Socioeconomic and racial predictors of undergoing laparoscopic hysterectomy for selected benign diseases: analysis of 341487 hysterectomies.
OBJECTIVE
Socioeconomic status and race are important determinants of health care access in the United States. The purpose of our study was to evaluate whether these factors influence use of laparoscopic hysterectomy for management of benign gynecologic diseases.


METHODS
Retrospective cohort study (Canadian Task Force classification II-3).


METHODS
Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 1998 to 2002.


METHODS
All records of women with primary discharge diagnosis of uterine leiomyomas or menorrhagia who underwent hysterectomy (laparoscopy or abdominal) were included in the study.


METHODS
Race (Caucasian, African-American, Hispanic, or other), median household income (<$25000, $25000-$34999, $35000-$44999, or > or =$45000), and insurance status (private, Medicare, Medicaid, or other) were evaluated as determinants of laparoscopic surgical intervention. Unconditional logistic regression was used to estimate likelihood of laparoscopic approach to hysterectomy.


RESULTS
Of 341487 records for hysterectomy, 295857 were performed by abdominal and 45630 by laparoscopic approach. In adjusted analyses, African-Americans, Hispanics, and other ethnicities were less likely to undergo laparoscopic hysterectomy; adjusted OR (95% CI): 0.44 (0.42-0.45), 0.58 (0.55-0.61), and 0.68 (0.64-0.72), respectively, as compared with Caucasians. As compared with women with median income of less than $25000, laparoscopic approach was more commonly performed on women with median household income $25000 to $34999, 1.18 (1.10-1.26); $35000 to $44999, 1.13 (1.0-1.21); and $45000 and above, 1.14 (1.06-1.22). As compared with women with Medicaid, laparoscopic approach was more likely to be performed on women with private insurance: 1.45 (1.42-1.62).


CONCLUSIONS
In the United States, median household income, insurance status, and race appear to be important independent determinants of access to laparoscopic hysterectomy for benign diseases.
Abenhaim
Haim Arie
HA
Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Azziz
Ricardo
R
Hu
Jianfang
J
Bartolucci
Alfred
A
Tulandi
Togas
T
D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007889:Leiomyoma / Q000191:economics / Q000208:ethnology / Q000601:surgery; D008595:Menorrhagia / Q000191:economics / Q000208:ethnology / Q000601:surgery; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012923:Social Class; D014481:United States; D014594:Uterine Neoplasms / Q000191:economics / Q000208:ethnology / Q000601:surgery; D044465:White People