Does Universal Insurance Mitigate Racial Differences in Minimally Invasive Hysterectomy?

Area of Science:

• Surgical Oncology
• Health Services Research
• Health Disparities

Background:

• Racial and ethnic disparities in healthcare access and outcomes are well-documented.
• Minimally invasive surgical approaches for hysterectomy, such as total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH), offer potential benefits over open total abdominal hysterectomy (TAH).

Purpose of the Study:

• To investigate racial differences in the utilization of minimally invasive hysterectomy (TVH and TLH) versus open hysterectomy (TAH) among a universally insured population.
• To identify potential disparities in surgical approach for hysterectomy across different racial groups.

Main Methods:

• Retrospective analysis of the 2006-2010 national TRICARE claims data, covering a universally insured population.
• Inclusion of women aged 18 and above undergoing hysterectomy, stratified into white, African American, Asian, and other racial groups.
• Risk-adjusted multinomial logistic regression models were used to compare the likelihood of receiving TVH or TLH versus TAH across racial groups.

Main Results:

• Out of 33,015 hysterectomies, 83.9% were for benign conditions. Minimally invasive procedures (TVH and TLH) accounted for 57% of surgeries, while TAH comprised 42%.
• African American and Asian patients were significantly less likely than white patients to receive TVH or TLH compared to TAH.
• These disparities persisted even after adjusting for potential confounding factors and were observed for benign hysterectomy indications.

Conclusions:

• Racial minority patients are less likely to undergo minimally invasive hysterectomy compared to an open abdominal approach, despite having universal insurance coverage.
• Factors beyond insurance access likely contribute to these observed racial disparities in surgical approach for hysterectomy.
• Further investigation is warranted to understand and address the underlying causes of these inequities in surgical care.