For U.S. Black women, shift of hysterectomy to outpatient settings may have lagged behind White women: a claims-based analysis, 2011-2013.

BACKGROUND: Hysterectomy is among the most common surgeries performed on U.S. women. For benign conditions, minimally invasive hysterectomy is recommended, whenever permitted by clinical indication and previous surgery history. No study has examined whether the use of less invasive hysterectomy spread more slowly for Black women. METHODS: We used the hysterectomy that occurs in outpatient settings as a proxy for minimally invasive hysterectomy. Using claims-based surgery data and census denominators, we calculated age-standardized rates of all hysterectomies in North Carolina from 2011 to 2013. Study participants were 41,899 women (64.6% non-Hispanic White, 28.3% non-Hispanic Black) who underwent hysterectomy for non-malignant indications. We fit Poisson models to determine whether changes in outpatient hysterectomy rates differed by Black-White race. We employed a difference-in-difference approach to control for racial differences in the severity of clinical indication. Further, we restricted to one state to minimize confounding from geographic differences in where Black and White women live. RESULTS: From 2011 to 2013, the overall hysterectomy rate decreased from 42.3 per 10,000 women (n = 14,648) to 37.9 per 10,000 (n = 13,241) (p < 0.0001). Most hysterectomy (67.6%) occurred in outpatient settings. The inpatient rate decreased 35.2% (p < 0.0001), to 10.3 per 10,000, while the outpatient rate increased 4.6% (p < 0.01), to 27.5 per 10,000. From 2011 to 2013, Black women's outpatient rate increased 22% (p < 0.0001): from 25.8 per 10,000 to 31.5. In contrast, among White women, outpatient rates remained stable (p = 0.79): at 28.3 per 10,000 in 2013. CONCLUSIONS: Rapid increases in outpatient hysterectomy among Black women compared to stable rates among White women indicate a race-specific catch-up phenomenon in the spread of minimally invasive hysterectomy. These results are consistent with the hypothesis that minimally invasive hysterectomy may have been adopted more slowly for Black women than their White counterparts after its introduction in the early 2000s. The persistently high rates of hysterectomy among young Black women and potentially slower adoption of minimally invasive procedures among these women highlight a potential racial disparity in women's healthcare.

Prevalence and predictors of sexual inexperience in adulthood.

The emergence of partnered sexual behavior represents an important developmental transition. However, little is known about individuals who remain sexually inexperienced well into adulthood. We used data from 2,857 individuals who participated in Waves I-IV of the National Longitudinal Study of Adolescent Health (Add Health) and reported no sexual activity (i.e., oral-genital, vaginal, or anal sex) by age 18 to identify, using discrete-time survival models, adolescent sociodemographic, biosocial, and behavioral characteristics that predicted adult sexual inexperience. The mean age of participants at Wave IV was 28.5 years (SD = 1.92). Over one out of eight participants who did not initiate sexual activity during adolescence remained abstinent as young adults. Sexual non-attraction significantly predicted sexual inexperience among both males (aOR = 0.5) and females (aOR = 0.6). Males also had lower odds of initiating sexual activity after age 18 if they were non-Hispanic Asian, reported later than average pubertal development, or were rated as physically unattractive (aORs = 0.6-0.7). Females who were overweight, had lower cognitive performance, or reported frequent religious attendance had lower odds of sexual experience (aORs = 0.7-0.8) while those who were rated by the interviewers as very attractive or whose parents had lower educational attainment had higher odds of sexual experience (aORs = 1.4-1.8). Our findings underscore the heterogeneity of this unique population and suggest that there are a number of different pathways that may lead to either voluntary or involuntary adult sexual inexperience. Understanding the meaning of sexual inexperience in young adulthood may have important implications for the study of sexuality development across the life course.

Childbearing is not associated with young women's long-term obesity risk.

OBJECTIVE: Contemporary childbearing is associated with greater gestational weight gain and postpartum weight retention than in previous decades, potentially leading to a more pronounced effect of childbearing on women's long-term obesity risk. Previous work on the association of childbearing with women's long-term obesity risk mostly examined births in the 1970s and 1980s and produced mixed results. The association of childbearing and obesity incidence in a diverse, contemporary sample of 2731 US women was estimated. METHODS: Propensity-score (PS) matching was used for confounding control when estimating the effect of incident parity (1996-2001) on 7-year incident obesity (BMI≥30 kg/m(2) ) (2001-2008). RESULTS: In the sample, 19.3% of parous women became obese, whereas 16.1% of unmatched nulliparous women did. After PS matching without and with replacement, the differences in obesity incidence were, respectively, 0.0 percentage points (ppts) (95% CI: -4.7 to 4.7) and 0.9 ppts (95% CI: -4.9 to 6.7). Results were similar in analyses of prevalent parity and obesity in 2008 (n = 6601) conducted to explore possible selection bias. CONCLUSIONS: These results imply that, in contemporary US parous women in their late 20s and early 30s, childbearing may not increase obesity incidence.