title: Decreasing trend of hysterectomy in Taiwan: A population-based study, 1997-2010.
abstract: OBJECTIVE
  Gynecologists in Taiwan are lacking a comprehensive picture of the changes in clinical practice and indications of hysterectomy over a long period of time. The aims of this study were to examine the national trends in the utilization of hysterectomy and to explore changes in its utilization rate over a 14-year period from 1997 to 2010.
  
  
  METHODS
  We conducted a population-based trend analysis using the claims data from the Taiwan's National Health Insurance program.
  
  
  RESULTS
  We identified a total of 341,993 women aged 20 years or older who underwent hysterectomy between 1997 and 2010. The total number of hysterectomies increased from 22,961 in 1997 to 27,757 cases in 1999, followed by a decline to 22,351 in 2010. Overall, 5406 fewer hysterectomies (-19.5%) were performed in 2010 when compared with those performed in 1999. The number of hysterectomies performed decreased from 1997 to 2010 for precancerous lesions (-55.6%), chronic pelvic pain (-35.2%), uterine leiomyoma (-13.1%), and uterine prolapse (-7.2%). However, the utilization of hysterectomy increased for endometriosis (+76.3%) and gynecologic cancer (+22.7%) during the same time frame.
  
  
  CONCLUSIONS
  The clinical utilization and primary indications of hysterectomy changed substantially in Taiwan from 1997 to 2010. The continued monitoring of changes in hysterectomy rates will be critical for understanding the appropriate indications for hysterectomy and oophorectomy, the emergence of alternative managements for uterine disorders, and future trends in women's reproductive health.
authors.affiliation: Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jerry Cheng-Yen
authors.initials: JC
authors.lastname: Lai
authors.affiliation: Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.affiliation: Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Sheng-Miauh
authors.initials: SM
authors.lastname: Huang
authors.affiliation: Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hu
authors.affiliation: Department of Medicine, Medical University of Lublin, Lublin, Poland.
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Wang
authors.affiliation: Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: yjchou@ym.edu.tw.
authors.forename: Yiing-Jenq
authors.initials: YJ
authors.lastname: Chou
authors.affiliation: Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan. Electronic address: KL421229@ms6.hinet.net.
authors.forename: Kung-Liahng
authors.initials: KL
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007044:Hysterectomy / Q000639:trends*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014591:Uterine Diseases / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
keywords: Taiwan; hysterectomy; leiomyoma; population surveillance; trends