MP18-09: Does Socioeconomic Status Impact Continuation of Onabotulinum Toxin Therapy for Urgency Urinary Incontinence?
Friday, May 13, 2022
4:30 PM – 5:45 PM
Location: Room 222
Zhina Sadeghi*, Emma C Bethel, Stephanie Daignault-Newton, Paholo G Barboglio Romo, Anne P Cameron, J Quentin Clemens, Priyanka Gupta, Yooni Yi, John T Stoffel, Ann Arbor, MI
FPMRS, Neurourology and reconstructive urology fellow University of Michigan Medicine
Introduction: We investigated demographic and socioeconomic variables associated with cessation of Onabotulinum toxin (BTX) therapy after 1 and =2 injections in adult patients treated for Urgency Urinary Incontinence (UUI).
Methods: People treated with BTX for UUI between 2015-18 were identified from CPT codes (n=835). The cohort was first assessed for variables associated with stopping BTX injection after an initial treatment. For this, the cohort was divided into patients receiving no additional BTX for 2 years after 1st injection (A) and those receiving at-least 1 additional BTX (B).
Next, the cohort was assessed for variables associated with stopping BTX after 2 injections. For this, we identified people with =2 BTX between 2015-20 (n=514) and divided the group into those who stopped after 2 BTX (C) and those who continued to receive additional BTX (D).
Socioeconomic differences were estimated using U.S. census tract indicators to calculate disadvantage index (DI- neighborhood proportion of female headed families; public assistance income; income$75K, age 16+ employed professionals; =Bachelor's degree). Indexes: 0.0 (least), 1.0 (most) disadvantaged or affluent.
Results: The mean cohort age (n=835) was 57 and 68% were female. The median DI was 0.078 and AI was 0.375.
Comparing groups, A (n=305) and B (n=418), A had a higher DI (DI=0.08 vs 0.07, p=0.021) and lower AI (0.35 vs 0.39 p=0.025), but no differences in other variables. Multivariable analysis showed patients with higher AI are less likely to stop after 1 BTX (p=0.045).
Examining patients with at least 2 BTX, Group-C (n=157) and D (n=357) did not differ in DI (p=0.57), AI (p=0.51) but differed in demographics by race (p=0.05) (Table-1). On multivariable analysis, race was associated with stopping BTX after 2 injections (p=0.03) and African-American (AA) patients were more likely to cease BTX after 2 injections (OR:2.3, CI 1.2-4.5).
Conclusions: Over 40% of patients who initiated BTX for UUI did not continue treatments following their first injection. These patients were more disadvantaged and less affluent than those receiving multiple treatments. Of those that had at least 2 BTX, race specifically AA, was associated with ceasing BTX after only 2 treatments.