Black-White Differences in Hysterectomy Prevalence: The CARDIA Study

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. (Am J Public Health. 2009;99:300-307. doi:10.2105/AJPH.2008.133702)