Socioeconomic factors may influence the surgical technique for benign hysterectomy.
BACKGROUND
Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background.


METHODS
All 22,150 women registered in the Danish Hysterectomy Database in the 2004-2008-period were included in this cohort study and linked to central registers providing information on education, income and employment. Analyses were carried out using multiple logistic regression models.


RESULTS
Among the 16,645 patients with information on all variables, 34% had a vaginal hysterectomy, while 60% had an abdominal and 6% a laparoscopic procedure. Women with a short education were more likely to undergo vaginal hysterectomy (30%) than women with a higher education (28%) (odds ratio (OR): 1.23; 95% confidence interval (CI): 1.10-1.38), but this association seemed to be fully explained by differences in surgery indication (OR: 0.99; CI: 0.87-1.13). Women out of work less often had a vaginal hysterectomy than women in work when adjusting for surgery indication (OR: 0.79; CI: 0.70-0.88).


CONCLUSIONS
Small socioeconomic differences in surgical approach in hysterectomy were observed and were seemingly explained by clinical surgery indications, with the exception of women out of work for whom vaginal hysterectomy is used less often.
Forskningscenter for Forebyggelse og Sundhed, Glostrup Hospital, 2600 Glostrup, Denmark. sibeda01@regionh.dk
Signe B
SB
Daugbjerg
Bent
B
Ottesen
Finn
F
Diderichsen
Birgitte L
BL
Frederiksen
Merete
M
Osler
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data*; D007182:Income; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008019:Life Style; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D014591:Uterine Diseases / Q000601:surgery*