Alagh Amy, Ramm Olga, Lyon Liisa L, Ritterman Weintraub Miranda L, Shatkin-Margolis Abigail
From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente Oakland, Kaiser Permanente East Bay-University of California San Francisco Urogynecology Fellowship Training Program.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of California San Francisco, Kaiser Permanente East Bay-University of California San Francisco Urogynecology Fellowship Training Program.
Urogynecology (Phila). 2025 Jan 1;31(1):26-33. doi: 10.1097/SPV.0000000000001501. Epub 2024 Mar 7.
Differences in the rate of diagnosis of POP have been described based on race and ethnicity; however, there are few data available on the management and treatment patterns of POP based on multiple factors of socioeconomic status and deprivation.
The objective of this study was to investigate the association between pelvic organ prolapse (POP) management and the Neighborhood Deprivation Index (NDI), a standardized multidimensional measure of socioeconomic status.
This retrospective cohort study included female members of a large integrated health care delivery system who were 18 years or older and had ≥4 years of continuous health care membership from January 1, 2015, to December 31, 2019. Demographic, POP diagnosis, urogynecology consultation, and surgical treatment of POP were obtained from the electronic medical record. Neighborhood Deprivation Index data were extrapolated via zip code and were reported in quartiles, with higher quartiles reflecting greater deprivation. Descriptive, bivariate, and logistic regression analyses were conducted by NDI.
Of 1,087,567 patients identified, 34,890 (3.2%) had a POP diagnosis. Q1, the least deprived group, had the highest prevalence of POP (26.3%). Most patients with POP identified as White (57.3%) and represented approximately a third of Q1. Black patients had the lowest rate of POP (5.8%) and comprised almost half of Q4, the most deprived quartile. A total of 13,730 patients (39.4%) had a urogynecology consultation, with rates ranging from 23.6% to 26.4% ( P < 0.01). Less than half (12.8%) of patients with POP underwent surgical treatment, and the relative frequencies of procedure types were similar across NDI quartiles except for obliterative procedures ( P = 0.01). When controlling for age, no clinically significant difference was demonstrated.
Differences in urogynecology consultation, surgical treatment, and surgical procedure type performed for prolapse across NDI quartiles were not found to be clinically significant. Our findings suggest that equitable evaluation and treatment of prolapse can occur through a membership-based integrated health care system.
基于种族和民族描述了盆腔器官脱垂（POP）的诊断率差异；然而，基于社会经济地位和贫困等多种因素的POP管理和治疗模式的数据却很少。
本研究的目的是调查盆腔器官脱垂（POP）管理与邻里贫困指数（NDI）之间的关联，NDI是一种社会经济地位的标准化多维衡量指标。
这项回顾性队列研究纳入了一个大型综合医疗保健系统的女性成员，她们年龄在18岁及以上，并且在2015年1月1日至2019年12月31日期间连续参加医疗保健会员≥4年。从电子病历中获取人口统计学、POP诊断、泌尿妇科会诊和POP手术治疗信息。通过邮政编码推断邻里贫困指数数据，并按四分位数报告，四分位数越高表明贫困程度越高。按NDI进行描述性、双变量和逻辑回归分析。
在1,087,567名确定的患者中，34,890名（3.2%）有POP诊断。最不贫困的Q1组POP患病率最高（26.3%）。大多数POP患者为白人（57.3%），约占Q1组的三分之一。黑人患者的POP发病率最低（5.8%），几乎占最贫困四分位数Q4组的一半。共有13,730名患者（39.4%）进行了泌尿妇科会诊，会诊率从23.6%到26.4%不等（P<0.01）。不到一半（12.8%）的POP患者接受了手术治疗，除闭塞性手术外，各NDI四分位数的手术类型相对频率相似（P=0.01）。在控制年龄后，未显示出临床显著差异。
未发现NDI四分位数间在泌尿妇科会诊、手术治疗以及针对脱垂进行的手术类型方面存在临床显著差异。我们的研究结果表明，通过基于会员制的综合医疗保健系统可以实现对脱垂的公平评估和治疗。
