{"doi":"10.1111/1471-0528.17509","title":"Geographic variation in the rate and route of hysterectomy for benign disease in the USA: A retrospective cross‐sectional study","abstract":"OBJECTIVES: To describe population rate of hysterectomy for benign disease in the USA, including geographic variation across states and Hospital Service Areas (HSAs; areas defined by common patient flows to healthcare facilities). DESIGN: Cross-sectional study. SETTING: Four US states including 322 HSAs. POPULATION: A total of 316 052 cases of hysterectomy from 2012 to 2016. METHODS: We compiled annual hysterectomy cases, merged female populations, and adjusted for reported rates of previous hysterectomy. We assessed small-area variation and created multi-level Poisson regression models. MAIN OUTCOME MEASURES: Prior-hysterectomy-adjusted population rates of hysterectomy for benign disease. RESULTS: The annual population rate of hysterectomy for benign disease was 49 per 10 000 hysterectomy-eligible residents, declining slightly over time, mostly among reproductive-age populations. Rates peaked among residents ages 40-49 years, and declined with increasing age, apart from an increase with universal coverage at age 65 years. We found large differences in age-standardised population rates of hysterectomy across states (range 42.2-69.0), and HSAs (range: overall 12.9-106.3; 25th-75th percentile 44.0-64.9). Among the non-elderly population, those with government-sponsored insurance had greater variation than those with private insurance (coefficient of variation 0.61 versus 0.32). Proportions of minimally invasive procedures were similar across states (71.0-74.8%) but varied greatly across HSAs (27-96%). In regression models, HSA population characteristics explained 31.8% of observed variation in annual rates. Higher local proportions of government-sponsored insurance and non-White race were associated with lower population rates. CONCLUSIONS: We found substantial variation in rate and route of hysterectomy for benign disease in the USA. Local population characteristics explained less than one-third of observed variation.","journal":"BJOG An International Journal of Obstetrics & Gynaecology","year":2023,"id":362118,"datarank":0.5352707905704941,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.20568710397006112,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.20568710397006112,"corpus_percentile":63.71161135607643,"corpus_rank":4692,"citation_count":8,"citer_count":8,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.7822,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":725410,"name":"Quetrell Heyward","orcid":"0000-0001-6321-6333","position":1,"is_corresponding":false},{"id":608566,"name":"Alaattin Erkanli","orcid":null,"position":2,"is_corresponding":false},{"id":1066711,"name":"Andrew P. Loehrer","orcid":"0000-0001-7747-224X","position":3,"is_corresponding":false},{"id":514844,"name":"Evan R. Myers","orcid":"0000-0002-9053-9864","position":4,"is_corresponding":false},{"id":402050,"name":"Laura J. Havrilesky","orcid":"0000-0002-4259-5992","position":5,"is_corresponding":false},{"id":286398,"name":"Haley Moss","orcid":"0000-0002-0563-1579","position":6,"is_corresponding":false},{"id":458427,"name":"Benjamin B. Albright","orcid":"0000-0001-5296-9575","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T01:14:19.266946Z","pmid":"37132056","pmcid":"PMC10593101","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}