Presentation and treatment pattern differences between asian and white patients with pelvic floor disorders

Abstract

Several epidemiological studies demonstrate that Asian/Asian American women have lower rates of pelvic floor disorders (PFDs) and care seeking behavior than white women, but little is reported about PFD symptoms or treatment preferences in this population. Our objective was to describe and compare the characteristics, symptoms, diagnoses, and treatment choices between Asian and white patients. This was a retrospective chart review of patients presenting for urogynecologic care at a tertiary care urban academic center between January 2019 and January 2020. The hospital's data warehouse identified age-matched within 1 year, self-identified Asian and white patients in a 1:3 ratio and collected their demographics and questionnaire data. Each chart was reviewed for systematically documented variables: chief complaint, goals for the visit, primary diagnosis at end of visit, and treatment chosen. Goals were coded into categories: symptom, lifestyle, emotional, information seeking, or others. Primary diagnoses were coded as pelvic organ prolapse (POP), stress urinary incontinence (SUI), mixed urinary incontinence (MUI), overactive bladder (OAB), myofascial pelvic floor dysfunction (MPFD), and other (e.g., anal incontinence and other gynecologic conditions). Treatments were categorized into expectant, behavioral, medical, or procedural/surgical. SPSS was used to perform descriptive statistical analysis of the overall cohort and diagnosis sub-groups. Eighty-five Asian and 255 age-matched white patients were identified. There was no difference in BMI, Charlson Comorbidity Index, or parity between groups (Figure 1). Asian patients were less likely to have a history of anxiety (20.0% vs 45.5%, p=<0.001) and more likely to be sexually active (65.1% vs 50.8%, p=0.025) than white patients. There was no difference in PFDI score or POP-Q stage at presentation to care. The two most common diagnoses in Asian women were MUI (31.8%) and POP (20.0%), while the most common in white women were MPFD (22.4%) and other (22.0%), p=0.008. There were no differences in treatment goals or preferences between groups with the majority in both groups looking to treat a symptom and less than one quarter in both groups choosing surgical/procedural treatments. In sub-analysis by diagnosis, only the POP subgroup demonstrated clinically relevant differences. Asian patients with POP were more likely to be sexually active (70.6% vs 37.1%, p=0.024) and reported less bother on the POPDI (16.7 [IQR 10.4-39.6] vs 41.7 [IQR 16.7-60.4], p=0.031) despite having the same median POPQ stage. Compared to white women presenting for urogynecologic care, Asian women were more likely to present with MUI and POP; however, they reported similar treatment goals and choose similar broad treatment categories. They were also less bothered by similar stages of POP.