Changing trends in Black-White racial differences in surgical menopause: a population-based study

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Am J Obstet Gynecol. 2021 Jun 7:S0002-9378(21)00614-1. doi: 10.1016/j.ajog.2021.05.045. Online ahead of print.


BACKGROUND: Bilateral oophorectomy before menopause, or surgical menopause, is associated with negative health outcomes, including increased risk of stroke and other cardiovascular outcomes; however, surgical menopause also dramatically reduces ovarian cancer incidence and mortality rates. Because there are competing positive and negative sequelae of surgical menopause, clinical guidelines have not been definitive. Previous research indicates that White women have higher rates of surgical menopause than other groups. However, previous studies may have underestimated rates of surgical menopause among Black women. Further, clinical practice has changed dramatically in the past 15 years, and there are no population-based studies using more recent data. Tracking actual racial differences in receipt of surgical menopause is important for ensuring equity in gynecologic care.

OBJECTIVES: This population-based surveillance study evaluated racial differences in rates of surgical menopause in all inpatient and outpatient settings in a large, racially diverse U.S. state with historically high rates of hysterectomy.

STUDY DESIGN: We evaluated all inpatient and outpatient surgeries in North Carolina from 2011 to 2014 for patients aged 20-44 years. Surgical menopause was defined as bilateral oophorectomy, with or without accompanying hysterectomy, among North Carolina residents. ICD-9 (International Classification of Diseases, Ninth Revision) and CPT (Current Procedural Terminology) codes were used to identify inpatient and outpatient procedures, respectively, and diagnostic indications. We estimated age- and race/ethnicity-specific rates of surgical menopause using county-specific population estimates based on the US 2010 census. We used Poisson regression with deviance-adjusted residuals to estimate incidence rate ratios in the entire state population. We tested changes in surgery rates over time (reference year: 2011), differences by setting (reference: inpatient), and differences by race/ethnicity (reference: Non-Hispanic White). Then we described surgery rates between Non-Hispanic White and Non-Hispanic Black patients.

RESULTS: Between 2011 and 2014, 11,502 surgical menopause procedures for benign indications, were performed in North Carolina among reproductive-aged residents. Most (95%) of these surgeries occurred concomitant with hysterectomy. Over the 4-year period, there was a 39% reduction in inpatient surgeries (IRR=0.61), and a 100% increase in outpatient surgeries (IRR=2.0). Restricting to surgeries among Non-Hispanic White and Black patients, the increase in outpatient surgeries was significantly higher among Non-Hispanic Black women (p<.01) for year*race interaction [ref=2011, Non-Hispanic White]). Total rates of bilateral oophorectomy for Non-Hispanic Black women rose more quickly than for non-Hispanic White women (p<.01). In 2011, the rate of surgical menopause was greater among White women (17.7 vs 13.2 per 10,000 women for Black women). By 2014, the racial trends were reversed (rate=24.8 for Non-Hispanic White women and 28.4 per 10,000 for Non-Hispanic Black women).

CONCLUSIONS: Our findings suggest that rates of surgical menopause increased in North Carolina in the early 2010s, especially among non-Hispanic Black women. By 2014, rates of surgical menopause among Non-Hispanic Black women had surpassed that of Non-Hispanic White women. Given the long-term health consequences associated with surgical menopause, we propose potential drivers of racially patterned increasing use of bilateral oophorectomy before age 45 years.

PMID:34111405 | DOI:10.1016/j.ajog.2021.05.045