Association of Neighborhood-level Socioeconomic Status with Pelvic Organ Prolapse Management

Importance
This study identifies how neighborhood-level socioeconomic status (SES) may impact patients’ treatment decision for pelvic organ prolapse (POP).

Objectives
To evaluate the association of neighborhood-level SES with decision of surgical versus conservative management for POP.

Study Design
This is a retrospective cohort study of patients newly diagnosed with POP at a tertiary medical center between 2015 and 2021. Patients lost to follow-up or poor surgical candidates were excluded. Patient characteristics, demographics, and treatment selection were abstracted from the electronic health record. Conservative management was defined as expectant, pessary, and/or pelvic floor physical therapy. 5-digit zip codes were linked to the Area Deprivation Index (ADI) and utilized as a surrogate for neighborhood-level SES. ADIs were dichotomized at or below the sample median (less disadvantaged area) and above the sample median (more disadvantaged area). Logistic regression models estimated the odds of choosing surgical versus conservative management as a function of the ADI.

Results
459 patients met eligibility criteria (88.2% non-Hispanic white). The median age was 63 years (IQR=52, 70) and the majority had stage 2 POP (65.7%). 59.3% had Medicare/Medicaid, 39.9% were privately insured, and 0.9% were uninsured. 74.7% selected surgical and 25.3% chose conservative management. Increasing age and higher POP-Q stage were significantly associated with selecting surgery (p=0.01). Women residing in a more disadvantaged area had a 67% increased odds of choosing surgical over conservative management (aOR=1.67, 95% CI=1.06, 2.64) after adjusting for age, race/ethnicity, BMI, and POP-Q stage.

Conclusions
Residing in a more disadvantaged zip code was associated with 67% increased odds of choosing surgical versus conservative management for POP.