Pelvic Organ Prolapse Surgical Treatment Rates in a Hispanic-Majority Population

Objectives: Despite evidence that sociodemographic (SES) factors influence surgical treatment of pelvic organ prolapse (POP), literature is lacking on how race, ethnicity, or primary language impact a patient’s likelihood to undergo surgery. Our tertiary care center provides urogynecologic care to an area of the US comprising a Hispanic “minority-majority” population, offering unique insight into how SES factors impact surgery rates. We sought to assess how race, ethnicity, and primary language predicts surgical treatment for POP in a minority-majority Hispanic population.

Methods: We identified patients with POP ICD 10 codes from Oct 2019-Dec 2022 who received surgical treatment for POP at a Urology/Urogynecology academic practice. Data was collected by retrospective chart review. Covariates were obtained by manual data abstraction. Continuous and categorical variables were analyzed using the t-test and chi-square test, respectively. For non-parametric data, Wilcoxon rank-sum test was used. A logistic regression model was fitted to identify independent predictors of surgery utilization.

Results: Of 943 patients over 38 months, 441 (46.8%) underwent surgery. SES characteristics by surgical conversion rates are shown in Table 1. Upon direct comparison patients who were younger, Hispanic or Latino, spoke Spanish as a primary language, had private insurance or were obese were more likely to undergo surgery (Table 1). Upon multivariate regression, however, only age and compartment of prolapse remained predictors of undergoing surgical repair, where younger patients and patients with apical prolapse (alone or in any combination of anterior and/or posterior prolapse) were significantly more likely to undergo surgery (OR=.98 [.96-.99], p=>.001 and R= 2.31 [1.13-4.72], p=>.001, respectively) (Table 2).

Conclusions: Our analysis suggests age and prolapse compartment are the only significant predictors of surgical treatment for POP in Hispanic minority-majority patient population. Previously suggested barriers to care, including minority status and non-English primary language, do not appear to exist in our population. Factors contributing to our results likely include concordance in linguistic, ethnic, and racial attributes between employees of the healthcare system (including physicians) and patients, in addition to protective factors associated with ethnic enclaves in our population. Further understanding of how cultural barriers in patient-provider relationships, such as provider language, impact the decision to undergo surgery.