Racial and Ethnic Disparities in the Management of Pelvic Organ Prolapse

Objectives: Although current research focuses on the racial and ethnic differences in surgical management of pelvic organ prolapse (POP), there is a gap in data regarding overall management approach. The objective of this study was to determine the association between patient race, ethnicity, primary language and chosen management of POP.

Methods: A retrospective cohort study of women ages 18-89 years old in a 36-month period from the health system’s local region was done. Using ICD-10 diagnosis codes for prolapse, 2,188 were identified. Patients were excluded if they did not have POP on exam or reported previous use of pessary or surgery for prolapse management. After screening for exclusion criteria, 1,377 patients were analyzed. Demographic and outcome measures were collected from the initial visit. Outcome measures included stage of prolapse, time from onset of prolapse symptoms, and preferred treatment modality (observation/physical therapy/pelvic floor exercises, pessary, or surgery). Multinomial logistic regression was used to analyze the data. A p-value less than 0.05 was considered statistically significant.

Results: Of the 1,377 patients, 62.4% were White, 4.8% Black/African American, 17.6% Hispanic/Latino, 2.3% Asian, 4.8% Other/Multiracial, and 8.1% Unknown/Not reported. English was 88.1% of patients’ primary language. At the initial visit, 44.9% of Non-Hispanic White patients were over the age of 65 compared to 39.3% of Black/African American, 26.4% of Hispanic/Latino. Of the management options, 51.8% chose observation/physical therapy, 29.5% chose surgery, and 18.7% chose pessary. Chi-square test of association demonstrated an association between race/ethnicity and treatment plan (p = 0.016). Compared to Non-Hispanic White patients, Hispanic/Latino patients had 1.53 times the odds (95% CI 1.12 -2.10) of choosing surgical treatment compared to observational treatment. In the adjusted model, patients ages 65 or older were 2.75 times more likely to choose pessary over observation/physical therapy/pelvic floor exercises (95% CI 1.74 - 4.34).

Conclusions: In all race categories, the majority of patients chose an observation as their initial treatment plan. Black/African American and Hispanic/Latino patients presented at a younger age for their initial visit compared to Non-Hispanic Whites. When controlling for possible confounders, patients ages 65 and older were more likely to choose pessary. In comparison to Non-Hispanic White patients, Hispanic/Latino patients were more likely to choose surgery as their treatment plan. Racial and ethnic differences exist for treatment chosen among women diagnosed with POP. Future research should aim at addressing these differences.