While overactive bladder (OAB) remains prevalent, only a minority of patients are prescribed Beta-3 agonists (B3) and progression to third-line therapies remains uncommon. The impact of non-clinical factors including socioeconomic disadvantage (SED) and insurance coverage on treatment access and escalation remain unclear. This study aims to evaluate associations between SED, and insurance payer type, with the treatment decisions for OAB patients within a large single institution setting.

A retrospective database of OAB patients was queried from 2014-2024. Variables included receipt of pharmacotherapy, and third-line therapies defined as sacral neuromodulation, tibial nerve stimulation, and intravesical botulinum toxin. The Area Deprivation Index (ADI), based on 17 U.S. Census variables in income, education, employment, and housing, represents a metric for assessing SED. Patients were stratified by national ADI quartile with 1st quartile representing least disadvantaged and 4th quartile the greatest disadvantaged. Insurance type was extracted from the electronic medical record. Outcomes were compared using Cochran Armitage Trend or Fisher’s exact test.

A total of 6786 patients with OAB diagnosis were included for analysis, 6394 (94.2%) had ADI data. The distribution of OAB patients was skewed towards higher disadvantaged ADI quartiles, noting 9.5%, 21.5%, 32.5%, and 36.4% (from 1st to 4th quartile, respectively). Treatment rates for anticholinergic (AC), B3, and third-line therapies are demonstrated in Figure 1. Increasing ADI Quartile was positively associated AC receipt (p<0.0001), and negatively associated with B3 receipt (p<0.0001). In total, 6688 (98.5%) of patients were categorized as either privately insured (PI) (n=2621, 39.2%) or Medicaire/Medicaid (MM) (n=4067, 60.8%). MM patients had higher rates of AC receipt (60.6% vs 48.3%, p<0.0001), and higher rates of B3 receipt (36.9% vs. 24.3%, p<0.0001) compared to PI patients. MM patients also had higher rates of 3rd-line therapy when compared to PI patients (28.9% vs. 19.3%, p<0.0001).

We present the first use of the Area Deprivation Index to explore SED in OAB treatment. We noted SED is associated with differential treatment patterns, with higher rates of AC and lower rates of B3 with increasing ADI quartile. Interestingly, MM had higher overall rates of all interventions when compared to PI patients.

Patients with OAB are increasingly likely to receive therapy with AC compared to B3 as SED increases. Patients with government sponsored insurance have higher rates of procedural therapy.