TY - JOUR
T1 - Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications
T2 - A Systematic Review
AU - Wieslander, Cecilia K.
AU - Grimes, Cara L.
AU - Balk, Ethan M.
AU - Hobson, Deslyn T.G.
AU - Ringel, Nancy E.
AU - Sanses, Tatiana V.D.
AU - Singh, Ruchira
AU - Richardson, Monica L.
AU - Lipetskaia, Lioudmila
AU - Gupta, Ankita
AU - White, Amanda B.
AU - Orejuela, Francisco
AU - Meriwether, Kate
AU - Antosh, Danielle D.
N1 - Funding Information:
Financial Disclosure Cara L. Grimes is the research chair for the Society of Gynecologic Surgeons (board position, travel support), Consultant, Provepharm Inc. and she received institutional research support from Reia. Ethan M. Balk received funding from SGS for methodology consultation. Amanda White reports receiving payment from Boston Scientific. Kate Meriwether is the research chair for the Society of Gynecologic Surgeons (board position, travel support). She received book royalties from Elsevier Publishing, has been a consultant for RBI Medical (industry device company, paid position), and received research support from Cook Myosure and Caldera Medical. The other authors did not report any potential conflicts of interest.
Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - OBJECTIVE: To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications.DATA SOURCES: PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022.METHODS OF STUDY SELECTION: The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies.TABULATION, INTEGRATION, AND RESULTS: Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy.CONCLUSION: Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021234511.
AB - OBJECTIVE: To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications.DATA SOURCES: PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022.METHODS OF STUDY SELECTION: The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies.TABULATION, INTEGRATION, AND RESULTS: Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy.CONCLUSION: Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021234511.
KW - Aged
KW - Female
KW - Humans
KW - United States
KW - Healthcare Disparities
KW - Medicare
KW - Hysterectomy/methods
KW - Ethnicity
KW - Hysterectomy, Vaginal
KW - Retrospective Studies
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U2 - 10.1097/AOG.0000000000005389
DO - 10.1097/AOG.0000000000005389
M3 - Review article
C2 - 37826848
AN - SCOPUS:85174641192
SN - 0029-7844
VL - 142
SP - 1044
EP - 1054
JO - Obstetrics and Gynecology
JF - Obstetrics and Gynecology
IS - 5
ER -