Anger Jennifer T, Rodríguez Larissa V, Wang Qin, Chen Er, Pashos Chris L, Litwin Mark S
Department of Urology, David Geffen School of Medicine and School of Public Health, University of California-Los Angeles, Los Angeles, California 90095-1738, USA.
J Urol. 2007 May;177(5):1846-50. doi: 10.1016/j.juro.2007.01.035.
The relationship between urinary incontinence and race/ethnicity is poorly understood. We analyzed Medicare claims data to identify racial differences in the diagnosis, treatment and outcomes of women with stress urinary incontinence.
We analyzed the 1999 to 2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women 65 years or older with a diagnosis of stress urinary incontinence were identified on the basis of International Classification of Diseases, 9th revision codes. Those who underwent an autologous or synthetic sling procedure during the index period were identified on the basis of Physicians Current Procedural Terminology Coding System, 4th edition codes. Racial differences in diagnosis, treatment and outcomes were compared.
Of all female Medicare beneficiaries older than 65 years overall only 1.1% had a claim that listed a diagnosis of stress urinary incontinence. White women were more likely than nonwhite women to have a claim listing a diagnosis of stress urinary incontinence. Approximately 27,120 slings were performed on the Medicare population during the study period. Among women with a diagnosis of stress urinary incontinence white and Hispanic women were disproportionately more likely to undergo a sling than were black or Asian women (p<0.01). After controlling for age and comorbidities, nonwhite women undergoing sling surgery were twice as likely to develop nonurological complications, pelvic organ prolapse and urinary obstruction within 1 year postoperatively.
We identified racial differences in the frequency of diagnosis of stress urinary incontinence, frequency of sling procedures and rate of postoperative complications after sling surgery. Further research is necessary to determine whether such differences are due to racial differences in incontinence incidence and severity or disparities in care for minorities.
尿失禁与种族/民族之间的关系尚不清楚。我们分析了医疗保险索赔数据，以确定压力性尿失禁女性在诊断、治疗和预后方面的种族差异。
我们分析了医疗保险和医疗补助服务中心提供的1999年至2001年医疗保险公共使用文件，该文件基于5%的全国受益人的随机样本。根据国际疾病分类第9版编码，确定65岁及以上诊断为压力性尿失禁的女性。在索引期内接受自体或合成吊带手术的患者，根据医师当前操作术语编码系统第4版编码确定。比较诊断、治疗和预后方面的种族差异。
在所有65岁以上的女性医疗保险受益人中，只有1.1%的人有一份列出压力性尿失禁诊断的索赔。白人女性比非白人女性更有可能有一份列出压力性尿失禁诊断的索赔。在研究期间，医疗保险人群中大约进行了27,120例吊带手术。在诊断为压力性尿失禁的女性中，白人和西班牙裔女性比黑人或亚洲女性更有可能接受吊带手术（p<0.01）。在控制年龄和合并症后，接受吊带手术的非白人女性在术后1年内发生非泌尿系统并发症、盆腔器官脱垂和尿路梗阻的可能性是白人女性的两倍。
我们发现了压力性尿失禁诊断频率、吊带手术频率以及吊带手术后术后并发症发生率方面的种族差异。有必要进一步研究以确定这些差异是由于尿失禁发病率和严重程度的种族差异还是对少数群体护理的差异。
