Impact of race, insurance, and procedural timing on sterilization method

Ovarian cancer is the fifth leading cause of cancer deaths in women. Removing the entirety of the tubes appears more effective in reducing ovarian cancer development compared to other sterilization methods. It is thus recommended to perform salpingectomy (SL) rather than tubal ligation (TL) for cancer risk reduction. Minority women are disproportionately affected by both ovarian cancer and disparities in healthcare access. Pregnancy is a period where un- or underinsured women may have improved access to health coverage. This makes the postpartum period an ideal time to provide sterilization if desired. Given the interplay of these factors on sterilization, our study sought to assess if race, insurance status, and procedural timing impacted the method of sterilization. This was a retrospective case control study. The study population included women who underwent an elective sterilization procedure at a single academic institution from 1/2010 to 12/2020. Women were excluded if salpingectomy was performed with any procedure other than cesarean section, if the procedure was not a SL or TL, or if race or insurance status was not listed. Race groups were Asian, Black, Hispanic, or White. The medical record, including operative note, was reviewed to obtain age, race, procedure type and timing, and insurance status. Timing was divided into peripartum, which included intrapartum or postpartum, or interval procedures. Cases were defined as patients who underwent SL, and controls underwent TL. All statistical analysis was carried out using R. Categorical data is presented as percent (n). A multivariate logistic regression was performed to assess the association of types of procedure with race, insurance status, and procedure timing. This is reported as odds ratios (OR) with 95% confidence intervals (CI). A sample of 2041 patients received sterilization procedures between 2010 and 2020. 962 were included in the analysis. Most exclusions were due to concurrent gynecologic or other abdominal procedures. 72% (695) of patients underwent TL, and 28% (267) underwent SL. 52% (503) of patients were White, 32% (309) Black, 13% (121) Hispanic, and 3% (29) Asian. 73% (702) of sterilizations were performed during the peripartum period. 61% (584) of patients had public insurance. On multivariate logistic regression, public insurance (OR 0.68 95% CI 0.5-0.9) and peripartum timing (OR 0.03 95%CI 0.02-0.04) were associated with less SL than TL while increased age (OR 1.1 95%CI 1.04-1.1) was associated with more SL. Race was not associated with procedure type on either bivariate or multivariate analysis. Despite the recommendation for salpingectomy, tubal ligation is more commonly performed in our health system. We found that while race was not associated with the type of sterilization, insurance status, procedural timing, and patient age were factors influencing the method of sterilization.