Datta Biplab Kumar, Tiwari Ashwini, Abdelgawad Yara H, Wasata Ruhun
Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA; Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA.
Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA; Department of Community & Behavioral Health Sciences, Augusta University, Augusta, GA, USA.
Sex Reprod Healthc. 2024 Dec;42:101019. doi: 10.1016/j.srhc.2024.101019. Epub 2024 Aug 28.
Hysterectomy is one of the common surgical procedures for women in the United States. Studies show that hysterectomy is associated with elevated risk of developing chronic conditions, whichmay cause financial toxicity in patients. This study aimed to assess whether women who underwent hysterectomy had a higher risk of experiencing medical financial hardship compared to women who didn't.
Using data on 32,823 adult women from the 2019 and 2021 waves of the National Health Interview Survey, we estimated binomial and multinomial logistic regressions to assess the relationship between hysterectomy and financial hardship, defined as problems paying or unable to pay any medical bills. Further, we performed a Karlson-Holm-Breen (KHB) decomposition to examine whether the association could be explained by chronic comorbidity.
While the prevalence of financial hardship was 13.6 % among all women, it was 16.2 % among women who underwent a hysterectomy. The adjusted odds of experiencing medical financial hardship among women with a hysterectomy were 1.36 (95 % CI: 1.22-1.52) times that of their counterparts who did not have a hysterectomy. The KHB decomposition suggested that 34.5 % of the size of the effect was attributable to chronic conditions. Women who had a hysterectomy were also 1.45 (95 % CI: 1.26-1.67) times more likely to have unpaid medical debts.
Our results suggested that women, who underwent a hysterectomy in the US, were vulnerable to medical financial hardship. Policy makers and health professionals should be made aware of this issue to help women coping against this adversity.
子宫切除术是美国女性常见的外科手术之一。研究表明，子宫切除术与患慢性病风险升高有关，这可能给患者带来经济负担。本研究旨在评估接受子宫切除术的女性相比未接受该手术的女性，经历医疗经济困难的风险是否更高。
利用2019年和2021年全国健康访谈调查中32,823名成年女性的数据，我们估计了二项式和多项逻辑回归，以评估子宫切除术与经济困难之间的关系，经济困难定义为支付医疗账单有问题或无法支付任何医疗账单。此外，我们进行了卡尔森 - 霍尔姆 - 布林（KHB）分解，以检验这种关联是否可以由慢性合并症来解释。
所有女性中经济困难的患病率为13.6%，而接受子宫切除术的女性中这一比例为16.2%。接受子宫切除术的女性经历医疗经济困难的调整后优势比是未接受子宫切除术女性的1.36倍（95%置信区间：1.22 - 1.52）。KHB分解表明，效应大小的34.5%可归因于慢性病。接受子宫切除术的女性有未支付医疗债务的可能性也高出1.45倍（95%置信区间：1.26 - 1.67）。
我们的结果表明，在美国接受子宫切除术的女性易受医疗经济困难影响。政策制定者和卫生专业人员应意识到这一问题，以帮助女性应对这一困境。
