Unequal Utilization of Overactive Bladder Treatment: The Role of Socioeconomic and Insurance Disparities

OBJECTIVE: To evaluate the association between neighborhood-level socioeconomic disadvantage (SED) and insurance type with pharmacologic and procedural treatment patterns in the management of overactive bladder (OAB). METHODS: We conducted a retrospective cohort study of patients diagnosed with OAB at a tertiary academic medical center between 2011 and 2023. Variables included receipt of pharmacotherapy, and minimally invasive therapy (MIT), corresponding to guideline-defined procedural interventions for OAB, such as sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and intravesical botulinum toxin (BTX). Neighborhood-level SED was measured using the area deprivation index (ADI), with patients stratified by national ADI quartile. Higher ADI scores indicate greater SED. Insurance type was recorded. RESULTS: Among 6786 patients included in the study, higher ADI (greater SED) was associated with increased anticholinergic use and decreased β3-agonist use (p < 0.0001). Privately insured patients were less likely to receive therapy than Medicare patients, while Medicare patients experienced the longest delay to MIT (93.6 vs. 89.9 vs. 73.0 months, respectively; p = 0.002). On multivariable analysis, ADI and insurance status independently predicted OAB treatment. Higher rates of BTX were observed among Medicare patients compared with Medicaid and private insurance (17.8% vs. 11.9% vs. 10.4%, p < 0.0001), while lower rates of SNM were observed among Black patients (5.9% vs. 11.4%, p < 0.0001). CONCLUSIONS: Socioeconomic and insurance disparities influence pharmacologic treatment of OAB, while procedural disparities are more strongly associated with insurance status and race. Using ADI as a validated measure of neighborhood-level SED, we found that patients from more disadvantaged areas were more likely to receive anticholinergic therapy and less likely to be prescribed β3-agonists.