Chen Innie, Wise Michelle R, Dunn Sheila, Anderson Geoffrey, Degani Naushaba, Lefebvre Guylaine, Bierman Arlene S
Department of Obstetrics and Gynecology, The University of Ottawa, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON.
Department of Obstetrics and Gynaecology, Auckland District Health Board and University of Auckland, Auckland, New Zealand.
J Obstet Gynaecol Can. 2017 Oct;39(10):861-869. doi: 10.1016/j.jogc.2017.03.109. Epub 2017 Jun 21.
This study sought to determine whether social factors (neighbourhood education and income) and geographic factors (urban or rural dwelling and local service area) are associated with hysterectomy rates, proportion of hysterectomies performed minimally invasively, and hysterectomy complication and readmission rates in Ontario.
The Canadian Institute for Health Information Discharge Abstract Database was used to perform a population-based retrospective cross-sectional study on women who had an abdominal, vaginal, and laparoscopic hysterectomy in 2007 for benign gynaecologic conditions in hospitals in Ontario, Canada. Crude and age-standardized rates of hysterectomy, proportion of hysterectomy performed minimally invasively (vaginal or laparoscopic), and rates of surgical complications were analyzed by neighbourhood educational attainment, neighbourhood income, rural or urban residency, and health service delivery area (Canadian Task Force Classification of Study Design II).
A total of 13 511 women who underwent hysterectomy were included. Age-standardized hysterectomy rates were higher for the lowest neighbourhood educational quartile compared with the highest (relative risk [RR] 1.49; 95% CI 1.39-1.60), higher with rural compared with urban dwelling (RR 1.54; 95% CI 1.47-1.61), varied with local health service delivery area (Local Health Integration Network [LHIN]) (range 133.4-439.5 per 100 000 women), and also varied non-linearly with neighbourhood income quintile. Proportion of hysterectomies performed minimally invasively did not vary with neighbourhood education or income, were higher for rural compared with urban areas (RR 1.10; 95% CI 1.03-1.19), and varied with LHIN (range 30.0-62.9 per 100 hysterectomies). Surgical complications varied with neighbourhood educational quartile, but not with income or urban or rural residence.
Considerable social and geographic variation exists in rates of hysterectomy in Ontario, whereas only geographic variation is seen in use of minimally invasive routes. Surgical complication rates vary only by neighbourhood education. Such findings suggest inequities in hysterectomy practice in Ontario, and there is a need to evaluate factors influencing patients' decision making, physicians' clinical and surgical practice, and health system policies to help address the observed disparities.
本研究旨在确定社会因素（社区教育程度和收入）和地理因素（城市或农村居住情况以及当地服务区域）是否与安大略省的子宫切除率、微创子宫切除比例、子宫切除并发症及再入院率相关。
利用加拿大卫生信息研究所出院摘要数据库，对2007年在加拿大安大略省医院因良性妇科疾病接受腹部、阴道及腹腔镜子宫切除术的女性进行基于人群的回顾性横断面研究。按社区教育程度、社区收入、农村或城市居住情况以及卫生服务提供区域（加拿大工作组研究设计分类II）分析子宫切除的粗率和年龄标准化率、微创子宫切除（阴道或腹腔镜）比例以及手术并发症发生率。
共纳入13511例行子宫切除术的女性。社区教育程度最低四分位数组的年龄标准化子宫切除率高于最高四分位数组（相对风险[RR]1.49；95%可信区间1.39 - 1.60），农村居住者高于城市居住者（RR 1.54；95%可信区间1.47 - 1.61），因当地卫生服务提供区域（地方卫生整合网络[LHIN]）而异（每10万名女性中范围为133.4 - 439.5），且与社区收入五分位数呈非线性变化。微创子宫切除比例不因社区教育程度或收入而变化，农村地区高于城市地区（RR 1.10；95%可信区间1.03 - 1.19），并因LHIN而异（每100例子宫切除中范围为30.0 - 62.9）。手术并发症因社区教育四分位数而异，但不因收入或城乡居住情况而异。
安大略省子宫切除率存在显著的社会和地理差异，而微创途径的使用仅存在地理差异。手术并发症发生率仅因社区教育程度而异。这些发现表明安大略省子宫切除实践中存在不平等现象，有必要评估影响患者决策、医生临床和手术实践以及卫生系统政策的因素，以帮助解决所观察到的差异。
