Patterns of black and white hysterectomy incidence among reproductive aged women

Abstract

Objective: To investigate the intersection of race and economic context in treatment with hysterectomy among reproductive aged women with noncancerous gynecologic conditions.

Data sources: We combined administrative billing records of inpatient and outpatient hysterectomy procedures (N = 28 301) occurring in North Carolina between 2011 and 2014 with census data to calculate county-level hysterectomy rates.

Study design: Spatial analysis techniques examined the distribution of black and white hysterectomy rates across counties, and county-level black and white rate differences were compared across economic contexts.

Data collection/extraction: We restricted to those of premenopausal age identifying as non-Hispanic black or white, undergoing hysterectomy for nonemergent causes (N = 28 301 procedures).

Principal findings: County-level hysterectomy rates were spatially patterned (Moran's I, P < .05) and similarly so for black and white women (LISA, P < .005). The black-white difference in hysterectomy rates was the largest in the high economic tier counties (22/10 000 person-years [PY], P < .05) and smallest in the mid and low economic tier counties (11/10 000 PY, P > .05 and 10/10 000 PY, P > .05, respectively).

Conclusion: Socioeconomic context is important to understand, particularly for black-white disparities in hysterectomy. Efforts should be made to understand the causes of higher rates of hysterectomy among blacks than whites, especially in counties in the highest economic tier.

Keywords: ecological studies; medical geography; obstetrics/gynecology; racial/ethnic differences in health care.

FIGURE 1

Scatter plot of county‐level nH black and white hysterectomy incidence rates (10 000 person‐years) among reproductive aged women, North Carolina, 2011‐2014 (N = 98). Figure 1 shows the nH black and white county‐level hysterectomy incidence rates per 10 000 person‐years for premenopausal (ages 18‐44) North Carolina residents. Rates were hysterectomy prevalence adjusted and age standardized to the 2010 age distribution of NC women ages 18‐44. Each dot represents a single county's hysterectomy incidence rate for both nH black and nH whites. Dots on the dashed line are those where the nH black and white rates are the same. Points above the dashed line represent counties with nH black rates that are higher than the nH white rates. Rate values for two counties (Yancey & Mitchell) were removed because either the nH black rates or the nH black and white rates were outliers (rate > mean rate × 3)

FIGURE 2

Scatter plots of non‐Hispanic black and non‐Hispanic white county‐level hysterectomy rates among reproductive aged women by county economic tier, North Carolina, 2011‐2014 (N = 98). Figure 2 shows county‐level hysterectomy rates of nH black residents along the y‐axes, against the hysterectomy rate of nH white residents (x‐axis), for 98 of the 100 counties in NC. Rates were hysterectomy prevalence adjusted and age standardized to the 2010 age distribution of NC women ages 18‐44. This figure provides graphic decomposition of within and between county racial/ethnic differences. Points on the diagonal dotted line represent equal rates, while distance away from that line shows the degree of rate difference within each county. Points above the dashed line represent counties with nH black rates that are higher than the nH white rates. Rate values for two counties were removed because they were outliers (rate > mean value × 3).