Association between hysterectomy status and stroke risk and cause-specific and all-cause mortality: evidence from the 2005-2018 National Health and Nutrition Examination Survey

Abstract

Background: Prior research on women who had hysterectomies has shown mixed results on whether or not hysterectomies increased the incidence of stroke and cause-specific or all-cause mortality.

Methods: Using information from the Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including linked mortality follow-up files available for public access, a multicycle cross-sectional design mortality linkage study was performed.

Results: Conducted during the years 2005-2018, the study sample included 14,214 female participants ranging in age from 20 to 85 years. The relationship between the hysterectomy status and the risk of stroke and cause-specific and all-cause mortality was examined using a series of weighted logistic regressions and Cox proportional hazards regressions, respectively. The presence of a hysterectomy was consistently linked to an elevated risk of stroke using weighted logistic regression models. The hysterectomy status, however, consistently showed no effect on survival by adjusted weighted Cox regression analysis.

Conclusion: Our study found a significant association between hysterectomy and stroke, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, ethnicity, marital status, income, education, and depression severity.

Keywords: NHANES; hysterectomy; mortality; stroke; women's health issues.

Figure 1

Flowchart of study participants.

Figure 2

Association between hysterectomy and stroke in subgroups. OR, odds ratio; CI, confidence interval. Each stratification was adjusted for age (continuous), ethnicity (White, Black, Mexican, or other), marital status (married, living with partner, separated, divorced, widowed, or never married), poverty income ratio [classified as low income (<1.3), middle income (1.3–3.5), and high income (≥3.5)], educational level (divided into <9th grade, 9–11th grade, high school graduate, some college or AA degree, and college graduate or above), and depression severity (none, mild, moderate, moderately severe, or severe), and the American Heart Association's Life's Simple 7 cardiovascular health score (continuous), except the stratification factor itself. Squares indicate ORs, with horizontal lines indicating 95% CIs. The center of the diamond indicates the overall OR between stroke risk and hysterectomy status in the overall population, with the outer points of the diamonds indicating 95% CI.

Figure 3

Kaplan–Meier curves were depicted to show the association between the hysterectomy and all-cause (A), cardiovascular (B), and malignant neoplasms (C) mortality, with follow-up in months.