Pelvic Floor Disorders among Minority Women: Differences in Prevalence, Severity and Health-Related Social Needs - Raveen Syan & Aaron Gurayah
June 3, 2024
Ruchika Talwar interviews Aaron Gurayah and Raveen Syan about their study on pelvic floor disorders among minority women. The research highlights that while these disorders affect a quarter of U.S. women, minority women receive treatments less frequently. The study examines the prevalence, severity, and impact of unmet health-related social needs among Hispanic and Black women, revealing that these women often face higher severity of symptoms due to unmet needs in areas such as mental health, housing, and education. The researchers emphasize the importance of addressing these social determinants to improve outcomes and suggest that mobile clinics can effectively reach underserved populations. Both Drs. Syan and Gurayah stress the need for better patient education and a holistic approach to healthcare that considers the social context of patients' lives.
Biographies:
Raveen Syan, MD, Assistant Professor of Clinical Urology, Desai Sethi Urology Institute, University of Miami, Miami, FL
Aaron Gurayah, MD, Urology Resident, NewYork-Presbyterian Hospital Weill Cornell, New York, NY
Ruchika Talwar, MD, Urologic Oncology Fellow, Department of Urology, Vanderbilt University Medical Center, Nashville, TN
Biographies:
Raveen Syan, MD, Assistant Professor of Clinical Urology, Desai Sethi Urology Institute, University of Miami, Miami, FL
Aaron Gurayah, MD, Urology Resident, NewYork-Presbyterian Hospital Weill Cornell, New York, NY
Ruchika Talwar, MD, Urologic Oncology Fellow, Department of Urology, Vanderbilt University Medical Center, Nashville, TN
Read the Full Video Transcript
Ruchika Talwar: Hi everyone. Welcome back to UroToday's Health Policy Center of Excellence. As always, my name is Ruchika Talwar, and today I'm joined by Dr. Aaron Gurayah from Cornell and Dr. Raveen Syan from the University of Miami, who will be discussing recent work that they published on pelvic floor disorders among minority women. Thank you both for spending time to chat with us today. We're really looking forward to hearing about your work.
Raveen Syan: Thank you.
Aaron Gurayah: Thanks so much for having us. Thank you for that introduction. So as stated, I'll be discussing pelvic floor disorders amongst minority women and the differences in prevalence, severity, and health-related social needs.
Pelvic floor disorders affect approximately a quarter of women in the United States, yet minority women consistently receive treatments for pelvic floor disorders at lower rates than non-minority women. Although studies have investigated racial and ethnic disparities in the prevalence of pelvic floor disorders, few have examined the impact of unmet health-related social needs among Hispanic and Black women. Thus, our aim was to characterize the prevalence and severity of pelvic floor disorders in different healthcare settings and assess how unmet health-related social needs affect minority women.
For this study, minority women were recruited between June 1, 2022, and December 31, 2022, from our academic urogynecology clinic, a general urology clinic at our safety net hospital, and a community outreach mobile clinic. The variability in these three clinical settings allowed us to study participants from different socioeconomic backgrounds with varying access to medical resources. We utilized the Urinary Distress Index-6, POPDI, and GUPI scales and surveys to identify patients with pelvic floor disorders. This included stress urinary incontinence, overactive bladder, and chronic pelvic pain syndrome. Unmet health-related social needs were determined based on the Centers for Medicare and Medicaid Services screening tool. We utilized individual multivariable logistic regression models to determine the association between these three classification variables, including race, ethnicity, clinical setting, and health-related social needs domains, with these six dependent variables. We controlled for age, insurance, and physical activity in each of these models.
For our sample, 131 women were recruited, 61 of whom were Hispanic, 53 were Black, and 17 identified as other. The cohort had a median of 52 years of age, and 40.5% were recruited from urogynecology clinics. In terms of the pelvic floor disorders, 74.8% self-reported overactive bladder, 45.8% reported symptoms of stress urinary incontinence, and 24.4% had chronic pelvic pain symptoms. In terms of our results, we found that Hispanic women were more likely to report overactive bladder and more severe urinary distress symptoms compared to Black women. Patients at our urogynecology clinic reported a higher prevalence of overactive bladder, stress urinary incontinence, and severe urinary distress scores compared to community mobile clinic patients. We found that the top three unmet health-related social needs domains were mental health, housing, and education. Hispanic women most commonly cited unmet housing needs, whereas Black women most frequently had unmet mental health needs.
