title: Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 years.
abstract: OBJECTIVE
  To investigate incidence trends and demographic, social and health factors associated with the rate of hysterectomy and morbidity outcomes in Western Australia and compare these with international studies.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  All hospitals in Western Australia where hysterectomies were performed from 1981 to 2003.
  
  
  METHODS
  All women aged 20 years or older who underwent a hysterectomy.
  
  
  METHODS
  Statistical analysis of record-linked administrative health data.
  
  
  METHODS
  Rates, rate ratios and odds ratios for incidence measures and length of stay in hospital and odds ratios for morbidity measures.
  
  
  RESULTS
  The age-standardised rate of hysterectomy adjusted for the underlying prevalence of hysterectomy decreased 23% from 6.6 per 1000 woman-years (95% CI 6.4-6.9) in 1981 to 4.8 per 1000 woman-years (95% CI 4.6-4.9) in 2003. Lifetime risk of hysterectomy was estimated as 35%. In 2003, 40% of hysterectomies were abdominal. The rate of hysterectomy to treat menstrual disorders fell from 4 per 1000 woman-years in 1981 to 1 per 1000 woman-years in 1993 and has since stabilised. Low socio-economic status, having only public health insurance, nonindigenous status and living in rural or remote areas were associated with increased risk of having a hysterectomy for menstrual disorders. Indigenous women had higher rates of hysterectomy to treat gynaecological cancers compared with nonindigenous women, particularly in rural areas. The odds of a serious complication were 20% lower for vaginal hysterectomies compared with abdominal procedures.
  
  
  CONCLUSIONS
  Western Australia has one of the highest hysterectomy rates in the world, although proportionally, significantly fewer abdominal hysterectomies are performed than in most countries.
authors.affiliation: Centre for Health Services Research, School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Spilsbury
authors.forename: J B
authors.initials: JB
authors.lastname: Semmens
authors.forename: I
authors.initials: I
authors.lastname: Hammond
authors.forename: A
authors.initials: A
authors.lastname: Bolck
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014904:Western Australia / Q000453:epidemiology