University of Helsinki, P.O. Box 4, 00014, Helsinki, Finland.
Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland.
BMC Womens Health. 2021 Jun 14;21(1):242. doi: 10.1186/s12905-021-01386-2.
A persistent research finding in Finland and elsewhere has been variation in medical practices both between and within countries. Variation seems to exist especially if medical decision making involves discretion and the best treatment cannot be identified unambiguously. This is true for hysterectomy when performed for benign causes. The aim of the current study was to investigate regional trends in hysterectomy in Finland and the potential convergence of rates over time.
We used hospital discharge register data on hysterectomies performed, diagnoses, age, and region of residence to examine hospital discharges for women undergoing hysterectomy in 2001-2018 among total female population aged 25 years or older in Finland. We examined hysterectomy rates among biannual cohorts by indication, calculated age-standardised rates and used multilevel models to analyse potential convergence over time.
Altogether 131,695 hysterectomies were performed in Finland 2001-2018. We found a decreasing trend, with the age-adjusted overall hysterectomy rate decreasing from 553/100,000 person years in 2001-2002 to 289/100,000 py in 2017-2018. Large but converging regional differences were found. The correlations between hospital district intercepts and slopes in time ranged from - 0.71 to - 0.97 (p < 0.001) suggesting diminishing variation.
Our findings demonstrate that change in hysterectomy practices and more uniformity across regions are achievable goals. Regional variation still exists suggesting differences in medical practices.
芬兰和其他国家的一项持续研究发现，医疗实践在国家之间和内部都存在差异。如果医疗决策涉及自由裁量权，并且无法明确确定最佳治疗方法，那么这种差异似乎尤其存在。对于因良性原因而进行的子宫切除术就是如此。本研究的目的是调查芬兰子宫切除术的区域趋势，以及随着时间的推移，这些趋势是否可能趋同。
我们使用医院出院登记数据，对 2001 年至 2018 年间芬兰年龄在 25 岁及以上的所有女性进行了因良性原因接受子宫切除术的女性的医院出院情况，包括子宫切除术、诊断、年龄和居住地的区域。我们按指征检查了每两年一次的队列中的子宫切除术率，计算了年龄标准化率，并使用多水平模型分析了随时间推移的潜在趋同。
2001 年至 2018 年间，芬兰共进行了 131695 例子宫切除术。我们发现了一种下降趋势，调整年龄后的总体子宫切除术率从 2001-2002 年的 553/100,000 人年下降到 2017-2018 年的 289/100,000 人年。发现了较大但趋同的区域差异。医院区截距和时间斜率之间的相关性范围为-0.71 至-0.97（p<0.001），表明差异在减小。
我们的研究结果表明，改变子宫切除术的实践和使区域更加统一是可以实现的目标。区域差异仍然存在，表明医疗实践存在差异。
