Women’s Health
Hysterectomy patterns and trends in Mexico, 2010-2019 Britton Trabert* Britton Trabert Lina Sofia Palacio Mejia Juan Eugenio Hernández Ávila Jorge Salmerón Liliana Gómez Flores Ramos Martín Lajous
Hysterectomy is the most common surgical procedure among reproductive age women. More than 50% of hysterectomies are performed for benign reasons, while gynecologic cancers account for ~10% of hysterectomies in the United States (US) and other high-income countries. Global cancer reporting does not correct for the proportion of the population who have undergone hysterectomy, which increases with age but has also demonstrated recent temporal declines in many countries. These changes have important implications for the interpretation and comparison of uterine cancer rates worldwide. The uncorrected uterine cancer rate in the US is more than triple the rate in Mexico. Given the lack of information on hysterectomy patterns in Mexico and marked differences in uterine cancer incidence when comparing Mexico and the US, we set out to describe recent hysterectomy trends in Mexico. We utilized data from the automated system of hospital discharges (including ambulatory care) that is curated and validated by the Ministry of Health and covers ~57% of the population. Age-standardized rates (ASRs) were calculated through the direct method using the US 2010 female population. The current analysis included 267,245 individuals 20+ years of age who had a hysterectomy from 2010-2019. The most common indication was fibroids (n=147,936, 55.4%), while gynecologic cancer represented only 5.8% of procedures (n=15,490). The overall ASR of hysterectomy was 137.6 per 100,000 woman-years (95% CI: 137.1-138.1). The ASR was stable from 2010-2015 (annual percent change: 0.8%; 95% CI: -1.3, 2.9) followed by a substantial decrease from 2015-2019 (-7.1%; -9.9, -4.4). There was wide geographic variation in hysterectomy rates across Mexico (Figure). While the declining hysterectomy rate observed in Mexico is consistent with recent decreases observed in many countries, the ASR of hysterectomy was much lower in Mexico than the US and does not explain the large difference in uterine cancer rates.
