Advertisement

A Systematic Review of Racial/Ethnic Disparities in Female Pelvic Floor Disorders

Published:October 07, 2021DOI:https://doi.org/10.1016/j.urology.2021.09.018

      ABSTRACT

      Numerous studies have investigated the influence of health disparities among women with pelvic floor disorders with varied results. Racial/ethnic disparities, in particular, inconsistently indicate differences in prevalence of disease, disease severity, and treatment outcomes. We aim to review the body of literature examining racial/ethnic disparities in pelvic floor disorders, including overactive bladder, stress urinary incontinence, pelvic organ prolapse, and interstitial cystitis. A better understanding of these disparities may help guide clinicians, researchers, and advocates in providing improved education, outreach opportunities, and access to care in minority women with pelvic floor disorders.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nygaard I
        • Barber MD
        • Burgio KL
        • et al.
        Prevalence of symptomatic pelvic floor disorders in US women.
        JAMA. 2008; 300: 1311-1316
      1. United States Census Bureau, State and County Facts 2020.

        • Mouritsen L
        • Larsen JP.
        Symptoms, bother and POPQ in women referred with pelvic organ prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 122-127
        • Stewart WF
        • Van Rooyen JB
        • Cundiff GW
        • et al.
        Prevalence and burden of overactive bladder in the United States.
        World J Urol. 2003; 20: 327-336
        • Farage MA
        • Miller KW
        • Berardesca E
        • Maibach HI.
        Psychosocial and societal burden of incontinence in the aged population: a review.
        Arch Gynecol Obstet. 2008; 277: 285-290
        • Galea S
        • Tracy M
        • Hoggatt KJ
        • Dimaggio C
        • Karpati A.
        Estimated deaths attributable to social factors in the United States.
        Am J Public Health. 2011; 101: 1456-1465
        • Brown O
        • Siddique M
        • Mou T
        • et al.
        Disparity of Racial/Ethnic Representation in Publications Contributing to Overactive Bladder Diagnosis and Treatment Guidelines.
        Female Pelvic Med Reconstr Surg. 2020;
        • Coyne KS
        • Sexton CC
        • Vats V
        • Thompson C
        • Kopp ZS
        • Milsom I.
        National community prevalence of overactive bladder in the United States stratified by sex and age.
        Urology. 2011; 77: 1081-1087
        • Zhu J
        • Hu X
        • Dong X
        • Li L.
        Associations between risk factors and overactive bladder: a meta-analysis.
        Female Pelvic Med Reconstr Surg. 2019; 25: 238-246
        • Cheung WW
        • Borawski D
        • Abulafia O
        • Vincent MT
        • Harel M
        • Bluth MH.
        Characterization of overactive bladder in women in a primary care setting.
        Open Access J Urol. 2011; 3: 29-34
        • Suskind AM
        • Quanstrom K
        • Zhao S
        • et al.
        Overactive bladder is strongly associated with frailty in older individuals.
        Urology. 2017; 106: 26-31
        • Tellechea L
        • Zuo S
        • Kohn JR
        • et al.
        The effect of social determinants of health on overactive bladder symptom severity.
        J Urol. 2020; (101097JU0000000000001545)
        • McKellar K
        • Bellin E
        • Schoenbaum E
        • Abraham N
        Prevalence, risk factors, and treatment for overactive bladder in a racially diverse population.
        Urology. 2019; 126: 70-75
        • Thom DH
        • van den Eeden SK
        • Ragins AI
        • et al.
        Differences in prevalence of urinary incontinence by race/ethnicity.
        J Urol. 2006; 175: 259-264
        • Huang AJ
        • Thom DH
        • Kanaya AM
        • et al.
        Urinary incontinence and pelvic floor dysfunction in Asian-American women.
        Am J Obstet Gynecol. 2006; 195: 1331-1337
        • Coyne KS
        • Margolis MK
        • Kopp ZS
        • Kaplan SA.
        Racial differences in the prevalence of overactive bladder in the United States from the epidemiology of LUTS (EpiLUTS) study.
        Urology. 2012; 79: 95-101
        • Coyne KS
        • Sexton CC
        • Bell JA
        • et al.
        The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL.
        Neurourol Urodyn. 2013; 32: 230-237
        • Mandimika CL
        • Murk W
        • McPencow AM
        • et al.
        Racial disparities in knowledge of pelvic floor disorders among community-dwelling women.
        Female Pelvic Med Reconstr Surg. 2015; 21: 287-292
        • Tennstedt SL
        • Link CL
        • Steers WD
        • McKinlay JB.
        Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) Survey.
        Am J Epidemiol. 2008; 167: 390-399
        • Townsend MK
        • Curhan GC
        • Resnick NM
        • Grodstein F.
        The incidence of urinary incontinence across Asian, black, and white women in the United States.
