Health disparities and access to advanced therapy for overactive bladder

Abstract

Aims: Refractory overactive bladder (OAB) is among the most common reasons for referral to specialists in voiding dysfunction. Significant racial and ethnic disparities exist in prevalence, severity, and management of OAB, presenting care barriers for marginalized patients. We aim to explicate these disparities and explore the factors that led to their existence and persistence. We will additionally offer suggestions to mitigate such disparities and approach equitable care for our patients. Methods: This is a narrative review of pertinent articles related to health disparities in OAB. Articles on OAB prevalence stratified by race and ethnicity, and variations in treatment patterns for patients of marginalized backgrounds were identified from the PubMed database. We also included a review of evidence from governmental and historical sources to provide sociocultural context.Results: Patients from marginalized backgrounds are underrepresented in OAB literature. There appear to be differences in symptom severity and prevalence based on race. OAB severity seems closely entwined with social determinants of health. Patients from marginalized populations experience numerous care barriers impeding the treatment of OAB.Finally, White patients are more likely to receive advanced management for OAB.Conclusions: Numerous health disparities exist in the diagnosis and management of OAB. This review is grounded in societal context: health injustice in the United States ultimately stems from systemic racism.Improving our understanding of care disparities and the systems that allow them to persist will bring us closer to equity and allow our patients from marginalized backgrounds to obtain the evidence-based care they deserve.

Differences in Anorectal Manometry Values Among Women With Fecal Incontinence in a Racially, Ethnically, and Socioeconomically Diverse Population

“…Discrepancies in symptoms, care-seeking patterns, and treatment choices and outcomes by race have been described for pelvic floor disorders. 4,26,29,30,46 The reasons underlying these racial differences are not well understood, although social factors such as socioeconomic status and other social determinants of health are thought to contribute. 30,47 Along these lines, it is possible that race itself plays a role in explaining our findings.…”

“…24,25 Numerous studies have emphasized the importance of acknowledging race in pelvic floor disorders, given that health inequities do exist. 7,[24][25][26][27][28][29][30]54 Considering variations in parameters used in clinical decision making, such as ARM values, is important because these differences could point to varying etiologies and suggest specific treatment options that could be more beneficial for different subgroups of women. Our study contributes data on 2 underrepresented minority groups to the ARM literature for women with FI and provides information that could be useful for future prospective study in a racially diverse cohort.…”

“…Moreover, whether any differences in ARM values exist between racial groups is unknown. Health inequities are known to exist among women of varying racial groups with pelvic floor disorders, with differences described in symptom severity, health-seeking behavior, and treatment outcomes 4,26–30 . The value of racial and ethnic involvement in research is well established especially given the changing demographics of the U.S. population, and social factors, including race, are significant contributors to an individual's health given the exposure to extrinsic factors via systemic and structural racism 31–34 .…”

Management of complex OAB patients: A call to action

“…11 Considering the treatment aspect, we are well aware of the barriers to receiving treatment for OAB symptoms in the real world. Many complex patients are not offered neuromodulation despite its proven efficacy in many disease states; hence this topic is thoroughly reviewed by Wang et al 12 Not only do disease states affect a patient's ability to receive care, but lack of adherence to therapy plays a substantial role in the treatment failure of many patients explored by Enemchukwu et al 13 as well as the unfortunately prevalent health disparities limiting access to advanced care reviewed by Roselli et al 14 This collection of articles discussing the complexity of care of OAB and its symptoms as well as the nuances of diagnosis will hopefully spark research in the treatment and phenotyping of this condition. We have highlighted the important considerations for therapy selection for some of the most medically challenging patient populations while reinforcing the importance of personalized medical approaches.…”

“…Considering the treatment aspect, we are well aware of the barriers to receiving treatment for OAB symptoms in the real world. Many complex patients are not offered neuromodulation despite its proven efficacy in many disease states; hence this topic is thoroughly reviewed by Wang et al 12 Not only do disease states affect a patient's ability to receive care, but lack of adherence to therapy plays a substantial role in the treatment failure of many patients explored by Enemchukwu et al 13 as well as the unfortunately prevalent health disparities limiting access to advanced care reviewed by Roselli et al 14 …”