Investigating Health Disparities: The Association Between Race, Language and Treatment in Patients with Overactive Bladder

Thursday, October 5, 2023

12:00 PM – 12:10 PM US PST

Location: Oregon Ballroom

Click to View Image
Image Label: Oral Medication Initiation by Any Provider

Click to View Image
Image Label: Patients diagnosed with OAB with Urogynecology care

Presenting Author(s)

Melissa Plummer, MD/MPH (she/her/hers)

Resident
Mass General Brigham
Boston, Massachusetts, United States

PDF

Co-Author(s)

SR

Shayla Reid, MD (she/her/hers)

Resident
Brigham and Womens/Massachusetts General Hospital
Boston, Massachusetts, United States
Marie J. Bangura, MD (she/her/hers)

Fellow
University of Michigan
Ypsilanti, Michigan, United States
KJ

Kaitlyn James, PhD

Reproductive Epidemiologist
Massachusetts General Hospital
Bostom, Massachusetts, United States
KH

Kristin Hung, MD (she/her/hers)

Principal Investigator
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure(s):

Melissa Plummer, MD/MPH: No financial relationships to disclose

Shayla Reid, MD: No financial relationships to disclose

Marie J. Bangura, MD: No financial relationships to disclose

Kaitlyn James, PhD: No financial relationships to disclose

Kristin Hung, MD: No financial relationships to disclose

Objectives: Overactive bladder (OAB) affects up to 30% of female patients of all races and ethnicities in the US. We previously conducted research showing a racial disparity in Urogynecology patients who undergo third line treatments for OAB at an urban academic center. All patients undergoing sacral neuromodulation and percutaneous tibial nerve stimulation were white, even though we found that PCP’s referred patients to Urogynecology at equal rates based on race and ethnicity. This study aims to determine whether this racial disparity persists in second line treatment and additionally if primary language affects treatment of OAB. The primary aim of this study is to examine if there are race or language differences in the initiation of oral OAB medication by providers. The secondary aim is to determine if there are race or language differences in patients who undergo Urogynecologic care for OAB.

Methods: The data was derived from the electronic medical record system database at a racially diverse academic urban center. We identified female patients who were diagnosed with OAB at their PCP appointment between 01/2017 and 01/2020. Of those patients with a diagnosis of OAB, we evaluated patients who were started on oral medication. Patients were stratified by race and ethnicity (White, Black, Hispanic, Asian and Other) and by primary language (English, Spanish, Arabic, and Other).

Results: A total of 1979 patients were diagnosed with OAB by their PCP from 1/2017 to 1/2020. There was no difference in initiation of oral medication when stratified by race and ethnicity. However, when stratified by primary language, more non-English speakers were initiated on medication compared with patients whose primary language was English (Table 1, p=0.001). This difference persisted when stratified by initiation of medication by PCP (p=0.031). More white patients diagnosed with OAB underwent Urogynecologic care compared with non-white patients (Table 2, p=0.001); there was also a significant difference when stratified by age (p=0.001).

Conclusions: This study is the first to examine both race and language disparities in the treatment of OAB. We found that non-English speakers are started on OAB medication by Urogynecologists and PCPs more often than English speakers. Taken in context with our previous findings of racial disparities in third line therapies, these findings suggest that minority patients may experience barriers to accessing treatment options that require more detailed counseling, such as first line pelvic floor physical therapy and third line neuromodulation therapies. We also found that non-white or older patients undergo Urogynecologic care less than white or younger patients. This finding suggests a widespread disparity in accessing specialty care that warrants further investigation.