摘要：Objectives. We evaluated the cross-sectional association between race and hysterectomy prevalence in a population-based cohort of US women and investigated participant characteristics associated with racial differences. Methods. The cohort consisted of 1863 Black and White women in the Coronary Artery Risk Development in Young Adults (CARDIA) study from 2000 to 2002 (years 15 and 16 after baseline). We used logistic regression to examine unadjusted and multivariable adjusted odds ratios. Results. Black women demonstrated greater odds of hysterectomy compared with White women (odds ratio [OR] = 3.52; 95% confidence interval [CI] = 2.52, 4.90). Adjustment for age, educational attainment, perceived barriers to accessing medical care, body mass index, polycystic ovarian syndrome, tubal ligation, depressive symptoms, age at menarche, and geographic location minimally altered the association (OR = 3.70; 95% CI = 2.44, 5.61). In a subset of the study population, those with directly imaged fibroids, the association was minimally attenuated (OR = 3.47; 95% CI = 2.23, 5.40). Conclusions. In both unadjusted and multivariable adjusted models, Black women, compared with White women, had increased odds of hysterectomy that persisted despite adjustment for participant characteristics. The increased odds are possibly related to decisions to undergo hysterectomy. Hysterectomy is one of the most frequently performed surgeries among women in the United States. Rates of hysterectomy far exceed those in a majority of other Western countries, which may be partially because of nonclinical factors. 1 Several studies report higher rates of hysterectomy among Black women compared with White women, often attributing the disparity to differences in socioeconomic or psychosocial factors. 2 – 5 However, the literature is incomplete, possibly because of limitations of the study designs used to evaluate hypotheses regarding factors associated with differential treatment decisions. In fact, most available studies are not population-based or have otherwise restricted samples that preclude adequate assessment of contributors to racial differences. Because most hysterectomies are performed for noncancer causes, 5 there is growing interest in understanding differences in antecedents to hysterectomy that may explain the disproportionately higher frequency among Black women. The initial step in this investigation was to identify individual characteristics that may help to explain why more Black women undergo hysterectomy in the United States compared with White women. Individual physiological and nonclinical characteristics likely influence one's decision to undergo hysterectomy or a clinician's recommendation for treatment. In addition to clinical indications, including presence of fibroids or persistent vaginal bleeding (for which the most appropriate method of treatment is not always clear), those attributes most strongly related include differences in access to health care, highest level of education, body mass index (BMI), and various lifestyle behaviors. 4 – 6 One proposed hypothesis is that individuals with lower socioeconomic status may be less knowledgeable about alternatives to hysterectomy and might subsequently delay seeking care longer, until gynecological problems are too severe to pursue nonhysterectomy treatment options. 6 , 7 Such assertions suggest that knowledge about and access to alternative treatments may differ among social, ethnic, and geographic groups. Alternately, information about less radical treatments may be differentially communicated to or accepted by patients. With a large, biethnic, population-based cohort of women, we cross-sectionally examined differences in hysterectomy prevalence between Black and White women and potential correlates of racial differences. Our primary objective was to identify characteristics associated with observed racial differences. We hypothesized that racial differences could be explained by statistically controlling for participant characteristics related to hysterectomy status—most notably psychosocial factors and medical history. The establishment of attributes that explain current racial disparities may reveal potential modifiable factors that influence decisions to undergo hysterectomy—with the ultimate goal of better identifying candidates for alternative and less radical treatments. Further, this could lead to tailored interventions that more effectively help women consider the multiple treatment options available.
