McHugh Erin G, Hinkes Samuel, Chisolm Attiyya, Nguyen Thuy-Vi, Wein Alan, Amin Katherine, Williams Adam, Syan Raveen
University of Miami Miller School of Medicine, Miami, FL.
Vanderbilt University, Nashville. TN.
Urology. 2024 Dec;194:76-81. doi: 10.1016/j.urology.2024.08.024. Epub 2024 Aug 20.
To assess how race, ethnicity, primary language, clinical and other sociodemographic factors predict surgical treatment for pelvic organ prolapse (POP) in a minority-majority Hispanic population.
We identified patients with POP ICD-10 codes from Oct 2019 to Dec 2022 at our Urogynecology academic practice. Data were collected by chart review. Covariates were obtained by manual abstraction. Continuous and categorical variables were analyzed using t-test and chi-square test, and Wilcoxon rank-sum test for non-parametric data. A logistic regression model was fitted to identify independent predictors of surgery.
Of 943 patients over 38 months, 441 (46.8%) underwent surgery. On univariate analysis, younger age, Hispanic/Latino ethnicity, Spanish as primary language, private insurance, stage of prolapse and obesity correlated with higher rates of surgical treatment. On multivariate regression, only age and prolapse compartment remained significant predictors. Younger age and apical prolapse increased the likelihood of surgery (OR=.98 [.96-.99], P = <.001; R=2.31 [1.13-4.72], P = <.001, respectively).
Controlling for confounders, age, and apical prolapse compartment predicted surgical treatment for POP in our Hispanic minority-majority population. Previously identified barriers to care including minority status and non-English primary language do not appear to exist in our population. This may be related to linguistic, ethnic, and racial concordance between healthcare staff and patients, alongside protective aspects of ethnic enclaves. Further research is warranted to understand the impact of cultural barriers, such as provider language, on patient-provider dynamics and surgical decision-making.
评估种族、民族、主要语言、临床及其他社会人口学因素如何预测以西班牙裔为主的多民族人群盆腔器官脱垂（POP）的手术治疗情况。
我们在2019年10月至2022年12月期间，从我们的泌尿妇科临床实践中，通过国际疾病分类第十版（ICD - 10）编码识别出患有POP的患者。数据通过病历审查收集。协变量通过人工提取获得。连续变量和分类变量分别使用t检验、卡方检验以及针对非参数数据的威尔科克森秩和检验进行分析。采用逻辑回归模型来确定手术的独立预测因素。
在38个月内的943例患者中，441例（46.8%）接受了手术。单因素分析显示，年龄较小、西班牙裔/拉丁裔、以西班牙语为主要语言、拥有私人保险、脱垂分期以及肥胖与更高的手术治疗率相关。多因素回归分析中，只有年龄和脱垂部位仍然是显著的预测因素。年龄较小和顶端脱垂增加了手术的可能性（比值比分别为0.98[0.96 - 0.99]，P < 0.001；2.31[1.13 - 4.72]，P < 0.001）。
在控制混杂因素后，年龄和顶端脱垂部位可预测我们以西班牙裔为主的多民族人群中POP的手术治疗情况。先前确定的就医障碍，包括少数族裔身份和非英语主要语言，在我们的人群中似乎并不存在。这可能与医护人员和患者之间的语言、种族和民族一致性以及族裔聚居区的保护作用有关。有必要进一步研究以了解文化障碍，如医护人员语言，对医患关系动态和手术决策的影响。
