Prevalence of Pelvic Organ Prolapse in US Racial Populations: A Systematic Review and Meta-analysis of Population-based Screening Studies

Mou T1, Warner K2, Brown O1, Yeh C3, Beestrum M4, Kenton K1, Bretschneider C1

Research Type


Abstract Category

Pelvic Organ Prolapse

Best in Category Prize: Pelvic Organ Prolapse
Abstract 60
Scientific Podium Short Oral Session 6
Pelvic Organ Prolapse Female Prolapse Symptoms Pelvic Floor
1. Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern Prentice Women’s Hospital, 2. Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 3. Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, 4. Galter Health Sciences Library, Northwestern University Feinberg School of Medicine

Tsung Mou



Hypothesis / aims of study
By year 2050, 40% of Americans aged 65 years and older will be from one of the following 5 racial/ethnic groups: Hispanic/Latino, non-Hispanic Black, Asian, American Indian, and Pacific Islander. The prevalence of pelvic organ prolapse (POP) is not well understood in women from underrepresented racial/ethnic populations. This is the first study with the aim to determine if there were differences in the pooled prevalence estimates of POP among underrepresented US racial populations from population-based epidemiologic studies.
Study design, materials and methods
A systematic search of MEDLINE, EMBASE, Cochrane, and Scopus was conducted to retrieve eligible studies. Studies were included if POP was identified by either physical exams or questionnaires, in population-based and non-care seeking settings, and with a representative sample of US community-dwelling women from more than one racial/ethnic groups with prevalence rates reported individually. Quality of the included articles were appraised with STROBE checklist. Meta-analysis was performed with the pooled estimates calculated, and chi-squared tests performed to examined association between race and POP prevalence.
Of the 2,604 studies reviewed, 5 were included. All 5 studies were deemed as high quality. Of the studies included, one used physical exam to determine the presence of POP (with WHI Prolapse Classification System grades 2 and 3 defined as prolapse to introitus or outside the vagina, respectively) while others used questionnaires to identify symptomatic POP or prior POP diagnoses (Table 1). Except Brazell et al (2013), all other studies demonstrated statistically significant differences in POP prevalence rates based on race/ethnicity (Figure 1). The overall pooled prevalence of POP for White, Hispanic, Black, and Asian American were 10.76% (95% CI 10.30-11.22%), 6.55% (95% CI 5.83-7.28%), 3.80% (95% CI 3.22-4.38%), and 3.40% (95% CI 2.09-4.71%), respectively. A significant difference in the pooled prevalence between these 4 racial/ethnic groups was found (p<0.01).
Interpretation of results
Our findings reflect the wide variation in POP prevalence among studies ranging from 1.1% to 14.6%. Our study found that White women had a higher POP pooled prevalence rate than Hispanic women; furthermore, these two populations each had greater pooled prevalence rates than Black women and Asian American women. Lastly, we also found women of American Indian and Pacific Island descents were absent from the current POP epidemiologic literature.
Concluding message
White women had the highest POP prevalence overall while Hispanic women experienced the highest POP burden compare to other minority groups. However, it is unclear from the current population-based literature to know if POP-related impacts on women’s quality of life also differed between racial and ethnic groups. Studies included in our meta-analysis have several inherent limitations due to the complexity and heterogeneity of racial/ethnic health disparities. Finally, there was no data on other underrepresented minority groups, specifically for Native Americans and Pacific Islanders. While awaiting for a better understanding and more effective treatments of POP, more studies are needed in order to accurately reflect the diversity of communities throughout the US and to identify women in underrepresented populations who may be at higher risk for POP. This information will guide clinicians and policy makers to tailor culturally appropriate services and deliver pelvic floor care to women from all backgrounds more efficiently and strategically.
Figure 1 Table 1. Prevalence of pelvic organ prolapse (POP) with racial minority populations in the United States
Figure 2 Figure 1. Forest plot of racial POP prevalence rates
Funding None Clinical Trial No Subjects None
16/06/2024 02:03:34