to identify health characteristics of the women. Information was recorded on rate of hysterectomy, dilatation and curettage, all hospitalization, and hospitalization for menstrual disorders for two years after tubal ligation or July 1, 1974. For the longer term analysis, information on hysterectomy up to December 31, 1982 was recorded. At two years there was no increase in adverse gynecologic outcomes between the two groups. Survival curves (life table method) comparing the two groups for up to nine years found higher hysterectomy rates for women aged 25-29 beginning at two years after tubal ligation and increasing with time. Multivariate analysis (Cox's regression model) confirmed that for women aged 25-29, tubal ligation increased the probability of a hysterectomy 1.6 times (1.2-2.3, 95% confidence interval) after controlling for previous gynecologic history, marital status, number of physician visits, and hospitalizations. For women aged 30 and over, tubal ligation was not a risk factor for subsequent hysterectomy in either the short or long term.     

Measuring the speed of India's fertility decline

This study compares fertility rates from the Sample Registration System (SRS) and the 1992-93 National Family Health Survey (NFHS) in India as a means of determining the speed of fertility decline. Fertility since the 1970s declined faster based on the SRS than the NFHS. The present level of fertility is expected to be higher than recorded in either data source. Misreporting of women's ages in both sources warrants use of the general fertility rate (GFR), annual births divided by the estimated mid-year population of women aged 15-49 years. During 1978-92, GFRs agreed quite well for the period 1988-92, but in the preceding 5-year periods the ratio of the NFHS and the SRS increased from 1.00 in 1988-92 to 1.14 in 1984-87 to 1.19 in 1978-82. The GFR estimated from the NFHS was 10% higher than the rate estimated from the SRS. The underestimation in the SRS is attributed to underreporting of female births. Frequent omissions of female births drives the sex ratio higher than the average of 105-107 male per 100 female births. In fact, in 1997 the SRS sex ratio at birth for 1981-90 was 110 per 100. Evaluation studies of SRS data reveal an improvement in birth registration over time but did not examine the sex ratio over time. Sex ratios at birth from NFHS data were stable over time at around 106 per 100. Annual estimates of births from NFHS data show peaks and troughs that suggest misreporting of children's ages. Heaping occurs at ages 5, 8, 10, and 12 years. The increase in the GFR between 1983-87 and 1988-92 suggests omission of recent births or displacement of them in the earlier period. Couple protection rates (CPR) increased from 23% in 1978 to 44% in 1992. The total fertility rate (TFR) estimated from the statistical model tested on over 90 countries (TFR = 7.2931 - 0.0700 CPR) declines more steeply than the SRS rates. TFR from CPR estimates were not as steep as the NFHS rates.     

Breast cancer risk and ovariectomy, hysterectomy, and tubal sterilization in the women's contraceptive and reproductive experiences study

Removal or impairment of ovaries before menopause may affect a woman's breast cancer risk by altering her cumulative exposure to ovarian hormones. The Women's Contraceptive and Reproductive Experiences Study, a population-based, multicenter case-control study of incident invasive breast cancer, recruited women aged 35-64 years (4,490 cases and 4,611 controls) who provided data on ovariectomy, hysterectomy, and tubal sterilization during in-person interviews. Controls were frequency-matched to cases by age, race, and study site. Unconditional logistic regression analysis was used. Women who had not undergone premenopausal reproductive surgery were the referent group. Bilateral ovariectomy was associated with reduced breast cancer risk overall (odds ratio (OR) = 0.59, 95% confidence interval (CI): 0.50, 0.69) and among women <45 years of age (ORs ranged from 0.31 to 0.52), but not among those who were older at surgery. It was also associated with a reduced risk for estrogen and progesterone receptor-positive tumors (OR = 0.63, 95% CI: 0.52, 0.75) but not receptor-negative tumors. Hysterectomy with ovarian conservation (OR = 0.83, 95% CI: 0.72, 0.96) and hysterectomy with partial ovary removal (OR = 0.73, 95% CI: 0.59, 0.91) were also associated with lower risk. No association with breast cancer risk was observed with tubal sterilization only or partial ovariectomy without hysterectomy. Reproductive organ surgeries may alter ovarian hormone levels, thereby affecting breast cancer risk.     

1988—2017年中国居民胃癌死亡趋势分析

目的 分析1988—2017年中国胃癌死亡率时间变化趋势,为制定胃癌防控措施提供科学依据。 方法 数据来源于WHO国际癌症研究中心和《中国卫生统计年鉴》,采用SPSS 22.0汇总和计算1988—2017年中国胃癌死亡率数据,采用Joinpoint回归模型分析胃癌死亡率时间变化趋势。 结果 1988—2017年间,中国居民城市男性、城市女性、乡村男性、乡村女性的胃癌标化死亡率平均年度变化百分比(average annual percent change,AAPC)分别为-2.45%、-2.80%、-2.28%、-2.88%,期间城市男性与城市女性胃癌标化死亡率年度变化百分比(annual percent change,APC)基本没有变化;乡村男性1988—2008年间(APC=-1.19%,P<0.01)与2008—2017年间(APC=-4.71%,P<0.01)不同,乡村女性1988—2004年间(APC=-1.32%,P<0.01)与2004—2017年间(APC=-4.83%,P<0.01)不同。城市男性、城市女性、乡村男性、乡村女性胃癌截缩死亡率AAPC分别为-2.49%、-3.03%、-3.27%、-4.19%,城市女性、乡村男性、乡村女性胃癌截缩死亡率的变化趋势与其标化死亡率的变化趋势基本相似,而城市男性胃癌截缩死亡率仅在1988—1996年期间有下降(APC=-4.91%,P<0.01),1996—2017期间无下降趋势。城市居民中,除男性50～54岁、女性65～69岁胃癌死亡率无下降趋势以外,其他年龄组均呈下降趋势;乡村居民中,除男性30～34岁及75～84岁、女性25～39岁及80～84岁胃癌死亡率无下降趋势以外,其他年龄组均呈下降趋势。 结论 1988—2017年期间中国居民胃癌死亡率总体呈下降趋势,但下降的趋势在城乡之间有差异,乡村居民胃癌死亡率下降幅度高于城市居民,不同年龄之间胃癌死亡率下降趋势有差异。