title: Educational level, prevalence of hysterectomy, and age at amenorrhoea: a cross-sectional analysis of 9536 women from six population-based cohort studies in Germany.
abstract: BACKGROUND
  Hysterectomy prevalence has been shown to vary by education level. Hysterectomy influences age at amenorrhoea. The aim of this study was to examine these associations in Germany within population-based data sets.
  
  
  METHODS
  Baseline assessments in six population-based cohorts took place from 1997 through 2006 and included 9,548 women aged 20-84 years. All studies assessed hysterectomy history, school and professional degrees. Degrees were categorized into three levels each. Adjusted prevalence ratios and 95% confidence intervals (95% CI) were estimated.
  
  
  RESULTS
  Prevalences were higher in West Germany than East Germany, increased by age, and leveled off starting at 55-64 years. The age- and study-adjusted prevalence ratio (lowest versus highest school level) was 2.61 (95% CI: 1.28-5.30), 1.48 (95% CI: 1.21-1.81), and 1.01 (95% CI: 0.80-1.28) for women aged 20-45, 45-64, and 65 and more years respectively. The estimated adjusted prevalence ratios per one unit decrement of the educational qualification score (range 1 = lowest, 8 = highest) were 1.29 (95% CI: 1.02-1.64), 1.08 (95% CI: 1.04-1.12), and 0.98 (95% CI: 0.93-1.03) for women aged 20-44, 45-64, and 65-84 years respectively. Age at amenorrhoea was on average 6.2 years lower (43.5 years versus 49.7 years) among women with a history of hysterectomy than those without.
  
  
  CONCLUSIONS
  Lower educational level was associated with a higher hysterectomy prevalence among women aged 20-64 years. Several mediators associated with educational level and hysterectomy including women's disease risk, women's treatment preference, and women's access to uterus-preserving treatment may explain this association. At population level, hysterectomy decreases the age of amenorrhoea on average by 6.2 years.
authors.affiliation: Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str, 8, 06112 Halle (Saale) Halle, Germany. andreas.stang@uk-halle.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stang
authors.forename: Alexander
authors.initials: A
authors.lastname: Kluttig
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.forename: Karin Halina
authors.initials: KH
authors.lastname: Greiser
authors.forename: Doris
authors.initials: D
authors.lastname: Stöckl
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005858:Germany; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008593:Menopause; D008875:Middle Aged; D059351:Organ Sparing Treatments; D057240:Patient Preference; D012307:Risk Factors; D014599:Uterus; D055815:Young Adult