Patients who encountered issues with family and community support, transportation, and utility issues were more likely to report chronic pelvic pain symptoms compared to those without these psychosocial issues. In conclusion, the variability in patient knowledge about pelvic floor disorder symptoms and treatments, along with having unmet health-related social needs, may contribute to the higher severity scores that we see in these minority women. Future research that involves conducting interviews with these women and getting more of this qualitative information may better help in understanding patient issues. Mobile clinics offer a very unique opportunity to engage with the community directly and address the needs of individuals who may not routinely have access to PCPs. Our findings support a dual approach to healthcare in which patient needs are addressed both in the clinic and in the community.
Ruchika Talwar: Thank you so much. This is a really interesting study, and I have quite a few questions about the results and why you hypothesize you're seeing some of these signals. However, first, Dr. Syan, I was wondering, could you tell me a little bit more about the mobile health clinic format at your institution?
Raveen Syan: Yeah, so mobile clinics in general are intended to be ways in which a health institution can deliver care to lower socioeconomic areas or areas with lower access to care. Specifically, at the University of Miami, ours is called Game Changer. It is funded through the Sylvester Cancer Center, which is the only NCI-designated cancer institute in South Florida. And it's literally a van. It's a big van that goes to numerous sites all around Miami-Dade County that have been recognized as areas where people have low access to care and lower rates of insurance. The primary purpose of these clinics is to deliver health information.
It also is an opportunity for people to actually get some basic care. So you can get pap smears, and counseling on prostate cancer and colon cancer information. And I may be missing some because it's constantly an evolving process as we identify the needs in the community. However, the focus really is cancer. So it was wonderful that it was recognized, the need to investigate benign disease as well. And so we partnered with what we call the Game Changer vehicle to deliver these questionnaires and provide information on where they can seek more help if they are experiencing these issues.
Ruchika Talwar: Yeah, I think you're so right. We focused a lot on screening for malignant diseases and awareness for oncologic conditions, but I think people are very, very quickly recognizing how some of these specific urologic disorders really can affect quality of life. And we are seeing major disparities due to the fact that patients who are already sort of at risk for not getting preventative care are more likely to not address these quality of life-related issues.
So let's dive into your results a bit. Why do you think we're seeing the differences in prevalence that you've been able to capture?
Raveen Syan: Although there are differences by minority and ethnic breakdown in the prevalence of various pelvic floor disorders, the differences are actually small. So although we see a statistically significant difference, what does that mean clinically? It's not that robust. Really, the point that we try to show is that, sure, there may be some differences, but they're subtle. What's more important really is what are things such as health-related social needs that are predisposing people towards worse disease, more severe disease, or more likely prevalence of disease. Because I think the whole community, hopefully at this point, recognizes that there is no biologic background to race and ethnicity. So really, there must be other things going on that describe these prevalence differences, and it's not race and it's not ethnicity. And that's really the purpose of our study, to show that these other things have meaningful impacts and are areas that we really can address and intervene.
Ruchika Talwar: Yeah, absolutely. And you're right, I think there's been a big shift in understanding socioeconomic factors and how those can be potential confounders when we're stratifying by race and ethnicity, which as you alluded to, are really social constructs in a lot of ways. Dr. Gurayah, tell me, looking at all of these results that you've presented, what in your eyes are the big takeaways for the urologic community? For people who see OAB patients, what is your message to them?
Aaron Gurayah: I think as Dr. Syan was referencing, a lot of the issues we see here are related to the actual access to care and the knowledge base that a lot of these minority patients may have in their communities. So I think as clinicians, as urologists, and urogynecologists, we could definitely do a better job of educating patients and really discuss with them what this disease looks like, what they may do to seek treatments, and what treatment options are out there for them. I think by doing this, we could really make a difference in their quality of life and how they go about their day-to-day lives dealing with these issues.
