Reviewer’ s report
Title: Increased blood glucose level following hysterectomy among reproductive women in India
Version: 0Date: 17 Jun 2020
Reviewer's report:This is a very interesting (and useful) work on risks of diabetes among hysterectomy women. Use
of nationally representative dataset from a South Asian country to examine the association
between elevated blood glucose and hysterectomy fills a crucial knowledge gap. The manuscript,however, needs some careful reworking and additional analysis. More specifically, I have thefollowing major comments/concerns focusing on statistical analysis:
1. The analysis appears to assess the prevalence of high blood glucose (141-160 mg/dL)
only—what is the reason of excluding very high group from analysis? Having the dependentvariable as >140 mg/dL instead of 141-160 mg/dL would give a more complete picture.
2. In the logistic model, BMI is used as a continuous variable. A categorical variable
(underweight, normal, overweight/obese) for BMI would be more meaningful.
3. Occupation (which is actually 'employment status' by definition used) was dropped from the
logistic regression—is it due to occupation's near significance (p=0.107) for hysterectomywomen? For inclusion of variables, using a more flexible cutoff points (p= 140 mg/dL—though itsa very minor deviation, please check if the number of people having borderline blood glucoselevel is substantial.
7. Rationale needs some reworking—currently the focus is on the level of hysterectomy in India,
but I believe authors also need to briefly describe here the fact that diabetes is of a particular publichealth concern for India due to its large number and increasing trends (number of diabetic peoplein India increased from 26 million in 1990 to 65 million in 2016; source: http://dx.doi.org/10.1016/S0140-6736(18)32172-X). Also in abstract, consider adding a line in the background thathysterectomy and diabetes are believed to be associated, and India has been seeing substantialincrease in diabetes burden.
8. Disagreement between methods and results in terms of explanatory variables - e.g., in p.6, ln
14-17, wealth quintiles were discussed but in results only three groups can be seen. Samehappened for age and BMI.
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Are the methods appropriate and well described?
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YesDoes the work include the necessary controls?
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