Variation in Overactive Bladder Treatment Type by Social Determinants of Health
Objectives: Our objective was to determine if OAB/UUI treatment type differs by SDOH, including insurance and estimated median household income (EMHI).
Study Design: This was a cross-sectional study of adult patients assigned female at birth with OAB/UUI, identified from 2017 to 2022 within a tertiary academic health system. The primary outcome was any OAB/UUI treatment provision. Secondary outcomes included specific treatments and specialty care. We examined associations between SDOH and OAB/UUI treatments using univariable analysis and multivariable logistic regression.
Results: Among 33,002 patients with OAB/UUI, 15.4% received treatment. Treatment provision was associated with American Indian/Alaska Native or Black/African American race, Latina ethnicity, Medicaid, low-income Medicare, or Medicare Advantage (vs private insurance) and EMHI ranging from $26,500 to $100,000 (compared with EMHI >$100,000). Patients with Black/African American race, Medicaid or no insurance, and EMHI ≤$80,000 had higher odds of anticholinergic prescription and lower odds of β3-agonist prescription. Advanced therapy was associated with traditional Medicare, Medicare Advantage, and EMHI $26,500–$100,000 and negatively associated with Asian race. Specialty care was associated with Black/African American race, Medicaid, Medicare Advantage, no insurance, and EMHI ≤$80,000.
Conclusions: Overactive bladder/urgency urinary incontinence treatment provision was associated with American Indian/Alaska Native and Black/African American race, Latina ethnicity, Medicaid, low-income Medicare, or Medicare Advantage insurance. Patients with Black/African American race and with lower EMHI had higher odds of receiving anticholinergic therapy and lower odds of receiving β3-agonist medication, despite higher likelihood of specialty care.
Muñoz, Jaclyn M. MD∗; Kim, Edward K. MD, MPH†; Andy, Uduak U. MD∗; Mumford, Sunni L. PhD‡; Harvie, Heidi S. MD, MBA, MSCE∗,§
∗Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA †Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA ‡Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine §The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Source: Muñoz, Jaclyn M. MD∗; Kim, Edward K. MD, MPH†; Andy, Uduak U. MD∗; Mumford, Sunni L. PhD‡; Harvie, Heidi S. MD, MBA, MSCE∗,§. Variation in Overactive Bladder Treatment Type by Social Determinants of Health. Urogynecology ():10.1097/SPV.0000000000001582, October 9, 2024. | DOI: 10.1097/SPV.0000000000001582