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For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013.

Publication ,  Journal Article
Robinson, WR; Cheng, MM; Howard, AG; Carpenter, WR; Brewster, WR; Doll, KM
Published in: BMC Health Serv Res
August 4, 2017

BACKGROUND: Hysterectomy is among the most common surgeries performed on U.S. women. For benign conditions, minimally invasive hysterectomy is recommended, whenever permitted by clinical indication and previous surgery history. No study has examined whether the use of less invasive hysterectomy spread more slowly for Black women. METHODS: We used the hysterectomy that occurs in outpatient settings as a proxy for minimally invasive hysterectomy. Using claims-based surgery data and census denominators, we calculated age-standardized rates of all hysterectomies in North Carolina from 2011 to 2013. Study participants were 41,899 women (64.6% non-Hispanic White, 28.3% non-Hispanic Black) who underwent hysterectomy for non-malignant indications. We fit Poisson models to determine whether changes in outpatient hysterectomy rates differed by Black-White race. We employed a difference-in-difference approach to control for racial differences in the severity of clinical indication. Further, we restricted to one state to minimize confounding from geographic differences in where Black and White women live. RESULTS: From 2011 to 2013, the overall hysterectomy rate decreased from 42.3 per 10,000 women (n = 14,648) to 37.9 per 10,000 (n = 13,241) (p < 0.0001). Most hysterectomy (67.6%) occurred in outpatient settings. The inpatient rate decreased 35.2% (p < 0.0001), to 10.3 per 10,000, while the outpatient rate increased 4.6% (p < 0.01), to 27.5 per 10,000. From 2011 to 2013, Black women's outpatient rate increased 22% (p < 0.0001): from 25.8 per 10,000 to 31.5. In contrast, among White women, outpatient rates remained stable (p = 0.79): at 28.3 per 10,000 in 2013. CONCLUSIONS: Rapid increases in outpatient hysterectomy among Black women compared to stable rates among White women indicate a race-specific catch-up phenomenon in the spread of minimally invasive hysterectomy. These results are consistent with the hypothesis that minimally invasive hysterectomy may have been adopted more slowly for Black women than their White counterparts after its introduction in the early 2000s. The persistently high rates of hysterectomy among young Black women and potentially slower adoption of minimally invasive procedures among these women highlight a potential racial disparity in women's healthcare.

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Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

August 4, 2017

Volume

17

Issue

1

Start / End Page

526

Location

England

Related Subject Headings

  • Young Adult
  • Women's Health
  • White People
  • Outpatients
  • North Carolina
  • Middle Aged
  • Hysterectomy
  • Humans
  • Healthcare Disparities
  • Health Policy & Services
 

Citation

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Robinson, W. R., Cheng, M. M., Howard, A. G., Carpenter, W. R., Brewster, W. R., & Doll, K. M. (2017). For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013. BMC Health Serv Res, 17(1), 526. https://doi.org/10.1186/s12913-017-2471-1
Robinson, Whitney R., Mariah M. Cheng, Annie Green Howard, William R. Carpenter, Wendy R. Brewster, and Kemi M. Doll. “For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013.BMC Health Serv Res 17, no. 1 (August 4, 2017): 526. https://doi.org/10.1186/s12913-017-2471-1.
Robinson WR, Cheng MM, Howard AG, Carpenter WR, Brewster WR, Doll KM. For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013. BMC Health Serv Res. 2017 Aug 4;17(1):526.
Robinson, Whitney R., et al. “For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013.BMC Health Serv Res, vol. 17, no. 1, Aug. 2017, p. 526. Pubmed, doi:10.1186/s12913-017-2471-1.
Robinson WR, Cheng MM, Howard AG, Carpenter WR, Brewster WR, Doll KM. For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013. BMC Health Serv Res. 2017 Aug 4;17(1):526.
Journal cover image

Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

August 4, 2017

Volume

17

Issue

1

Start / End Page

526

Location

England

Related Subject Headings

  • Young Adult
  • Women's Health
  • White People
  • Outpatients
  • North Carolina
  • Middle Aged
  • Hysterectomy
  • Humans
  • Healthcare Disparities
  • Health Policy & Services