Megahed N, Pai S, Robison E, Briskin R, Menhaji K, Spector S, Hidalgo R, and Antosh D. Racial and ethnic disparities in pelvic floor disorder awareness. Am J Obstet Gynecol 2022; 226(3):S1299-S1300.
Am J Obstet Gynecol
Objectives: Pelvic floor disorders (PFD) affect the quality of life for many women and can be a significant cause of distress. With the United States’ aging population, PFD are becoming increasingly prevalent. Previous population based studies identified both differences in prevalence and baseline knowledge of PFD by race and ethnicity. These prior studies assessing PFD knowledge were limited to single geographical areas or institutions. We aim to conduct a multicenter study across the United States to better understand the baseline knowledge and perceptions of PFD and its variance across different races and ethnicities. Our goal is to provide data that will help deliver culturally competent information to patients.
Materials and Methods: This was a multicenter cross-sectional study involving six sites. Upon initial presentation to a urogynecology clinic, patients were evaluated with the Prolapse and Incontinence Knowledge Questionnaire along with additional questions aimed to assess differences in PFD descriptive language, barriers to care, and attitude towards PFD. Surveys were distributed at participating institutions from October 2019 to February 2021. Statistical analyses were performed with Fisher's exact test and Chi-square test, using p <0.05 for statistical significance.
Results: A total of 287 women completed the survey, with 27 excluded due to omission of race and or ethnicity responses. Respondents identified their ethnicity as Hispanic (21.8%) and race as White (70.5%), African American (AA) (19.2%), and Other Women of Color (OWOC) (10.3%). Overall, the mean percent correct for the urinary incontinence (UI) and pelvic organ prolapse (POP) sub-scores were 61.2 ± 28.2 and 60.5 ± 28.2, respectively. AA and OWOC had lower scores compared to White respondents in both UI (AA 60.7 ± 30.1; OWOC 46.8 ± 31.2; W 63.5 ± 26.5; p = 0.018) and POP (AA 55.5 ±30.1; OWOC 48.9 ± 31.0; W 64 ± 26.2; p = 0.011). Hispanic women scored lower in both UI (43.9 ± 29.8 vs 66.5 ± 25.3, p <0.001) and POP (46.2 ± 28.4 vs 66.5 ± 25.3, p<0.001) when compared to non-Hispanic respondents. AA and OWOC had decreased knowledge of POP language compared to White respondents (32.3 ± 30.8 % correct vs 35.4 ± 33.6 % correct vs 50.4 ± 32.9 % correct, p <0.001). This was similar for Hispanic compared to non-Hispanic respondents (33.3 ± 31.2 % correct vs 40.1 ± 32.5 % correct, p<0.001). Responses to UI and POP misconception questions were not different by race or ethnicity.
Conclusion: This is the first multicenter, cross-sectional survey of a diverse patient population assessing knowledge and perception of PFD. We observed differences between baseline knowledge and language proficiency of PFD amongst AA, White, and OWOC, as well as between Hispanic and non-Hispanic women. This suggests the presence of racial disparities in women pursuing urogynecologic care and highlights the importance of delivering culturally sensitive information to educate women of diverse backgrounds.