The Effect of Health Disparities on Quality of Life and Work Productivity and Its Association with Medication Prescribed and Surgeries Performed in Females with Urinary Incontinence

Abstract

Background: Urinary incontinence (UI) imposes a significant negative impact on a patient’s physical, socioeconomic, and psychological well-being. The prevalence of UI has been continuously rising in the last two decades, and more frequently in females. Health disparities adversely affect minority people from receiving adequate healthcare. Nearly 40% of the U.S. population identified themselves as a race/ethnicity minority in 2020. The objectives of this work are to describe the currently prescribed medications and performed surgical treatments, and to assess racial and ethnic disparities in receiving treatment for UI females. Also, we want to assess the relationship between health disparities using The National Institute of Minority Health and Health Disparities (NIMHD) framework and quality of life (QoL) as well as racial and socioeconomic health disparities and work productivity in female patients with UI. Methods: This was a retrospective observational study using electronic health care data and the National Institute of Diabetes and Digestive and Kidney Diseases database (NIDDK) trials data. We included females diagnosed with UI. We used frequencies of the medications and surgical treatment for female patients with UI to assess the trends of treatment utilization. Racial and ethnic disparities in receiving treatment were also assessed using binary and multinomial logistic regressions. The relationship between health disparities and QoL and work productivity was assessed using multiple linear regression models and proportional-odds regression model. Results: Oxybutynin was the most frequently prescribed medication with 77,920 prescriptions, followed by mirabegron with 48,052 prescriptions. There was a total of 23,898 UI surgeries performed, and sling was the dominant one. Black or African Americans and Asians were less likely to receive UI surgery compared to White females. Black or African Americans also were more likely to get oxybutynin and less likely to get mirabegron to treat UI compared to Whites. Also, ethnic disparities exist in receiving treatment. In the biological domain of NIMHD framework, our findings showed that obesity, depression/frustration, previous prolapse surgery, hysterectomy, and diabetes were significant predictors of lower QoL. Regarding the behavioral domain, limiting physical activity due to UI, and smoking were linked with worse QoL. In the physical/built environment domain, mobility limitations by car or bus contribute to reduced QoL. Sociocultural factors like ethnicity, marital status, income, education, and language significantly influence QoL. work productivity of Hispanic or non-Hispanic other group was greatly affected compared to whites (OR: 1.77, p value: 0.0007 and OR:1.618, p value= 0.0167 respectively). Higher education and income were linked to better work productivity. Also, married females who were greatly affected in work productivity were significantly lower compared to non-married females (OR: 0.590, p value: <.0001). Conclusion: This work showed that Sling was consistently the most performed surgery every year for UI females. Oxybutynin and mirabegron were the most prescribed medications. Racial and ethnic health disparities were shown in receiving treatment for female patients with UI. Health disparities influence UI females’ QoL. Also, racial and socioeconomic disparities play an important role in individuals’ work productivity.