Influence of migration status on hysterectomy surgical approach and indications for benign conditions-a nationwide cohort register study.

Abstract

Migration status and socioeconomic factors may influence access to and provision of gynaecological surgical care. However, evidence from European settings remains limited. This study aimed to examine disparities in surgical approach and indications for hysterectomy by migration status, while adjusting for education and income, among women with benign gynaecological conditions in Norway. We conducted a nationwide register-based cohort study using data from the Norwegian Patient Registry, including all women who underwent hysterectomy for benign indications in Norway between 2008 and 2020 (n = 38 913). Surgical approach was categorized as laparoscopic, vaginal, or open abdominal. Multinomial logistic regression was used to estimate odds ratios (OR), 95% confidence intervals (CI) and absolute risk difference for laparoscopic and vaginal hysterectomy compared with open surgery, adjusting for demographic, clinical, and socioeconomic factors. The frequency of surgical indications was assessed by migration status and regional group of birth. Migrants had lower odds of undergoing laparoscopic hysterectomy (OR 0.66, 95% CI: 0.57-0.77) and vaginal hysterectomy (OR 0.60, 95% CI: 0.49-0.75), compared with open surgery. Higher income was associated with increased odds of laparoscopic hysterectomy, with a stronger association observed among migrants. Migrants had lower proportions of hysterectomies performed due to genital prolapse and higher proportions due to fibroid compared with Norwegian-born women. Migration status is associated with surgical approach and hysterectomy indications, suggesting inequities in minimally invasive surgery despite Norway's universal health coverage. These findings highlight the need for efforts to ensure equitable surgical care in gynaecology.