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.