Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study

Abstract

Objectives Rates of severe maternal morbidity have highlighted persistent and growing racial disparities in the United States (US). We aimed to contrast temporal trends in peripartum hysterectomy by race/ethnicity and quantify the contribution of changes in maternal and obstetric factors to temporal variations in hysterectomy rates. Methods We conducted a population-based, retrospective study of 5,739,569 US residents with a previous cesarean delivery, using National Vital Statistics System’s Natality Files (2011–2021). Individuals were stratified by self-identified race/ethnicity and classified into four periods based on year of delivery. Temporal changes in hysterectomy rates were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). We used sequential logistic regression models to quantify the contribution of maternal and obstetric factors to temporal variations in hysterectomy rates. Results Over the study period, the peripartum hysterectomy rate increased from 1.23 (2011–2013) to 1.44 (2019–2021) per 1,000 deliveries (OR 2019–2021 vs. 2011–2013 = 1.17, 95% CI 1.10 to 1.25). Hysterectomy rates varied by race/ethnicity with the highest rates among Native Hawaiian and Other Pacific Islander (NHOPI; 2.73 per 1,000 deliveries) and American Indian or Alaskan Native (AIAN; 2.67 per 1,000 deliveries) populations in 2019–2021. Unadjusted models showed a temporal increase in hysterectomy rates among AIAN (2011–2013 rate = 1.43 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.87, 95% CI 1.02 to 3.45) and White (2011–2013 rate = 1.13 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.21, 95% CI 1.11 to 1.33) populations. Adjustment ranged from having no effect among NHOPI individuals to explaining 14.0% of the observed 21.0% increase in hysterectomy rates among White individuals. Conclusion Nationally, racial disparities in peripartum hysterectomy are evident. Between 2011–2021, the rate of hysterectomy increased; however, this increase was confined to AIAN and White individuals.