DeAndrade Samantha, DePorto Krystal, Crawford Kaitlin, Saporito Lucas, Nguyen AnMarie, Yazdany Tajnoos, Tenggardjaja Christopher
From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
Urogynecology (Phila). 2025 Mar 1;31(3):174-182. doi: 10.1097/SPV.0000000000001633. Epub 2025 Jan 30.
Racial/ethnic and socioeconomic disparities have been observed in the mode of pelvic organ prolapse surgery. Some of the disparities may be attributed to differences in access to care and advanced surgical technology across the United States, although this is difficult to study.
We aimed to investigate whether racial/ethnic or socioeconomic disparities in a mode of prolapse surgery exist in a managed care setting, where differences in access are minimized.
This was a retrospective cohort study of patients who underwent apical pelvic organ prolapse surgery within Kaiser Permanente Southern California facilities between 2014 and 2017. We conducted bivariate tests to examine the associations between patient characteristics and multivariate logistic regression to predict the odds of having obliterative and native tissue repair surgical procedures by race and income.
The analytic sample consisted of 2,798 patients who underwent prolapse surgery. Hispanic/Latina, Non-Hispanic White, Non-Hispanic Black, Asian, and "other" race represented 51.1%, 37.0%, 5.7%, 5.3%, and 0.8% of the sample, respectively. Median household income varied by racial groups. After adjusting for patient characteristics and regional factors, we did not find significant differences in apical prolapse surgery mode by race/ethnicity or income level.
Within this managed care setting, no disparities in mode of apical prolapse surgery were observed by race/ethnicity or income level when regional and patient-level confounders were controlled for, such as prolapse stage and comorbidities. This may suggest that a significant driver of racial/ethnic disparities observed in prolapse surgery may be attributed to structural level factors.
盆腔器官脱垂手术方式存在种族/族裔和社会经济差异。尽管难以进行研究，但部分差异可能归因于美国各地在获得医疗服务和先进手术技术方面的差异。
我们旨在调查在管理式医疗环境中（这种环境下获得医疗服务的差异最小化），脱垂手术方式是否存在种族/族裔或社会经济差异。
这是一项对2014年至2017年在南加州凯撒医疗中心接受顶端盆腔器官脱垂手术的患者进行的回顾性队列研究。我们进行了双变量检验以检查患者特征之间的关联，并进行多变量逻辑回归以预测按种族和收入进行闭塞性和自体组织修复手术的几率。
分析样本包括2798例接受脱垂手术的患者。西班牙裔/拉丁裔、非西班牙裔白人、非西班牙裔黑人、亚洲人和“其他”种族分别占样本的51.1%、37.0%、5.7%、5.3%和0.8%。家庭收入中位数因种族群体而异。在调整患者特征和区域因素后，我们未发现按种族/族裔或收入水平划分的顶端脱垂手术方式存在显著差异。
在这种管理式医疗环境中，当控制区域和患者层面的混杂因素（如脱垂阶段和合并症）时，未观察到按种族/族裔或收入水平划分的顶端脱垂手术方式存在差异。这可能表明，脱垂手术中观察到的种族/族裔差异的一个重要驱动因素可能归因于结构层面的因素。
