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AJPH First Look, published online ahead of print Dec 4, 2008
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February 2009, Vol 99, No. 2 | American Journal of Public Health 300-307
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.133702

RESEARCH AND PRACTICE

Black–White Differences in Hysterectomy Prevalence: The CARDIA Study

Julie K. Bower, MPH, Pamela J. Schreiner, PhD, Barbara Sternfeld, PhD and Cora E. Lewis, MD, MSPH

Julie K. Bower and Pamela J. Schreiner are with the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis. Barbara Sternfeld is with the Division of Research, Kaiser Permanente, Oakland, CA. Cora E. Lewis is with the Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham.

Correspondence: Requests for reprints should be sent to Pamela J. Schreiner, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 Second St S, Suite 300, Minneapolis, MN 55454 (e-mail: schre012{at}umn.edu).

Objectives. We evaluated the cross-sectional association between race and hysterectomy prevalence in a population-based cohort of US women and investigated participant characteristics associated with racial differences.

Methods. The cohort consisted of 1863 Black and White women in the Coronary Artery Risk Development in Young Adults (CARDIA) study from 2000 to 2002 (years 15 and 16 after baseline). We used logistic regression to examine unadjusted and multivariable adjusted odds ratios.

Results. Black women demonstrated greater odds of hysterectomy compared with White women (odds ratio [OR] = 3.52; 95% confidence interval [CI] = 2.52, 4.90). Adjustment for age, educational attainment, perceived barriers to accessing medical care, body mass index, polycystic ovarian syndrome, tubal ligation, depressive symptoms, age at menarche, and geographic location minimally altered the association (OR = 3.70; 95% CI = 2.44, 5.61). In a subset of the study population, those with directly imaged fibroids, the association was minimally attenuated (OR = 3.47; 95% CI = 2.23, 5.40).

Conclusions. In both unadjusted and multivariable adjusted models, Black women, compared with White women, had increased odds of hysterectomy that persisted despite adjustment for participant characteristics. The increased odds are possibly related to decisions to undergo hysterectomy.






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