Hysterectomy rates for benign gynecologic conditions vary by race/ethnicity. We investigated racial/ethnic variations in rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications at Kaiser Permanente Northern California (KPNC), an integrated health care system.METHODS:
We conducted a retrospective IRB-approved cohort study of 1,050 patients randomly selected from the 6,892 patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 at KPNC. Primary outcomes were use of treatments prior to hysterectomy. Demographic covariates included age and median household income. Clinical characteristics included comorbidities, benign gynecologic indication, type of hysterectomy and counseling status. Chi-square and Fisher exact tests were used for bivariate analyses and logistic regression for multivariable analyses.RESULTS:
Of the 1,050 charts reviewed, 980 (93.3%) patients met inclusion criteria. Prior to a hysterectomy, 99.3% of patients were counseled regarding alternative treatments and 18.7% declined alternative treatment options. In bivariate analyses, there were racial/ethnic variations in the proportion of women who received alternative treatments. Among Asians, 70.5% received an alternative treatment compared to 77.8% for blacks, 84.4% for Hispanics and 82.2% for whites (p-value=0.0037). These variations did not persist in multivariate analyses, adjusting for demographic and clinical characteristics. Of the 18.7% who declined alternative treatment, the majority (41.9%) were white.CONCLUSION:
The majority of patients were counseled about alternative treatments and 80% tried at least one prior to undergoing a hysterectomy. Unlike previous studies, there were no differences in receiving alternative treatments between whites, Asians, blacks and Hispanics within our integrated health system.