Implication of Neighborhood Deprivation Index on Pelvic Organ Prolapse Diagnosis and Management

Wednesday, October 4, 2023

4:05 PM – 4:15 PM US PST

Location: Oregon Ballroom

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Image Label: Table 1: Patient demographic, clinical and treatment characteristics among patients with pelvic organ prolapse (POP) and according to neighborhood deprivation index (NDI)

Presenting Author(s)

Amy Alagh, MD (she/her/hers)

Clinical Fellow
Kaiser Oakland/UCSF FPMRS program
Berkeley, California, United States

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Co-Author(s)

OR

Olga Ramm, MD (she/her/hers)

Fellowship Director
Kaiser Permanente East Bay
Oakland, California, United States
LL

Liisa L. Lyon, MS

Data Analytics Consultant
Division of Research, Kaiser Permanente Northern California, Oakland
Oakland, California, United States
MR

Miranda L. Ritterman Weintraub, PhD, MPH (she/her/hers)

Lead Senior Research Manager
Kaiser Permanente Northern California
Oakland, California, United States
AS

Abigail Shatkin-Margolis, MD

Assistant Professor
University of California San Francisco
San Francisco, California, United States

Disclosure(s):

Amy Alagh, MD: No financial relationships to disclose

Olga Ramm, MD: No financial relationships to disclose

Liisa L. Lyon, MS: No financial relationships to disclose

Miranda L. Ritterman Weintraub, PhD, MPH: No financial relationships to disclose

Abigail Shatkin-Margolis, MD: No financial relationships to disclose

Objectives: To investigate the associations between pelvic organ prolapse (POP) diagnosis and management, and socioeconomic status (SES) as defined by patient neighborhood deprivation index (NDI), a standardized measure of SES based on multiple dimensions of social position, within a managed healthcare organization.

Methods: This retrospective cohort study included female adults, aged 18 years and older, from a large integrated healthcare delivery system between 1/1/2015 and 12/31/2019, with at least four years of continuous healthcare membership. Patient demographics, clinical, and surgical diagnoses were obtained from the electronic medical record system. Diagnosis of POP and surgical intervention for POP treatment were identified using ICD-9 or ICD-10 codes and CPT codes, respectively. NDI data were identified for each patient according to their United States census tract, using the institution’s geographic information science database. NDI data was reported in quartiles, with higher quartiles reflecting greater deprivation. Descriptive and bivariate analyses were conducted to describe the cohort and assess variations according to NDI quartile.

Results: Of the 1,087,567 patients identified, 34,972 (3.2%) had a POP diagnosis. The mean age of patients diagnosed with POP was 61.6 years (±14.1) and the mean body mass index was 28.2 (±6.2). Approximately 8.6% of POP patients had a history of prior hysterectomy, although there were no variations by NDI quartile (p=0.63). The highest number of patients diagnosed with POP (26.31%) was in Q1, the least deprived group. The majority of patients with POP identified as White (57.27%) and were primarily represented in Q1, the least deprived quartile (32.15%). By contrast, Black patients represented the smallest racial/ethnic group (5.76%) and were disproportionately represented in Q4, the most deprived quartile (47.24%). A total of 4945 (14.17%) patients received surgical intervention for POP and there was a statistically significant difference between the number of patients per NDI quartile receiving surgical management (p < 0.01). The proportion of patients with POP who underwent surgical management was the highest in Q4 and the lowest in Q3, at 14.98% and 13.17%, respectively.

Conclusions: The association between patient SES and inequity in access to healthcare has been thoroughly documented. Although a statistically significant difference was found for the rate of surgical intervention by NDI quartile, the proportions of patients receiving surgical intervention were clinically comparable, with a difference between Q4 and Q3 of 1.8%. While socioeconomic disparities persist in our community, we have demonstrated impartial surgical management of POP in this single healthcare delivery system, which strives to eliminate disparities in access to subspecialist care and treatment for POP. This study underscores the importance of equal access to healthcare services and the potential for achieving equitable outcomes irrespective of patient socioeconomic standing.