Ruchika Talwar: Likewise, Dr. Syan. What about you? What are your parting words for the urologic community?
Raveen Syan: I really hope that this study helps encourage people to understand how much more goes into people's disease processes than simply just insurance and the type of doctor you have. For example, with the findings that Dr. Gurayah presented, chronic pelvic pain syndrome is a disease that is largely affected by stress. And when we show that people with transportation issues, issues paying for their utilities, and people who have poor community support are more severely affected by these diseases, that's a profound finding. And I think it hopefully reminds people to acknowledge that our health is guided by much more than just what our genetics say and the doctors we see. We really have to treat the person in the community. And that's especially important in minority communities where these things can be very limited.
Ruchika Talwar: Yeah. Such an important message. Great points. And again, thank you both for sharing your work with us. And to our audience, thanks for tuning in. We'll see you next time.
Ruchika Talwar: Hi everyone. Welcome back to UroToday's Health Policy Center of Excellence. As always, my name is Ruchika Talwar, and today I'm joined by Dr. Aaron Gurayah from Cornell and Dr. Raveen Syan from the University of Miami, who will be discussing recent work that they published on pelvic floor disorders among minority women. Thank you both for spending time to chat with us today. We're really looking forward to hearing about your work.
Raveen Syan: Thank you.
Aaron Gurayah: Thanks so much for having us. Thank you for that introduction. So as stated, I'll be discussing pelvic floor disorders amongst minority women and the differences in prevalence, severity, and health-related social needs.
Pelvic floor disorders affect approximately a quarter of women in the United States, yet minority women consistently receive treatments for pelvic floor disorders at lower rates than non-minority women. Although studies have investigated racial and ethnic disparities in the prevalence of pelvic floor disorders, few have examined the impact of unmet health-related social needs among Hispanic and Black women. Thus, our aim was to characterize the prevalence and severity of pelvic floor disorders in different healthcare settings and assess how unmet health-related social needs affect minority women.
For this study, minority women were recruited between June 1, 2022, and December 31, 2022, from our academic urogynecology clinic, a general urology clinic at our safety net hospital, and a community outreach mobile clinic. The variability in these three clinical settings allowed us to study participants from different socioeconomic backgrounds with varying access to medical resources. We utilized the Urinary Distress Index-6, POPDI, and GUPI scales and surveys to identify patients with pelvic floor disorders. This included stress urinary incontinence, overactive bladder, and chronic pelvic pain syndrome. Unmet health-related social needs were determined based on the Centers for Medicare and Medicaid Services screening tool. We utilized individual multivariable logistic regression models to determine the association between these three classification variables, including race, ethnicity, clinical setting, and health-related social needs domains, with these six dependent variables. We controlled for age, insurance, and physical activity in each of these models.
For our sample, 131 women were recruited, 61 of whom were Hispanic, 53 were Black, and 17 identified as other. The cohort had a median of 52 years of age, and 40.5% were recruited from urogynecology clinics. In terms of the pelvic floor disorders, 74.8% self-reported overactive bladder, 45.8% reported symptoms of stress urinary incontinence, and 24.4% had chronic pelvic pain symptoms. In terms of our results, we found that Hispanic women were more likely to report overactive bladder and more severe urinary distress symptoms compared to Black women. Patients at our urogynecology clinic reported a higher prevalence of overactive bladder, stress urinary incontinence, and severe urinary distress scores compared to community mobile clinic patients. We found that the top three unmet health-related social needs domains were mental health, housing, and education. Hispanic women most commonly cited unmet housing needs, whereas Black women most frequently had unmet mental health needs.
Patients who encountered issues with family and community support, transportation, and utility issues were more likely to report chronic pelvic pain symptoms compared to those without these psychosocial issues. In conclusion, the variability in patient knowledge about pelvic floor disorder symptoms and treatments, along with having unmet health-related social needs, may contribute to the higher severity scores that we see in these minority women. Future research that involves conducting interviews with these women and getting more of this qualitative information may better help in understanding patient issues. Mobile clinics offer a very unique opportunity to engage with the community directly and address the needs of individuals who may not routinely have access to PCPs. Our findings support a dual approach to healthcare in which patient needs are addressed both in the clinic and in the community.
