Barriers and Promotors to Health Service Utilization for Pelvic Floor Disorders in the United States: Systematic Review and Meta-analysis of Qualitative and Quantitative Studies

Mou, Tsung; González, J. G.; Gupta, Ankita; O’Shea, Michele; Thibault, Mary Duarte; Gray, Elizabeth; Beestrum, Molly; Brown, Oluwateniola; Cichowski, Sara

doi:10.1097/ogx.0000000000001115

Cited by 1 publication

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“…Multiple disparities have also been established in the literature regarding the management of POP. 4 Shah et al 5 found that rates of prolapse surgery were highest in White women compared with Black and non-White women. Non-White women are more likely to have obliterative surgery performed and less likely to undergo surgery with a minimally invasive approach.…”

Section: Why This Mattersmentioning

confidence: 99%

“…Additional studies have found significant gaps in the established literature regarding the effects of socioeconomic factors and structural barriers that may prohibit individuals from seeking care for POP and other pelvic floor disorders. 4,10 The objective of this study was to evaluate the association of SES on the decision for surgical versus conservative management of POP in a population of new patients seen in a tertiary medical center urogynecology clinic from 2015 to 2021. We hypothesized that lower SES would be associated with a higher rate of conservative management.…”

Section: Why This Mattersmentioning

confidence: 99%

“…Additional studies have found no difference in the prevalence of POP by race and ethnicity, highlighting that the decision to seek care for POP may be influenced by socioeconomic factors. 3,4 Recognition may reflect differences in patient education level, medical literacy, or cultural acceptance of female conditions such as POP. These disparities may reflect the systemic consequences of racial inequities in the current health care system.…”

Section: Why This Mattersmentioning

confidence: 99%

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Association of Neighborhood-Level Socioeconomic Status With Prolapse Management Decision

Downing,

Dong,

Ardizzone

et al. 2024

UROGC

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Importance This study identifies how neighborhood-level socioeconomic status (SES) may affect patients' treatment decisions for pelvic organ prolapse (POP). Objective This study aimed to evaluate the association of neighborhood-level SES with the decision of surgical versus conservative POP management. Study Design This was a retrospective cohort study of patients newly diagnosed with POP at a tertiary medical center between 2015 and 2021. Patients lost to follow-up or poor surgical candidates were excluded. Patient characteristics, demographics, and treatment selection were abstracted from the electronic health record. Conservative management was defined as expectant, pessary, and/or pelvic floor physical therapy. Five-digit zip codes were linked to the Area Deprivation Index and used as a surrogate for neighborhood-level SES. Area Deprivation Indices were dichotomized at or below the sample median (less disadvantaged area) and above the sample median (more disadvantaged area). Logistic regression models estimated the odds of choosing surgical versus conservative management as a function of the Area Deprivation Index. Results A total of 459 patients met the eligibility criteria (non-Hispanic White, 88.2%). The median age was 63 years (interquartile range, 52–70 years), and the majority had stage 2 POP (65.7%). Of all patients, 59.3% had Medicare/Medicaid, 39.9% were privately insured, and 0.9% were uninsured. Furthermore, 74.7% selected surgical management, and 25.3% chose conservative management. Increasing age and higher Pelvic Organ Prolapse Quantification System stage were significantly associated with selecting surgery (P = 0.01). Women residing in a more disadvantaged area had a 67% increased odds of choosing surgical over conservative management (adjusted odds ratio, 1.67; 95% confidence interval, 1.06–2.64) after adjusting for age, race/ethnicity, body mass index, and Pelvic Organ Prolapse Quantification System stage. Conclusions Residing in a more disadvantaged zip code was associated with 67% increased odds of choosing surgical versus conservative POP management.

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Section: Why This Mattersmentioning

confidence: 99%

Section: Why This Mattersmentioning

confidence: 99%

Section: Why This Mattersmentioning

confidence: 99%

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