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Med. Sci. 2017, 5(2), 10; doi:10.3390/medsci5020010

Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities

1
Belhaven University-Atlanta, 4151 Ashford Dunwoody Rd, #130, Atlanta, GA 30319, USA
2
MPH Program, Department of Public Health and Health Administration, College of Health Science and Public Health, Eastern Washington University, 668 North Riverpoint Blvd., Room 230, Spokane, WA 99202, USA
*
Authors to whom correspondence should be addressed.
Academic Editor: Antoni Torres
Received: 11 March 2017 / Revised: 6 May 2017 / Accepted: 8 May 2017 / Published: 16 May 2017
(This article belongs to the Section Gynecology)
View Full-Text   |   Download PDF [255 KB, uploaded 16 May 2017]

Abstract

Hysterectomy, the driving force for symptomatic uterine fibroids since 1895, has decreased over the years, but it is still the number one choice for many women. Since 1995, uterine artery embolization (UAE) has been proven by many researchers to be an effective treatment for uterine fibroids while allowing women to keep their uteri. The preponderance of data collection and research has focused on care quality in terms of efficiency and effectiveness, with little on location and viability related to care utilization, accessibility and physical availability. The purpose of this study was to determine and compare the cost of UAE and classical abdominal hysterectomy with regard to race/ethnicity, region, and location. Data from National Hospital Discharge for 2004 through 2008 were accessed and analyzed for uterine artery embolization and hysterectomy. Frequency analyses were performed to determine distribution of variables by race/ethnicity, location, region, insurance coverage, cost and procedure. Based on frequency distributions of cost and length of stay, outliers were trimmed and categorized. Crosstabs were used to determine cost distributions by region, place/location, procedure, race, and primary payer. For abdominal hysterectomy, 9.8% of the sample were performed in rural locations accross the country. However, for UAE, only seven procedures were performed nationally in the same period. Therefore, all inferential analyses and associations for UAE were assumed for urban locations only. The pattern differed from region to region, regarding the volume of care (numbers of cases by location) and care cost. Comparing hysterectomy and UAE, the patterns indicate generally higher costs for UAE with a mean cost difference of $4223.52. Of the hysterectomies performed for fibroids on Black women in the rural setting, 92.08% were in the south. Overall, data analyzed in this examination indicated a significant disparity between rural and urban residence in both data collection and number of procedures conducted. Further research should determine the background to cost and care location differentials between races and between rural and urban settings. Further, factors driving racial differences in the proportions of hysterectomies in the rural south should be identified to eliminate disparities. Data are needed on the prevalence of uterine fibroids in rural settings. View Full-Text
Keywords: uterine fibroids; reproductive health; care utilization; hysterectomy; uterine artery embolization; healthcare; disparities; gynecological conditions; women’s health uterine fibroids; reproductive health; care utilization; hysterectomy; uterine artery embolization; healthcare; disparities; gynecological conditions; women’s health
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Glass Lewis, M.; Ekúndayò, O.T. Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities. Med. Sci. 2017, 5, 10.

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