Ruchika Talwar: Thank you so much. This is a really interesting study, and I have quite a few questions about the results and why you hypothesize you're seeing some of these signals. However, first, Dr. Syan, I was wondering, could you tell me a little bit more about the mobile health clinic format at your institution?
Raveen Syan: Yeah, so mobile clinics in general are intended to be ways in which a health institution can deliver care to lower socioeconomic areas or areas with lower access to care. Specifically, at the University of Miami, ours is called Game Changer. It is funded through the Sylvester Cancer Center, which is the only NCI-designated cancer institute in South Florida. And it's literally a van. It's a big van that goes to numerous sites all around Miami-Dade County that have been recognized as areas where people have low access to care and lower rates of insurance. The primary purpose of these clinics is to deliver health information.
It also is an opportunity for people to actually get some basic care. So you can get pap smears, and counseling on prostate cancer and colon cancer information. And I may be missing some because it's constantly an evolving process as we identify the needs in the community. However, the focus really is cancer. So it was wonderful that it was recognized, the need to investigate benign disease as well. And so we partnered with what we call the Game Changer vehicle to deliver these questionnaires and provide information on where they can seek more help if they are experiencing these issues.
Ruchika Talwar: Yeah, I think you're so right. We focused a lot on screening for malignant diseases and awareness for oncologic conditions, but I think people are very, very quickly recognizing how some of these specific urologic disorders really can affect quality of life. And we are seeing major disparities due to the fact that patients who are already sort of at risk for not getting preventative care are more likely to not address these quality of life-related issues.
So let's dive into your results a bit. Why do you think we're seeing the differences in prevalence that you've been able to capture?
Raveen Syan: Although there are differences by minority and ethnic breakdown in the prevalence of various pelvic floor disorders, the differences are actually small. So although we see a statistically significant difference, what does that mean clinically? It's not that robust. Really, the point that we try to show is that, sure, there may be some differences, but they're subtle. What's more important really is what are things such as health-related social needs that are predisposing people towards worse disease, more severe disease, or more likely prevalence of disease. Because I think the whole community, hopefully at this point, recognizes that there is no biologic background to race and ethnicity. So really, there must be other things going on that describe these prevalence differences, and it's not race and it's not ethnicity. And that's really the purpose of our study, to show that these other things have meaningful impacts and are areas that we really can address and intervene.
Ruchika Talwar: Yeah, absolutely. And you're right, I think there's been a big shift in understanding socioeconomic factors and how those can be potential confounders when we're stratifying by race and ethnicity, which as you alluded to, are really social constructs in a lot of ways. Dr. Gurayah, tell me, looking at all of these results that you've presented, what in your eyes are the big takeaways for the urologic community? For people who see OAB patients, what is your message to them?
Aaron Gurayah: I think as Dr. Syan was referencing, a lot of the issues we see here are related to the actual access to care and the knowledge base that a lot of these minority patients may have in their communities. So I think as clinicians, as urologists, and urogynecologists, we could definitely do a better job of educating patients and really discuss with them what this disease looks like, what they may do to seek treatments, and what treatment options are out there for them. I think by doing this, we could really make a difference in their quality of life and how they go about their day-to-day lives dealing with these issues.
Ruchika Talwar: Likewise, Dr. Syan. What about you? What are your parting words for the urologic community?
Raveen Syan: I really hope that this study helps encourage people to understand how much more goes into people's disease processes than simply just insurance and the type of doctor you have. For example, with the findings that Dr. Gurayah presented, chronic pelvic pain syndrome is a disease that is largely affected by stress. And when we show that people with transportation issues, issues paying for their utilities, and people who have poor community support are more severely affected by these diseases, that's a profound finding. And I think it hopefully reminds people to acknowledge that our health is guided by much more than just what our genetics say and the doctors we see. We really have to treat the person in the community. And that's especially important in minority communities where these things can be very limited.
Ruchika Talwar: Yeah. Such an important message. Great points. And again, thank you both for sharing your work with us. And to our audience, thanks for tuning in. We'll see you next time.