Association Among Individual Race, Hospital Racial Composition, and Access to Minimally Invasive Hysterectomy for Patients With Uterine Leiomyomas

Abstract

OBJECTIVE: To assess the relative associations of individual race and hospital racial composition on the likelihood of undergoing minimally invasive hysterectomy for the treatment of uterine leiomyomas in New York State. METHODS: We performed a retrospective cohort study that used the New York SPARCS (Statewide Planning and Research Cooperative System) database to identify women with uterine leiomyomas who underwent hysterectomy from 2000 to 2018. Hospitals were grouped by racial composition into quartiles based on the proportion of non-Hispanic Black (Black) patients, with quartile 1 corresponding to the lowest proportion of Black patients and quartile 4 corresponding to the greatest proportion of Black patients. Surgical route was characterized as minimally invasive (laparoscopic, vaginal, or robot-assisted) or abdominal hysterectomy. The contributions of individual race and hospital racial composition on route of hysterectomy were assessed with a series of logistic regression models accounting for patient and hospital characteristics. RESULTS: A total of 259,161 women with leiomyomas who underwent hysterectomies at 215 hospitals were identified. The rate of minimally invasive hysterectomy increased from 20.2% in 2000 to 65.7% in 2018. From 2000 to 2009, 29.6% of White patients underwent minimally invasive hysterectomy compared with 12.3% of Black women (P<.001). Minimally invasive hysterectomy was performed in 34.4% of patients in hospitals that served the lowest percentage of Black patients, compared with 15.9% in centers serving the highest percentage of Black patients (P<.001). Similar trends were noted for the 2010–2018 time period. In a series of models, both individual race (odds ratio [OR] 0.52; 95% CI, 0.48–0.56) and hospital racial quartile (OR 0.43; 95% CI, 0.32–0.58) remained associated with performance of minimally invasive hysterectomy. CONCLUSION: Black women and women who receive care at hospitals that serve a greater proportion of Black patients are less likely to receive minimally invasive surgery when undergoing definitive surgical management for uterine leiomyomas. These disparities are worsening.