Ethnoracial Differences in Premenopausal Hysterectomy: The Role of Symptom Severity

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Citation

Robinson, Whitney R.; Mathias, Joacy G.; Wood, Mollie E.; Anderson, Lauren G.; Howard, Annie Green; Carey, Erin T.; Nicholson, Wanda K.; Carey, Timothy S.; Myers, Evan; & Stürmer, Til, et al. (2023). Ethnoracial Differences in Premenopausal Hysterectomy: The Role of Symptom Severity. Obstetrics & Gynecology, 142(2), 350-359. PMCID: PMC10351903

Abstract

OBJECTIVE: To evaluate whether greater symptom severity can explain higher hysterectomy rates among premenopausal non-Hispanic Black compared with White patients in the U.S. South rather than potential overtreatment of Black patients.
METHODS: Using electronic health record data from 1,703 patients who underwent hysterectomy in a large health care system in the U.S. South between 2014 and 2017, we assessed symptom severity to account for differences in hysterectomy rates for noncancerous conditions among premenopausal non-Hispanic Black, non-Hispanic White, and Hispanic patients. We used Poisson generalized linear mixed modeling to estimate symptom severity (greater than the 75th percentile on composite symptom severity scores of bleeding, bulk, or pelvic pain) as a function of race-ethnicity. We calculated prevalence ratios (PRs). We controlled for factors both contra-indicating and contributing to hysterectomy.
RESULTS: The overall median age of non-Hispanic White (n=1,050), non-Hispanic Black (n=565), and Hispanic (n=158) patients was 40 years. The White and Black patients were mostly insured (insured greater than 95%), whereas the Hispanic patients were often uninsured (insured 58.9%). White and Black patients were mostly treated outside academic medical centers (nonmedical center: 63.7% and 58.4%, respectively); the opposite was true for Hispanic patients (nonmedical center: 34.2%). Black patients had higher bleeding severity scores compared with Hispanic and White patients (median 8, 7, and 4 respectively) and higher bulk scores (median 3, 1, and 0, respectively), but pain scores differed (median 3, 5, and 4, respectively). Black and Hispanic patients were disproportionately likely to have severe symptoms documented on two or more symptoms (referent: not severe on any symptoms) (adjusted PR [Black vs White] 3.02, 95% CI 2.29-3.99; adjusted PR [Hispanic vs White] 2.61, 95% CI 1.78-3.83). Although Black and Hispanic patients were more likely to experience severe symptoms, we found no racial and ethnic differences in the number of alternative treatments attempted before hysterectomy.
CONCLUSION: We did not find evidence of overtreatment of Black patients. Our findings suggest potential undertreatment of Black and Hispanic patients with uterine-sparing alternatives earlier in their disease progression.

URL

http://dx.doi.org/10.1097/aog.0000000000005225

Reference Type

Journal Article

Year Published

2023

Journal Title

Obstetrics & Gynecology

Author(s)

Robinson, Whitney R.
Mathias, Joacy G.
Wood, Mollie E.
Anderson, Lauren G.
Howard, Annie Green
Carey, Erin T.
Nicholson, Wanda K.
Carey, Timothy S.
Myers, Evan
Stürmer, Til
Doll, Kemi M.

Article Type

Regular

PMCID

PMC10351903

Continent/Country

United States

State

North Carolina

Race/Ethnicity

Black
White

Sex/Gender

Women

ORCiD

Robinson, W - 0000-0003-4009-0488
Howard, AG - 0000-0003-0837-8166