For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013
Abstract 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 hysterect...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2471-1 |
| _version_ | 1818013388058394624 |
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| author | Whitney R. Robinson Mariah M. Cheng Annie Green Howard William R. Carpenter Wendy R. Brewster Kemi M. Doll |
| author_facet | Whitney R. Robinson Mariah M. Cheng Annie Green Howard William R. Carpenter Wendy R. Brewster Kemi M. Doll |
| author_sort | Whitney R. Robinson |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-14T06:32:33Z |
| format | Article |
| id | doaj.art-63228d5f83954169a49c4529b802f76b |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-14T06:32:33Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-63228d5f83954169a49c4529b802f76b2022-12-22T02:07:34ZengBMCBMC Health Services Research1472-69632017-08-011711910.1186/s12913-017-2471-1For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013Whitney R. Robinson0Mariah M. Cheng1Annie Green Howard2William R. Carpenter3Wendy R. Brewster4Kemi M. Doll5Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel HillCarolina Population Center, University of North Carolina at Chapel HillCarolina Population Center, University of North Carolina at Chapel HillLineberger Comprehensive Cancer Center, University of North Carolina at Chapel HillLineberger Comprehensive Cancer Center, University of North Carolina at Chapel HillDepartment of Obstetrics and Gynecology, University of WashingtonAbstract 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.http://link.springer.com/article/10.1186/s12913-017-2471-1De-implementationHealth disparities African-AmericanGynecologyAdministrative dataAmbulatory surgeryClaims-based data |
| spellingShingle | Whitney R. Robinson Mariah M. Cheng Annie Green Howard William R. Carpenter Wendy R. Brewster 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 Services Research De-implementation Health disparities African-American Gynecology Administrative data Ambulatory surgery Claims-based data |
| title | For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013 |
| title_full | For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013 |
| title_fullStr | For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013 |
| title_full_unstemmed | For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013 |
| title_short | For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011–2013 |
| title_sort | for u s black women shift of hysterectomy to outpatient settings may have lagged behind white women a claims based analysis 2011 2013 |
| topic | De-implementation Health disparities African-American Gynecology Administrative data Ambulatory surgery Claims-based data |
| url | http://link.springer.com/article/10.1186/s12913-017-2471-1 |
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