Tweets by PFD Week 2024

Rapid Fire Oral Presentations 03: Disparities, Office Practice & Special Populations

The Rural-Urban Divide and Urogynecologic Healthcare Disparities

Friday, October 25, 2024

4:00 PM – 4:03 PM EDT

Location: Independence Ballroom A-D (Meeting Level 4)

Objectives:

Objective: Gynecological health disparities have been shown to exist in patients living in rural communities compared to those living in urban environments. The primary outcome was to describe pelvic floor disorder symptoms burden among rural and urban dwelling women. We secondarily sought to evaluate if symptom burden was different among patient based on how disadvantage by classified. We hypothesized that rural-dwelling patients would have greater symptom burden.

Methods: We performed a retrospective analysis of new patient visits to our clinic between January 2016 to December 2021. The following demographic and clinical characteristics were abstracted from the electronic medical record: age, race, Pelvic Floor Disorder Inventory (PFDI-20) composite scores and subscores, county, 9-digit zip code, distance traveled to clinic, insurance type, surgical history, and initial Pelvic Organ Prolapse Quantification (POP-Q) score. Patients were categorized as living in a rural or urban county based on State Department of Health Services (DHS) designation. Based on 9-digit zip code, they were further classified as living in a Rural vs Urban and Underserved vs Advantaged community (RUDA) and were also assigned a state-level Area Deprivation Index (ADI) score. The ADI is the most heavily, independently validated tool for US neighborhood-level disadvantage.

Results: A total of 2,627 new patient encounters were included in the analysis. The mean age was 57.3±16.2 years and most patients were white (93%). For patients with a primary diagnosis of prolapse, most prolapse was stage II or greater. Approximately 20% of patients were from a rural county (n=51).
For the entire cohort, mean PFDI-20 score was 91.2 (SD 54.7); the mean POPDI-6, CRADI-8, and UDI-6 subscores were 29.5 (SD 22.2), 22.8 (SD 20.4), and UDI-6 39.8 (SD 24.8). POPDI-6, CRADI-8, and PFDI-20 scores were statistically significantly worse for woman living in rural counties. POPDI-6, CRADI-8, and PFDI-20 scores were worse for patients living in Rural Underserved and Urban Underserved communities. PFDI-20 and all subscores worsened as the ADI score worsened. (Table 1)

Conclusions: In rural states, rural versus urban may not accurately describe healthcare disparities such as access to healthcare. More granular definitions of disadvantage, such as RUDA or ADI, may be provide more robust and insight into healthcare disparities.

Disclosure(s):

Kristina J. Warner, MD: No financial relationships to disclose

Kelley Stewart, MD: No financial relationships to disclose

Gabrielle M. Avery, MD, MPH: No financial relationships to disclose

Caroline Cox, MD: No financial relationships to disclose

Ushma J. Patel, MD: No financial relationships to disclose

Dobie L. Giles, MD, MS, MBA: No relevant disclosure to display

Christine A. Heisler, MD, MS: No financial relationships to disclose

Jon F. Pennycuff, MD, MSPH: No relevant disclosure to display

Rapid Fire Presenter(s)

Kristina J. Warner, MD (she/her/hers)

Urogynecologist
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

KS

Kelley Stewart, MD

Fellow Physician
University of Wisconsin
Madison, Wisconsin, United States

Disclosure(s): No financial relationships to disclose
Gabrielle M. Avery, MD, MPH (she/her/hers)

OBGYN Resident
University of Wisconsin Hospitals & Clinics
Madison, Wisconsin, United States

Disclosure(s): No financial relationships to disclose
CC

Caroline Cox, MD

Assistant Professor
University of Wisconsin
Madison, Wisconsin, United States

Disclosure(s): No financial relationships to disclose
Ushma J. Patel, MD (she/her/hers)

Fellow Physician
University of Wisconsin
Madison, Wisconsin, United States

Disclosure(s): No financial relationships to disclose
Dobie L. Giles, MD, MS, MBA (he/him/his)

Professor
University of Wisconsin School of Medicine & Public Health
Middleton, Wisconsin, United States

Disclosure(s): No relevant disclosure to display
Christine A. Heisler, MD, MS (she/her/hers)

Associate Professor, Division Director, Fellowship Program Director
University of Wisconsin
Madison, Wisconsin, United States

Disclosure(s): No financial relationships to disclose
Jon F. Pennycuff, MD, MSPH (he/him/his)

Surgeon
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States

Disclosure(s): No relevant disclosure to display