Variation in hysterectomy prevalence and trends among U.S. States and Territories-Behavioral Risk Factor Surveillance System, 2012-2020.

PURPOSE: We estimated up-to-date state- and territory-level hysterectomy prevalence and trends, which can help correct the population at risk denominator and calculate more accurate uterine and cervical cancer rates. METHODS: We analyzed self-reported data for a population-based sample of 1,267,013 U.S. women aged ≥ 18 years who participated in the Behavioral Risk Factor Surveillance System surveys from 2012 to 2020. Estimates were age-standardized and stratified by sociodemographic characteristics and geography. Trends were assessed by testing for any differences in hysterectomy prevalence across years. RESULTS: Hysterectomy prevalence was highest among women aged 70-79 years (46.7%) and ≥ 80 years (48.8%). Prevalence was also higher among women who were non-Hispanic (NH) Black (21.3%), NH American Indian and Alaska Native (21.1%), and from the South (21.1%). Hysterectomy prevalence declined by 1.9 percentage points from 18.9% in 2012 to 17.0% in 2020. CONCLUSIONS: Approximately one in five U.S. women overall and half of U.S. women aged ≥ 70 years reported undergoing a hysterectomy. Our findings reveal large variations in hysterectomy prevalence within and between each of the four census regions and by race and other sociodemographic characteristics, underscoring the importance of adjusting epidemiologic measures of uterine and cervical cancers for hysterectomy status.

Social Determinants of Cancer Risk Among American Indian and Alaska Native Populations: An Evidence Review and Map.

Objectives: To explore current literature on social determinants of health (SDOH) and cancer among American Indian and Alaska Native (AI/AN) populations. Methods: We searched Ovid MEDLINE®, CINAHL, and PsycINFO databases for articles published during 2000 to 2020, which included terms for SDOH and cancer occurrence in AI/AN populations. We derived the data extraction elements from the PROGRESS-Plus framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity extension guided the evidence map. Results: From 2180 screened articles, 297 were included. Most were observational (93.9%), employed a cross-sectional design (83.2%), were categorized as cancer occurrence and surveillance research (62%), and included no cancer-related risk factors (70.7%). Race, gender, and place were the most frequently included PROGRESS-Plus categories. Religion, relationship features, and characteristics of discrimination were least common. Only 12% of articles mentioned historical/current trauma or historical context. Conclusions: Gaps exist in our understanding of SDOH as drivers of cancer disparities in AI/AN populations. Future studies in health equity science may incorporate historical and cultural factors into SDOH frameworks tailored for AI/AN populations.

US hysterectomy prevalence by age, race and ethnicity from BRFSS and NHIS: implications for analyses of cervical and uterine cancer rates.

PURPOSE: Previous reports of gynecologic cancer rates have adjusted for hysterectomy prevalence with data from the Behavioral Risk Factor Surveillance System (BRFSS) or the National Health Interview Survey (NHIS). We sought to determine if BRFSS and NHIS produce similar estimates of hysterectomy prevalence. METHODS: Using data from BRFSS and NHIS, we calculated hysterectomy prevalence for women aged 20-79 years, stratified by 10-year age groups, survey year (2010, 2018), and race/ethnicity (Hispanic, non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, non-Hispanic all other race groups). RESULTS: BRFSS and NHIS produced similar increasing trends in hysterectomy prevalence by age and directional differences by race and ethnicity. Fewer than 2% of women aged 20-29 years and more than 4 out of 10 women aged 70-79 years reported having had a hysterectomy. CONCLUSION: Our analyses suggest adjustment for hysterectomy prevalence with data from either survey would likely reduce distortion in cervical and uterine cancer rates. BRFSS, a survey which has a larger sample size than NHIS, may better support analyses of hysterectomy estimates for smaller subpopulations.

Higher prevalence of hysterectomy among rural women than urban women: Implications for measures of disparities in uterine and cervical cancers.

PURPOSE: Differences in hysterectomy prevalence by rural or urban residence could distort comparisons of rural-urban cervical and uterine cancer incidence. Using data from a large population-based survey, we sought to understand whether hysterectomy prevalence varies by rural or urban residence and whether the relationship between hysterectomy prevalence and rurality varies by race or ethnicity. METHODS: Our analysis included 197,759 female respondents to the 2018 Behavioral Risk Factor Surveillance System, aged 20-79 years. We calculated population weighted proportions and 95% confidence intervals for hysterectomy prevalence, stratified by rural-urban residence and 5-year age groups. We also report estimates of hysterectomy prevalence by rural-urban residence for specific race and ethnic groups. FINDINGS: Hysterectomy prevalence increased with age and was more common among rural women than urban women. The largest absolute difference occurred among women aged 45-49 years; 28.6% of rural women (95% CI: 25.1-32.2) and 16.6% of urban women (95% CI: 15.3-17.8) reported a hysterectomy. For hysterectomy prevalence by race and ethnicity, rural estimates were higher than urban estimates for the following groups of women: non-Hispanic Asian, non-Hispanic other race, non-Hispanic Black, and non-Hispanic White. Among Hispanic women and non-Hispanic American Indian/Alaska Native women, rural-urban differences in hysterectomy prevalence were not statistically different at the 95% confidence level. CONCLUSIONS: Our results suggest that variation in hysterectomy prevalence, if not adjusted in the analysis, could produce distorted comparisons in measures of the relationship between rurality and uterine and cervical cancer rates. The magnitude of this confounding bias may vary by race and ethnicity.