Predictors of hysterectomy: An Australian study,☆☆,

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Abstract

Objective: We evaluated the relative importance of predictors of hysterectomy. Study Design: A questionnaire survey of an Australia-wide sample of adult female twins was conducted; self-report data were validated against reports from treating physicians. Results: A total of 3096 women (94%) and 366 physicians (87%) responded. The sensitivity of patient report of hysterectomy was 98.2%. Best predictors of hysterectomy were endometriosis (odds ratio 4.85, 95% confidence interval 3.17-7.43), medical consultation for menorrhagia (odds ratio 3.55, 95% confidence interval 2.47-5.12), joint effects of fibroids with medical consultation for chronic or persisting pelvic pain (odds ratio 3.34, 95% confidence interval 1.42 to 7.87), having smoked >40 cigarettes per day (odds ratio 3.24, 95% confidence interval 1.10-9.55), joint effects of fibroids with consultation for menstrual problems (odds ratio 2.61, 95% confidence interval 1.36-5.01), and tubal ligation (odds ratio 1.77, 95% confidence interval 1.31-2.39). Less-important predictors were age and higher education level (protective). Conclusion: Consulting a physician about pelvic pain and menstrual problems, especially heavy bleeding, are recognized steps toward hysterectomy. Of particular interest for future genetic analyses are the high odds of hysterectomy for women with endometriosis, fibroids, or menorrhagia. (Am J Obstet Gynecol 1999;180:945-54.)

Section snippets

Sample

Participants were members of a cohort of 1979 female twin pairs, ascertained originally in 1980 to 1982 from the Australian Twin Register, and followed up in 1988 to 1990.1, 2 The current study comprised a third wave of data collection from the original cohort of female twins. In 1993 to 1994 questionnaires that focused on gynecologic conditions and hysterectomy were sent to both members of 1570 female twin pairs plus a further 158 individual female twins in incomplete pairs (3298 individuals)

Response

A total of 3096 women returned a questionnaire that was at least partially completed, giving an individual response rate of 94%. The respondents comprised 1431 pairs where both cotwins responded and 234 single twins, a pairwise response rate of 91%. Major reasons for nonresponse were death (n = 24) or they were uncontactable (n = 93) or too busy to participate (n = 76).

Of women reporting hysterectomy (n = 524), 439 (86%) gave consent to approach relevant physicians and response was obtained

Comment

The aim of this component of our research was to identify predictors of hysterectomy from an epidemiologic rather than a clinical sample. Our findings affirmed that women accurately reported hysterectomy; there were few true inconsistencies between women’s and physicians’ reports. Careful checking revealed very few reasons why the patient’s report should not be accepted and suggested that the physician’s negative response in some cases may have substituted for not knowing the patient’s

Acknowledgements

We thank Olivia Zheng, Ann Eldridge, Lorna Greenwood, Theresa Pangan, Petra Kuhnert, Gu Zhu, and John Pearson for research and computing assistance.

References (37)

  • GA Colditz et al.

    Reproducibility and validity of self-reported menopausal status in a prospective cohort study

    Am J Epidemiol

    (1987)
  • KM Brett et al.

    Hysterectomy use: the correspondence between self-reports and hospital records

    Am J Public Health

    (1994)
  • MB Harris et al.

    Changing hysterectomy patterns after introduction of laparoscopically assisted vaginal hysterectomy

    Am J Obstet Gynecol

    (1994)
  • NA Bickell et al.

    A matter of opinion about hysterectomies: experts’ and practicing community gynecologists’ ratings of appropriateness

    Am J Public Health

    (1995)
  • SE Geller et al.

    The impact of nonclinical factors on practice variations: the case of hysterectomies

    Health Serv Res

    (1996)
  • JF Steege

    Indications for hysterectomy: have they changed?

    Clin Obstet Gynecol

    (1997)
  • MP Vessey et al.

    The epidemiology of hysterectomy: findings in a large cohort study

    Br J Obstet Gynaecol

    (1992)
  • A Clarke et al.

    Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study

    Br J Obstet Gynaecol

    (1995)
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    Supported by the Mayne Bequest Fund (University of Queensland) and the Australian Gynaecological Endoscopy Society.

    ☆☆

    Reprint requests: S.A. Treloar, PhD, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Queensland 4029, Australia.

    0002-9378/99 $8.00 + 0   6/1/96055

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