        Am J Obstet Gynecol. 2010; 202 (e371-377): 378
        • Wu JM
        • Vaughan CP
        • Goode PS
        • et al.
        Prevalence and trends of symptomatic pelvic floor disorders in U.S. women.
        Obstet Gynecol. 2014; 123: 141-148
        • Hall SA
        • Link CL
        • Hu JC
        • Eggers PW
        • McKinlay JB.
        Drug treatment of urological symptoms: estimating the magnitude of unmet need in a community-based sample.
        BJU Int. 2009; 104: 1680-1688
        • Syan R
        • Zhang CA
        • Enemchukwu EA.
        Racial and Socioeconomic Factors Influence Utilization of Advanced Therapies in Commercially Insured OAB Patients: An Analysis of Over 800,000 OAB Patients.
        Urology. 2020; 142: 81-86
        • Ju R
        • Garrett J
        • Wu JM.
        Anticholinergic medication use for female overactive bladder in the ambulatory setting in the United States.
        Int Urogynecol J. 2014; 25: 479-484
        • Benner JS
        • Nichol MB
        • Rovner ES
        • et al.
        Patient-reported reasons for discontinuing overactive bladder medication.
        BJU Int. 2010; 105: 1276-1282
        • Carlson KV
        • Rovner ES
        • Nair KV
        • Deal AS
        • Kristy RM
        • Schermer CR.
        Factors Associated with Improvements in Patient-Reported Outcomes During Mirabegron or Antimuscarinic Treatment of Overactive Bladder Syndrome: A Registry Study (PERSPECTIVE).
        Adv Ther. 2019; 36: 1906-1921
        • Rashid N
        • Vassilakis M
        • Lin KJ
        • Kristy R
        • Ng DB.
        Primary nonadherence to overactive bladder medications in an integrated managed care health care system.
        J Manag Care Spec Pharm. 2017; 23: 484-493
        • Shaya FT
        • Blume S
        • Gu A
        • Zyczynski T
        • Jumadilova Z.
        Persistence with overactive bladder pharmacotherapy in a Medicaid population.
        Am J Manag Care. 2005; 11: S121-S129
        • Yu YF
        • Nichol MB
        • Yu AP
        • Ahn J.
        Persistence and adherence of medications for chronic overactive bladder/urinary incontinence in the California Medicaid program.
        Value Health. 2005; 8: 495-505
        • Berger MB
        • Patel DA
        • Miller JM
        • Delancey JO
        • Fenner DE.
        Racial differences in self-reported healthcare seeking and treatment for urinary incontinence in community-dwelling women from the EPI Study.
        Neurourol Urodyn. 2011; 30: 1442-1447
        • Goldman HB
        • Anger JT
        • Esinduy CB
        • et al.
        Real-world patterns of care for the overactive bladder syndrome in the United States.
        Urology. 2016; 87: 64-69
        • Laudano MA
        • Seklehner S
        • Sandhu J
        • et al.
        Disparities in the use of sacral neuromodulation among Medicare beneficiaries.
        J Urol. 2015; 194: 449-453
        • Dobberfuhl AD
        • Mahal A
        • Dallas KB
        • Choi KM
        • Comiter CV
        • Elliott CS.
        Statewide success of staged sacral neuromodulation for the treatment of urinary complaints in California (2005-2011).
        Female Pelvic Med Reconstr Surg. 2020; 26: 437-442
        • Greenberg DR
        • Syan R
        • Young-Lin N
        • Comiter CV
        • Enemchukwu E.
        Outcomes of sacral nerve stimulation for treatment of refractory overactive bladder among octogenarians.
        Neuromodulation. 2019; 22: 738-744
        • Cameron AP
        • Anger JT
        • Madison R
        • Saigal CS
        • Clemens JQ
        • Urologic diseases in America P
        National trends in the usage and success of sacral nerve test stimulation.
        J Urol. 2011; 185: 970-975
        • Willis-Gray MG
        • Sandoval JS
        • Maynor J
        • Bosworth HB
        • Siddiqui NY.
        Barriers to urinary incontinence care seeking in White, Black, and Latina women.
        Female Pelvic Med Reconstr Surg. 2015; 21: 83-86
        • Handa VL
        • Pierce CB
        • Munoz A
        • Blomquist JL.
        Longitudinal changes in overactive bladder and stress incontinence among parous women.
        Neurourol Urodyn. 2015; 34: 356-361
        • Akbar A
        • Liu K
        • Michos ED
        • et al.
        Racial differences in urinary incontinence prevalence, overactive bladder and associated bother among men: the multi-ethnic study of atherosclerosis.
        J Urol. 2021; 205: 524-531
        • Sears CL
        • Wright J
        • O'Brien J
        • et al.
        The racial distribution of female pelvic floor disorders in an equal access health care system.
        J Urol. 2009; 181: 187-192
        • Shah AD
        • Kohli N
        • Rajan SS
        • Hoyte L.
        Surgery for stress urinary incontinence in the United States: does race play a role?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1085-1092
        • Anger JT
        • Rodriguez LV
