Do Health Disparities Exist in the Insured Refractory OAB Patient Population?

Syan R1, Zhang C1, Enemchukwu E1

Research Type

Clinical

Abstract Category

Overactive Bladder

Abstract 274
Overactive Bladder 1
Scientific Podium Short Oral Session 15
Thursday 30th August 2018
10:20 - 10:27
Hall B
Urgency/Frequency Urgency Urinary Incontinence Neuromodulation Overactive Bladder Incontinence
1. Stanford University
Presenter
R

Raveen Syan

Links

Abstract

Hypothesis / aims of study
Studies suggest racial disparities exist among patients with overactive bladder (OAB).  Minority Medicare populations have been shown to be less likely to undergo sacral neuromodulation therapy (SNS) than White patients (1). Our study aim was to determine whether racial disparities exist for any of the third line therapies amongst commercially insured patients.
Study design, materials and methods
We queried Optum, a national administrative health and pharmacy claims database, between the years of 2003-2016. All patients with non-neurogenic OAB were identified using ICD9 and ICD10 diagnosis codes. Patient demographics and treatment interventions were collected, including oral medication therapies (anticholinergic and beta3 agonists), and advanced therapies (OnabotulinumtoxinA (BTX), SNS, and peripheral tibial nerve stimulation (PTNS)). Multivariate analysis was performed.
Results
2,446,652 patients with OAB were identified. Of these, 519,279 (21.2%) were treated with oral therapies and/or advanced therapies. Of those who were treated, oral medical therapy use was high amongst all races. Regarding advanced therapies, Asians were more likely to undergo BTX than Whites, and Whites were more likely to undergo SNS and PTNS (p<0.05). On multivariate analysis, predictors of advanced OAB therapy use were age <65, occupation as a homemaker or retired, education level less than a bachelor’s degree and prior oral medical therapy use (p<0.05). Male, Asian and Hispanic patients were less likely than their counterparts to undergo an advanced OAB therapy (p<0.05) (Table 1).
Interpretation of results
In an insured population undergoing advanced OAB therapies, Asians were more likely to undergo Botox, while Whites were more likely to undergo SNS and PTNS. Younger patients (age <65), homemakers/retirees, patients with less than a bachelor’s degree and prior OAB oral medication users were more likely to undergo an advanced OAB therapy, while commercially insured males, Asians, and Hispanics were less likely to undergo advanced OAB therapies.
Concluding message
While commercial insurance coverage may provide access to advanced therapies, numerous socioeconomic factors appear to drive advanced therapy choices that are not explained by race alone. Further studies are needed to explore these treatment patterns.
Figure 1