Socioeconomic and Racial Predictors of Undergoing Laparoscopic Hysterectomy for Selected Benign Diseases: Analysis of 341 487 Hysterectomies

Study Objective: Socioeconomic status and race are important determinants of health care access in the United States. The purpose of our study was to evaluate whether these factors influence use of laparoscopic hysterectomy for management of benign gynecologic diseases. Design: Retrospective cohort study (Canadian Task Force classification II-3). Setting: Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 1998 to 2002. Patients: All records of women with primary discharge diagnosis of uterine leiomyomas or menorrhagia who underwent hysterectomy (laparoscopy or abdominal) were included in the study. Interventions: Race (Caucasian, African-American, Hispanic, or other), median household income (<$25 000, $25 000-$34 999, $35 000-$44 999, or ≥$45 000), and insurance status (private, Medicare, Medicaid, or other) were evaluated as determinants of laparoscopic surgical intervention. Unconditional logistic regression was used to estimate likelihood of laparoscopic approach to hysterectomy. Measurements and Main Results: Of 341 487 records for hysterectomy, 295 857 were performed by abdominal and 45 630 by laparoscopic approach. In adjusted analyses, African-Americans, Hispanics, and other ethnicities were less likely to undergo laparoscopic hysterectomy; adjusted OR (95% CI): 0.44 (0.42-0.45), 0.58 (0.55-0.61), and 0.68 (0.64-0.72), respectively, as compared with Caucasians. As compared with women with median income of less than $25 000, laparoscopic approach was more commonly performed on women with median household income $25 000 to $34 999, 1.18 (1.10-1.26); $35 000 to $44 999, 1.13 (1.0-1.21); and $45 000 and above, 1.14 (1.06-1.22). As compared with women with Medicaid, laparoscopic approach was more likely to be performed on women with private insurance: 1.45 (1.42-1.62). Conclusion: In the United States, median household income, insurance status, and race appear to be important independent determinants of access to laparoscopic hysterectomy for benign diseases.