Racial and Socioeconomic Factors Influence Utilization of Advanced Therapies in Commercially Insured OAB Patients: An Analysis of over 800,000 OAB Patients - Beyond the Abstract

Overactive bladder (OAB) is a highly prevalent disorder, affecting 11-16% of the general population.1 Though prevalence and degree of bother vary by racial/ethnic populations, where African Americans and Latinos have higher rates of OAB than Whites, these differences in prevalence can be as small as 2-5%.2-6 However, care-seeking attitudes vary significantly by race/ethnicity, where only 5-6% of Asians and African Americans will seek care for bothersome incontinence symptoms compared to 70% of White patients.7 In addition, patients with lower income and education levels are associated with a reduced likelihood of discussing incontinence symptoms.8 However, differences in utilization of OAB therapies across various racial/ethnic groups and the influence of socioeconomic factors have not been well studied. In addition, access to care may influence utilization. Our study sought to determine overall utilization rates and explore any racial and/or sociodemographic associations with advanced therapy utilization amongst patients with commercial insurance coverage. 

We analyzed patients with a diagnosis of OAB within the Optum® database, which represents 72 million Americans with commercial insurance and Medicare Advantage enrollees across the United States. We gathered information on the use of oral therapies as well as third-line therapies, which include onabotulinumtoxinA (BTX), sacral nerve stimulation (SNS), and percutaneous tibial nerve stimulation (PTNS) between 2003-2017. We found that, amongst over 4.2 million patients with OAB, 807,612 (or 19% of patients with OAB) received some form of medical therapy. The vast majority of these patients (95%) received oral therapy only, and only 4.7% of patients received a third-line therapy. Asians had the lowest use of both oral and advanced therapies compared to other racial/ethnic groups. When examining trends in the use of the various advanced therapy options, we found that Asians and Hispanics were least likely to utilize SNS therapy and most likely to use PTNS compared to Blacks and Whites. BTX use, however, was similar between races/ethnicities. Overall, we found that female gender, younger age, higher annual income, and prior use of oral medications were significantly associated with receiving advanced therapies. Nonwhite race, a lower education level (less than a bachelor’s degree), and the Northeast region were associated with a lower likelihood of receiving advanced therapies. 

To our knowledge, our study represents the largest and most ethnically diverse population-based study of OAB treatment patterns. By utilizing a commercially insured patient population and controlling for education and annual income level in our multivariate analysis, we aimed to minimize the effect of some socioeconomic factors such as financial barriers and access to care. Despite this, racial and ethnic differences were still observed. Our findings suggest that beyond socioeconomic barriers, cultural differences may play a role in the racial/ethnic disparities in OAB treatment patterns. The low overall rates of OAB diagnoses, oral therapy use, and advanced therapy use in our cohort should be noted.  This may reflect the degree of bother (where the majority of patients do not require advanced medical therapy), and/or various socioeconomic factors, as suggested by our study. Improving access and utilization of advanced therapies in medication refractory patients will require culturally competent patient counseling that addresses the concerns of diverse racial and sociodemographic groups, address barriers such as mistrust, and identify causes of poor patient-procedure communication and relationships. Future directions of our study include an evaluation of the role of provider type (Urologist, Gynecologist, or Female Pelvic Medicine and Reconstructive Surgery (FPRMRS) specialist), as well as practice type (academic versus private practice) and their potential influences on access and advanced therapy utilization. 


Written by: Raveen Syan, Chiyuan A Zhang, Ekene A Enemchukwu

Department of Urology, University of Miami, Miami, FL. Electronic address: ., Department of Urology, University of Miami, Miami, FL., Department of Urology, University of Miami, Miami, FL; Department of Urology, Stanford University, Stanford, CA.


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