Hysterectomy rates are declining in Canada, but they vary widely across the country, according to a new report.

Hysterectomy is the second most common surgery for Canadian women, after caesarean sections, Thursday's report by the Canadian Institute for Health Information said.

In 2008-2009, almost 47,000 women had a hysterectomy. After adjusting for the aging of the population, the national hysterectomy rate in 2008-2009 was 338 per 100,000 population, down from 484 per 100,000 in 1997.

The age-standardized rates across provinces and territories "varied substantially," the report's authors said, from 185 per 100,000 in Nunavut to 512 per 100,000 in Prince Edward Island.

The age-standardized rate of hysterectomy for women living in rural areas (464 per 100,000) was 46 per cent higher than the rate for Canadians living in urban areas (318 per 100,000).

Menstrual disorders were the top reason for hysterectomies in rural areas, versus uterine fibroids (benign tumours) in urban areas, said Indra Pulcins, director of health indicators and performance management for CIHI.

The differences may be due to access to health care, said Pulcins.

“The differences in hysterectomy rates for menstrual disorders between urban and rural Canada may point to differences in clinical practice, rather than health differences,” said Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynecologists of Canada.

“Menstrual disorders include irregular or abnormal levels of bleeding, pain, etc. While hysterectomies may be necessary, there are other, less-invasive treatment options that may not be as widely available to women in rural areas," she added in a release.

The report also found declining rates of deaths in hospital from heart attacks and subsequent re-admissions from 2003 to 2008.

Canadians living in the least-affluent neighbourhoods were 37 per cent more likely to have a heart attack than those in the most-affluent areas: 255 per 100,000 population versus 186 per 100,000, respectively. The report found that differences in treatment and quality of care for heart attacks were small or insignificant between socio-economic groups.

The independent institute keeps track of a range of information to help health planners and policy-makers.