在获取和等待时间的差异泌尿妇科程序：使用相对指数不平等的比较分析

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.009

N Dogra , S Shamiya , A Allen-Valley , K Rai , C Gungor , T Zigras , L Rosella , A Murji , A Cipolla , E Miazga

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引用次数: 0

摘要

研究目的利用相对不平等指数（Relative Index of Inequality， RII）评估与良性非脱垂子宫切除术相比，泌尿妇科手术在可及性和手术等待时间上的社会经济差异。设计回顾性队列研究于2022年4月至2024年3月进行，按社会经济地位（SES）五分位数检查手术进入模式。加拿大安大略省的一个大型医院网络，位于人口多样化的地区，为150多万居民提供服务。医院手术记录与基于区域的SES指数相关联，以评估泌尿妇科和良性子宫切除术的通路模式。患者或参与者包括因脱垂或防失禁手术而接受子宫切除术的患者。排除包括急诊手术、18岁以下患者和非安大略省居民。SES使用安大略省边缘化指数进行分配。比较组包括良性子宫切除术的患者，不包括阴道子宫切除术和脱垂诊断。干预措施我们计算了相对不平等指数（RII），这是一种基于回归的测量方法，用于量化获取方面的不平等。测量和主要结果包括325例泌尿妇科手术和693例良性子宫切除术。排除极端异常值（前5%的等待时间）后，泌尿妇科的中位等待时间为275天（IQR 124.8-393.5），良性子宫切除术的中位等待时间为92天（IQR 43.0-197.0）（p < 0.001）。与良性子宫切除术相比，泌尿妇科手术的RII更高（2.68比1.79），表明最低经济地位组患者接受泌尿妇科手术的比率比最高经济地位组低2.68倍。子宫切除并脱垂修复组差异最大（RII = 3.85）。结论：与良性非脱垂性子宫切除术相比，泌尿妇科手术的等待时间更长，而且边缘化社区的人群获得子宫切除术的机会不成比例。这些发现强调需要以公平为重点的策略来改善获得泌尿妇科护理的机会，特别是对社会经济地位较低的患者。

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Disparities in Access and Wait Times for Urogynecology Procedures: A Comparative Analysis Using the Relative Index of Inequality

Study Objective

To evaluate socioeconomic disparities in access and surgical wait times for urogynecology procedures compared to benign non-prolapse hysterectomy, using the Relative Index of Inequality (RII).

Design

Retrospective cohort study conducted from April 2022 to March 2024, examining surgical access patterns by socioeconomic status (SES) quintiles.

Setting

A large hospital network in Ontario, Canada, located in a demographically diverse region serving over 1.5 million residents. Hospital surgical records were linked with area-based SES indices to evaluate urogynecology and benign hysterectomy access patterns.

Patients or Participants

Patients undergoing hysterectomy for prolapse or anti-incontinence procedures were included. Exclusions included emergency surgery, patients under 18 years, and non-Ontario residents. SES was assigned using the Ontario Marginalization Index. The comparator group included patients undergoing benign hysterectomy excluding vaginal hysterectomy and prolapse diagnoses.

Interventions

We calculated the Relative Index of Inequality (RII), a regression-based measure, used to quantify inequities in access.

Measurements and Primary Results

325 urogynecology procedures and 693 benign hysterectomies were included. After excluding extreme outliers (top 5% of wait times), the median wait time was 275 days (IQR 124.8–393.5) for urogynecology versus 92 days (IQR 43.0–197.0) for benign hysterectomy (p < 0.001). RII was higher for urogynecology procedures compared to benign hysterectomy (2.68 versus 1.79), indicating that patients in the lowest SES group underwent urogynecological surgery at rates 2.68 times lower than those in the highest SES group. Highest disparities were observed in hysterectomy with prolapse repair (RII = 3.85).

Conclusion

Compared to benign non-prolapse hysterectomy, urogynecology procedures are associated with longer wait times and disproportionate inequity in access by populations from marginalized neighborhoods. These findings highlight the need for equity-focused strategies to improve access to urogynecology care, particularly for patients in lower socioeconomic groups.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.