        • Wang Q
        • Chen E
        • Pashos CL
        • Litwin MS.
        Racial disparities in the surgical management of stress incontinence among female Medicare beneficiaries.
        J Urol. 2007; 177: 1846-1850
        • Syan R
        • Dallas KB
        • Sohlberg E
        • Rogo-Gupta L
        • Elliott CS
        • Enemchukwu EA.
        Rates and risk factors for future stress urinary incontinence surgery after pelvic organ prolapse repair in a large population-based cohort in California.
        Urology. 2019; 123: 81-86
        • Sharif F
        • Mahmud F
        • Suman S
        • Cheng AL
        • Shepherd JP
        • Sutkin G.
        Risk factors for returning to the operating room for a second surgery after midurethral sling for stress urinary incontinence.
        Female Pelvic Med Reconstr Surg. 2020; 26: 443-446
        • Rortveit G
        • Brown JS
        • Thom DH
        • Van Den Eeden SK
        • Creasman JM
        • Subak LL.
        Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort.
        Obstet Gynecol. 2007; 109: 1396-1403
        • Whitcomb EL
        • Rortveit G
        • Brown JS
        • et al.
        Racial differences in pelvic organ prolapse.
        Obstet Gynecol. 2009; 114: 1271-1277
        • Brazell HD
        • O'Sullivan DM
        • Tulikangas PK.
        Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse.
        Am J Obstet Gynecol. 2013; 209 (e471-475): 476
        • Shah AD
        • Kohli N
        • Rajan SS
        • Hoyte L.
        Racial characteristics of women undergoing surgery for pelvic organ prolapse in the United States.
        Am J Obstet Gynecol. 2007; 197 (e71-78): 70
        • Dunivan GC
        • Cichowski SB
        • Komesu YM
        • Fairchild PS
        • Anger JT
        • Rogers RG.
        Ethnicity and variations of pelvic organ prolapse bother.
        Int Urogynecol J. 2014; 25: 53-59
        • Alas AN
        • Dunivan GC
        • Wieslander CK
        • et al.
        Health care disparities among english-speaking and spanish-speaking women with pelvic organ prolapse at public and private hospitals: what are the barriers?.
        Female Pelvic Med Reconstr Surg. 2016; 22: 460-466
        • Berry SH
        • Elliott MN
        • Suttorp M
        • et al.
        Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States.
        J Urol. 2011; 186: 540-544
        • Clemens JQ
        • Link CL
        • Eggers PW
        • et al.
        Prevalence of painful bladder symptoms and effect on quality of life in black, Hispanic and white men and women.
        J Urol. 2007; 177: 1390-1394
        • Barry MJ
        • Link CL
        • McNaughton-Collins MF
        • McKinlay JB
        • Boston area community health I
        Overlap of different urological symptom complexes in a racially and ethnically diverse, community-based population of men and women.
        BJU Int. 2008; 101: 45-51
        • Lifford KL
        • Curhan GC.
        Prevalence of painful bladder syndrome in older women.
        Urology. 2009; 73: 494-498
        • Nickel JC
        • Tripp D
        • Teal V
        • et al.
        Sexual function is a determinant of poor quality of life for women with treatment refractory interstitial cystitis.
        J Urol. 2007; 177: 1832-1836
        • Bogart LM
        • Suttorp MJ
        • Elliott MN
        • Clemens JQ
        • Berry SH.
        Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome/interstitial cystitis.
        Urology. 2011; 77: 576-580
        • Link CL
        • Pulliam SJ
        • Hanno PM
        • et al.
        Prevalence and psychosocial correlates of symptoms suggestive of painful bladder syndrome: results from the Boston area community health survey.
        J Urol. 2008; 180: 599-606
        • Gormley EA
        • Lightner DJ
        • Burgio KL
        • et al.
        Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline.
        J Urol. 2012; 188: 2455-2463
        • Lightner DJ
        • Gomelsky A
        • Souter L
        • Vasavada SP.
        Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.
        J Urol. 2019; 202: 558-563
        • George S
        • Duran N
        • Norris K.
        A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders.
        Am J Public Health. 2014; 104: e16-e31
        • Duralde ER
        • Walter LC
        • Van Den Eeden SK
        • et al.
        Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women.
        Am J Obstet Gynecol. 2016; 214 (e261-266 e269): 266
        • Wilkins CH
        • Schindler SE
        • Morris JC.
        Addressing health disparities among minority populations: why clinical trial recruitment is not enough.
        JAMA Neurol. 2020; 77: 1063-1064
        • Heller C
        • Balls-Berry JE
        • Nery JD
        • et al.
        Strategies addressing barriers to clinical trial enrollment of underrepresented populations: a systematic review.
        Contemp Clin Trials. 2014; 39: 169-182