Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study.

Objectives: Rates of severe maternal morbidity have highlighted persistent and growing racial disparities in the United States (US). We aimed to contrast temporal trends in peripartum hysterectomy by race/ethnicity and quantify the contribution of changes in maternal and obstetric factors to temporal variations in hysterectomy rates. Methods: We conducted a population-based, retrospective study of 5,739,569 US residents with a previous cesarean delivery, using National Vital Statistics System's Natality Files (2011–2021). Individuals were stratified by self-identified race/ethnicity and classified into four periods based on year of delivery. Temporal changes in hysterectomy rates were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). We used sequential logistic regression models to quantify the contribution of maternal and obstetric factors to temporal variations in hysterectomy rates. Results: Over the study period, the peripartum hysterectomy rate increased from 1.23 (2011–2013) to 1.44 (2019–2021) per 1,000 deliveries (OR 2019–2021 vs. 2011–2013 = 1.17, 95% CI 1.10 to 1.25). Hysterectomy rates varied by race/ethnicity with the highest rates among Native Hawaiian and Other Pacific Islander (NHOPI; 2.73 per 1,000 deliveries) and American Indian or Alaskan Native (AIAN; 2.67 per 1,000 deliveries) populations in 2019–2021. Unadjusted models showed a temporal increase in hysterectomy rates among AIAN (2011–2013 rate = 1.43 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.87, 95% CI 1.02 to 3.45) and White (2011–2013 rate = 1.13 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.21, 95% CI 1.11 to 1.33) populations. Adjustment ranged from having no effect among NHOPI individuals to explaining 14.0% of the observed 21.0% increase in hysterectomy rates among White individuals. Conclusion: Nationally, racial disparities in peripartum hysterectomy are evident. Between 2011–2021, the rate of hysterectomy increased; however, this increase was confined to AIAN and White individuals. [ABSTRACT FROM AUTHOR]

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