From the Female Pelvic Medicine and Reconstructive Surgery, Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH.
Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA.
Urogynecology (Phila). 2024 Mar 1;30(3):345-351. doi: 10.1097/SPV.0000000000001488.
This study identifies how neighborhood-level socioeconomic status (SES) may affect patients' treatment decisions for pelvic organ prolapse (POP).
This study aimed to evaluate the association of neighborhood-level SES with the decision of surgical versus conservative POP management.
This was 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. Five-digit zip codes were linked to the Area Deprivation Index and used as a surrogate for neighborhood-level SES. Area Deprivation Indices 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 Area Deprivation Index.
A total of 459 patients met the eligibility criteria (non-Hispanic White, 88.2%). The median age was 63 years (interquartile range, 52-70 years), and the majority had stage 2 POP (65.7%). Of all patients, 59.3% had Medicare/Medicaid, 39.9% were privately insured, and 0.9% were uninsured. Furthermore, 74.7% selected surgical management, and 25.3% chose conservative management. Increasing age and higher Pelvic Organ Prolapse Quantification System 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 (adjusted odds ratio, 1.67; 95% confidence interval, 1.06-2.64) after adjusting for age, race/ethnicity, body mass index, and Pelvic Organ Prolapse Quantification System stage.
Residing in a more disadvantaged zip code was associated with 67% increased odds of choosing surgical versus conservative POP management.
本研究旨在探讨邻里社会经济地位（SES）如何影响盆腔器官脱垂（POP）患者的治疗决策。
评估邻里 SES 与手术与保守 POP 管理决策之间的关联。
这是一项回顾性队列研究，纳入 2015 年至 2021 年期间在三级医疗中心新诊断为 POP 的患者。排除失访或手术候选不佳的患者。从电子病历中提取患者特征、人口统计学和治疗选择。将五位数字的邮政编码与区域贫困指数相关联，并将其用作邻里 SES 的替代指标。区域贫困指数以样本中位数为界（贫困程度较低的地区）和高于样本中位数（贫困程度较高的地区）分为两类。逻辑回归模型估计选择手术与保守治疗的可能性，作为区域贫困指数的函数。
共有 459 名患者符合入选标准（非西班牙裔白人，88.2%）。中位年龄为 63 岁（四分位距，52-70 岁），大多数为 2 期 POP（65.7%）。所有患者中，59.3%有医疗保险/医疗补助，39.9%有私人保险，0.9%没有保险。此外，74.7%的患者选择手术治疗，25.3%的患者选择保守治疗。年龄增长和更高的盆腔器官脱垂量化系统分期与选择手术显著相关（P = 0.01）。调整年龄、种族/族裔、体重指数和盆腔器官脱垂量化系统分期后，居住在贫困程度较高地区的女性选择手术而非保守治疗的可能性增加 67%（调整后的优势比，1.67；95%置信区间，1.06-2.64）。
居住在贫困程度较高的邮政编码地区与选择手术而非保守 POP 管理的可能性增加 67%相关。
