
          CDC Study Reveals--South's Hysterectomy Rate Highest
          By Tullos, AllenAET
          Vol. 8, No. 3, 1986, pp. 13-14
          
          Nearly five million American women underwent hysterectomies in the
last decade, making this procedure one of the most frequently
performed operations for women of reproductive age and an important
public health concern. Since 1970, the Centers for Disease Control
(CDC) in Atlanta have provided epidemiologic surveillance of
hysterectomies performed on women from fifteen to forty-four years of
age. This summer the CDC released a report which examined, among other
factors, the influence of race and geographic section of the US on
hysterectomy rates for 1981-1982, and which updated the analysis of
hysterectomy rates for 1970-1980. The results of the survey contain
striking findings for women of reproductive age in the Southern
states.
          The data that was used for this surveillance effort was gathered
from 1970 to 1982 as part of the ongoing National Hospital Discharge
Survey. This survey samples hospitals throughout the US in order to
estimate the number of patients, their diagnoses and the surgical
procedures they undergo. The sample of hospitals is designed to
reflect an overall distribution of short-stay hospitals in the United
States. In most cases women will have a hysterectomy done in a
short-stay hospital. The CDC survey is a sample, not the actual number
of hysterectomies done in the US, and as such may contain unknown
biases.
          A 1983 analysis showed that the nationwide hysterectomy rate
declined from 1975 to 1980 among women of reproductive age. The
current study however, indicates that the noted decline may have begun
to plateau, although rates in 1982 were the lowest since 1970. The
average age at time of hysterectomy for women in the fifteen to
forty-four age group was similar in all geographic areas, ranging from
34.2 years in the South to 36.6 years in the Northeast.
          As in previous years, major differences in hysterectomy rates by
section of the country have persisted (see Figure 1). The South
continues to show the highest rates. The most striking differences
exist between the South and the Northeast. The hysterectomy rate for
women of reproductive age in the South was two and a half times that
for women in the Northeast.
          During 1979-1980, differences in hysterectomy rates between blacks
and whites declined noticeably. In 1981, however, the rates of blacks
and whites diverged, only to converge again in 1982. In 1982 (the most
recent year for which data is available), for the first time since
surveillance began in 1970, blacks had a lower hysterectomy rate than
whites.
          Variations in hysterectomy rates by section of the country have
persisted since 1970. Lacking more than the limited data from the
sample study, CDC researchers are quite cautious about speculating on
the regional differences. "As epidemiologists in the federal
government," comments Dr. Kathleen Irwin, researcher on the CDC study,
"we feel that our job is to present the numbers and let other people
speculate on them."
          The CDC study suggests only that "patient-related factors may
include regional differences in the incidence of gynecologic
conditions and in general attitudes toward surgery or sterilization
during the reproductive years. Physician-related factors may include
regional differences in trends in training and practice."
          "If there were true differences in the South compared to other
regions," asks Dr. Irwin, "what could these be? There could be a whole
range of differences. Our study looked at only one factor at a time:
race, region, age group for the United States. We didn't look at race
and region at the same time. It could be an age-related phenomenon:
that the age distribution in the South is different than in other
parts of the country among women who are likely to get
hysterectomies. It may be that there is a higher prevalence in the
South of certain diseases of the uterus which are treated with
hysterectomies. It could be that physicians in the South are more
liable to treat a given condition with a hysterectomy.
          "Because of the nature of our analysis," says Dr. Irwin, "we're not
in a position to say which one of those things or which combination it
could be."
          "It's disturbing to me," commented clinic administrator Lynn
Thogersen, of the Atlanta Feminist Women's Health Center, "as a
women's health care 

provider, and as a woman, to see the rate of
hysterectomies for women in general being so high, and especially to
see the difference for women in the South when compared with other
areas of the country. Certainly we wonder if all these hysterectomies
were necessary.
          "One thing that might have a bearing on the numbers in the South,"
continues Thogersen, "is the fact that in all of the Southern states,
unlike states such as New York and California, Medicaid no longer pays
for abortions, and hasn't since about 1981. We wonder if in fact women
are choosing hysterectomy as a way of controlling their fertility
because other options aren't available to them.
          "And I wonder if one reason that rates of hysterectomies have
dropped in other sections of the country is due to the availability of
tubal ligations as a method of sterilization. Sterilization, including
both male and female, is now the most used method of contraception in
the United States, but it's mostly women who are choosing
sterilization.
          "Statistics like these," concludes Thogersen, "make you want to ask
many other questions for which we have no answers. What, for instance,
is the difference in hysterectomy rates between black and white women
in the South? Between poor and middle-class women? What, if any,
significance can be read in this study about the traditional timidity
and acceptance of professional authority shown by women in the South
toward the largely white male ranks of physicians? Simply put, we need
to know much more about what lies behind these disturbing rates."
          
            The CDC study, "Hysterectomy Among Women of Reproductive
Age, Unites States, Update for 1981- 1982," was published in the CDC
Surveillance Summary, Vol. 35, No. ISS (June 1986). The
study was conducted by Kathleen L Irwin, M.D. and Herbert B. Peterson,
M.D. (both of the Epidemiologic Studies Branch) and Joyce M. Hughes
and Sara W. Gill (of the Research and Statistics Branch), Division of
Reproductive Health, Center for Health Promotion and
Education.
          
        