Socioeconomic Status and Choice of Primary Management of Stress Urinary Incontinence: A Retrospective Cohort Study

Objectives

Stress urinary incontinence (SUI) affects 25% of Canadian women. Characterizing socioeconomic barriers is essential for advocacy and patient-centred counselling. Our objective was to estimate the association between socioeconomic status and the primary management strategy among patients presenting for consultation for management of SUI.

Methods

This retrospective cohort study used billing and diagnostic data from 2019 to 2022 to identify all patients with SUI presenting to a tertiary urogynaecology clinic in Nova Scotia, Canada. Socioeconomic status was estimated using after tax neighbourhood income quintiles derived using postal codes from 2021 Canadian census data and the PCCF+ 8A1 tool. The primary outcome was a composite of interventions not covered by our provincial health care plan. Logistic regression models were used to estimate the association between neighbourhood income and choice of patient cost-incurring interventions.

Results

A total of 293 patients had a diagnosis of SUI and met criteria for inclusion: 4.4% chose expectant, 71.7% chose a conservative intervention that incurred patient cost, and 17.1% chose surgery. There was no difference in the odds of choosing a conservative intervention that incurred patient cost between those from low- and high-income neighbourhoods (OR 1.33; 95% CI 0.75–2.34). Fewer patients from low-income neighbourhoods presented for consultation.

Conclusions

There was no difference in the likelihood of choosing a conservative intervention that incurred patient cost among patients with SUI from low- and high-income neighbourhoods. However, fewer patients from low-income neighbourhoods presented for care. Advocacy for equitable access to consultation and treatment may reduce barriers to access.