Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration

Cathea M Carey; Jodie G Katon; Andrew S Bossick; Kristen E Gray; Kemi M Doll; Alicia Y Christy; Lisa S Callegari

doi:10.1089/heq.2022.0130

Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration

Health Equity. 2022 Dec 16;6(1):909-916. doi: 10.1089/heq.2022.0130. eCollection 2022.

Authors

Cathea M Carey¹, Jodie G Katon¹, Andrew S Bossick^{2

3}, Kristen E Gray^{1

2}, Kemi M Doll^{2

4}, Alicia Y Christy⁵, Lisa S Callegari^{1

2

4}

Affiliations

¹ Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington, USA.
² Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
³ Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
⁴ Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA.
⁵ Women's Health Services, Veterans Administration, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA.

Abstract

Introduction: Uterine fibroids are the most common indication for hysterectomy. Minimally invasive hysterectomy (MIH) confers lower risk of complications and shorter recovery than open surgical procedures; however, it is more challenging to perform with larger fibroids. There are racialized differences in fibroid size and MIH rates. We examined the role of uterine size in black-white differences in MIH among Veterans in the Department of Veterans Affairs (VA).

Methods: Using VA clinical and administrative data, we conducted a cross-sectional study among black and white Veterans with fibroids who underwent hysterectomy between 2012 and 2014. We abstracted postoperative uterine weight from pathology reports as a proxy for uterine size. We used a generalized linear model to estimate the association between race and MIH and tested an interaction between race and postoperative uterine weight (≤250 g vs. >250 g). We estimated adjusted marginal effects for racial differences in MIH by postoperative uterine weight.

Results: The sample included 732 Veterans (60% black, 40% white). Postoperative uterine weight modified the association of race and MIH (p for interaction=0.05). Black Veterans with postoperative uterine weight ≤250 g had a nearly 12-percentage point decrease in MIH compared to white Veterans (95% CI -23.1 to -0.5), with no difference by race among those with postoperative uterine weight >250 g.

Discussion: The racial disparity among Veterans with small fibroids who should be candidates for MIH underscores the role of other determinants beyond uterine size. To eliminate disparities in MIH, research focused on experiences of black Veterans, including pathways to treatment and provider-patient interactions, is needed.

Keywords: Veterans; fibroid size; minimally invasive hysterectomy; racial disparities; uterine fibroids.