Relationship between hysterectomy and stroke in National Health and Nutrition Examination Survey (NHANES) 2007–2018: a cross-sectional study

Abstract

Hysterectomy is the most common type of gynecological operation in the United States. However, complications can occur during or after the operation. Some studies suggest that hysterectomy may increase the risk of stroke. However, other studies have found different conclusions on this matter. This inconsistent conclusion may be due to small sample sizes or limited covariates. So, we sought to further investigate the correlation between hysterectomy and stroke. Our analysis was based on the data from 2007-2018 National Health and Nutrition Examination Survey (NHANES). We excluded participants with missing hysterectomy data (Question "Have you had a hysterectomy, including a partial hysterectomy, that is, surgery to remove {your/her} uterus or womb?"), participants with missing stroke data (Question "Has a doctor or other health professional ever told you that you had a stroke?), a total of 15,241 participants were included in our analysis. To estimate the correlation between hysterectomy and stroke, logistic regression models were used after adjusting for sociodemographic and health-related factors, including age, race, education level, marital status, annual family income, body mass index (BMI), alcohol consumption in the past 12 months, having smoked at least 100 cigarettes in a lifetime, hypertension, hypercholesterolemia, and diabetes. The unadjusted model suggests that women who had undergone a hysterectomy were 3.15 [95% confidence interval (CI): 2.67-3.71] times more likely to have a stroke than women who had not undergone a hysterectomy. In the crude and fully-adjusted models, the correlation between hysterectomy and stroke was consistent [odds ratio (OR)crude-adjusted =1.55 (95% CI: 1.30-1.85), ORfully-adjusted =1.36 (95% CI: 1.14-1.63)]. In the subgroup analysis stratified by age, hysterectomy seemed to have more risk for stroke occurrence regardless of subgroup, even after adjusting sociodemographic and health-related factors. Interestingly, the women who were less than or equal to 50 years old had greater odds of stroke (ORfully-adjusted =1.96) compared with women who were aged older than 50 (ORfully-adjusted =1.42). In our study, we concluded hysterectomy may increase the risk of stroke. However, as our study is a cross-sectional study and unmeasured covariates may still exist, more researches are required to confirm this conclusion.