We analyzed patients with a diagnosis of OAB within the Optum® database, which represents 72 million Americans with commercial insurance and Medicare Advantage enrollees across the United States. We gathered information on the use of oral therapies as well as third-line therapies, which include onabotulinumtoxinA (BTX), sacral nerve stimulation (SNS), and percutaneous tibial nerve stimulation (PTNS) between 2003-2017. We found that, amongst over 4.2 million patients with OAB, 807,612 (or 19% of patients with OAB) received some form of medical therapy. The vast majority of these patients (95%) received oral therapy only, and only 4.7% of patients received a third-line therapy. Asians had the lowest use of both oral and advanced therapies compared to other racial/ethnic groups. When examining trends in the use of the various advanced therapy options, we found that Asians and Hispanics were least likely to utilize SNS therapy and most likely to use PTNS compared to Blacks and Whites. BTX use, however, was similar between races/ethnicities. Overall, we found that female gender, younger age, higher annual income, and prior use of oral medications were significantly associated with receiving advanced therapies. Nonwhite race, a lower education level (less than a bachelor’s degree), and the Northeast region were associated with a lower likelihood of receiving advanced therapies.
To our knowledge, our study represents the largest and most ethnically diverse population-based study of OAB treatment patterns. By utilizing a commercially insured patient population and controlling for education and annual income level in our multivariate analysis, we aimed to minimize the effect of some socioeconomic factors such as financial barriers and access to care. Despite this, racial and ethnic differences were still observed. Our findings suggest that beyond socioeconomic barriers, cultural differences may play a role in the racial/ethnic disparities in OAB treatment patterns. The low overall rates of OAB diagnoses, oral therapy use, and advanced therapy use in our cohort should be noted. This may reflect the degree of bother (where the majority of patients do not require advanced medical therapy), and/or various socioeconomic factors, as suggested by our study. Improving access and utilization of advanced therapies in medication refractory patients will require culturally competent patient counseling that addresses the concerns of diverse racial and sociodemographic groups, address barriers such as mistrust, and identify causes of poor patient-procedure communication and relationships. Future directions of our study include an evaluation of the role of provider type (Urologist, Gynecologist, or Female Pelvic Medicine and Reconstructive Surgery (FPRMRS) specialist), as well as practice type (academic versus private practice) and their potential influences on access and advanced therapy utilization.
Written by: Raveen Syan, Chiyuan A Zhang, Ekene A Enemchukwu
Department of Urology, University of Miami, Miami, FL. Electronic address: ., Department of Urology, University of Miami, Miami, FL., Department of Urology, University of Miami, Miami, FL; Department of Urology, Stanford University, Stanford, CA.
References:
- Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–1315.
- Coyne KS, Sexton CC, Bell JA, Thompson CL, Dmochowski R, Bavendam T, Chen CI, Quentin Clemens J. 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 Mar;32(3):230-7.
- Sze EH, Jones WP, Ferguson JL, Barker CD, Dolezal JM. Prevalence of urinary incontinence symptoms among black, white, and Hispanic women. Obstet Gynecol. 2002 Apr;99(4):572-5.
- 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 Feb 15;167(4):390-9
- 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 Jan;79(1):95-101
- Thom DH, van den Eeden SK, Ragins AI, Wassel-Fyr C, Vittinghof E, Subak LL, Brown JS. Differences in prevalence of urinary incontinence by race/ethnicity. J Urol. 2006 Jan;175(1):259-64
- Huang AJ, Thom DH, Kanaya AM, Wassel-Fyr CL, Van Den Eeden, SK, Ragins AI et al: Urinary incontinence and pelvic floor dysfunction in Asian-American women. Am J Obstet Gynecol, 2006.
- Duralde ER, Walter LC, Van Den Eeden SK, Nakagawa S, Subak LL, Brown JS, Thom DH, Huang AJ. Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women. Am J Obstet Gynecol. 2016 Feb;214(2):266.e1-266.e9