title: Socio-economic position across the life course and hysterectomy in three British cohorts: a cross-cohort comparative study.
abstract: OBJECTIVE
  To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts.
  
  
  METHODS
  Cross-cohort comparative study.
  
  
  METHODS
  Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland.
  
  
  METHODS
  Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status.
  
  
  METHODS
  Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy.
  
  
  METHODS
  Self-reported hysterectomy with or without oophorectomy.
  
  
  RESULTS
  Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance.
  
  
  CONCLUSIONS
  Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.
authors.affiliation: MRC National Survey of Health and Development, Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Cooper
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.forename: David A
authors.initials: DA
authors.lastname: Leon
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Wadsworth
authors.forename: Diana
authors.initials: D
authors.lastname: Kuh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D010052:Ovariectomy / Q000706:statistics & numerical data; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology