Investigating Racial, Ethnic, and Socioeconomic Disparities in Pelvic Organ Prolapse Surgery.

Importance: 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.

Objective: 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.

Study design: 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.

Results: 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.

Conclusions: 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.