Whitney Robinson investigates factors behind high hysterectomy rates among young African-American women in the South to inform equitable treatment interventions.
Whitney Robinson, PhD, smiles when she talks about data. She is a social epidemiologist and associate professor at the UNC Gillings School of Global Public Health. In her research, she focuses on why rates of gynecologic treatment differ among groups of people. For instance, why do young African-American women, especially in the South, have such high rates of hysterectomy — a procedure in which a woman’s uterus is removed?
Driving Health Solutions for Under-represented Groups: Too often, the populations who are most burdened by or vulnerable to diseases are underrepresented in research studies and underserved in access to care. We’re Gillings. We’re on it! Equity is a core Gillings value, and our faculty work to find ways to better deploy health-care data and resources to help those who need them most.
“I’m looking into why young women get hysterectomies after being diagnosed with these really common gynecologic issues, like fibroids, endometriosis and painful periods. Hysterectomies are the second most commonly performed surgery among young and middle-aged women in the United States, but they’ve been understudied. My feeling is that this issue affects millions of women’s ability to attend work, have a satisfying sex life and raise a family, and that’s worth examining.”
The health issues that can lead to a hysterectomy have a variety of other possible treatments, ranging from hormonal birth control to more minor surgeries. For Robinson, the concern is: Who has access to these cheaper, less invasive treatments?
“That’s what we want to understand,” she says. “When a young woman opts for a hysterectomy, is it because her doctor pushed for it? If so, did the provider push because it’s an easily reimbursable procedure, or because their training highlighted it? Or, do minority women truly have more severe symptoms and clinical complexity? Maybe a woman chooses the more invasive treatment because she lives in a rural area and couldn’t stomach the possibility of many return visits to her provider if the less invasive treatments didn’t work. Or, maybe there’s a cultural element that influenced her.”
To understand this complex question, Robinson and her team are bringing together datasets from a nonprofit hospital system, the national census and a large registry of health professionals. Two years into a grant from the National Institute on Minority Health and Health Disparities, they are finally poised to analyze the immense amount of data they’ve collected and cleaned. Robinson is especially excited because the tens of thousands of data points include uninsured women.
“This is critical from a health equity lens,” she explains. “Many of the women who receive hysterectomies are too young to qualify for Medicare and can’t afford private insurance. Historically, data analyses have missed uninsured women of reproductive age, and they are a key population for this question.”
Robinson also is excited because the sheer size of the dataset — representing more than 10,000 women — reveals patterns that weren’t clear in earlier studies. For example, her team has already learned that, in North Carolina, young Native American women have even higher rates of hysterectomies than young African-American women.
The ultimate goal of this research is to inform action: Which public health interventions will advance women’s care? If the hysterectomy differences are due to higher clinical need among minority women, then improving care will require developing new uterine-sparing treatments that are more effective for treating their symptoms. On the other hand, if young women receive different treatments due to their race, interventions should prioritize more unbiased delivery of existing treatment options.
“Hysterectomies can be life-changing,” Robinson says. “For some women, they offer amazing relief from a host of symptoms. They also mean the end of a woman’s ability to have biological children and they can bring immediate menopause. For a young woman, getting a hysterectomy is a big decision — we want it to be the most informed, equitable decision possible.”
Robinson discusses other aspects of her research on AcaDames, the podcast that she co-hosts with Sarah Birken, PhD, assistant professor of health policy and management at the Gillings School. In each episode, they delve into the experience of being a woman in academia. The common thread between her research and this passion project, Robinson says, is her interest in women’s health and well-being. As she puts it: “Whatever it takes to ensure women feel confident and are fully engaging in life.”
