Sociodemographic Factors and Overactive Bladder Treatment and Follow-up Patterns

Importance Loss to follow-up for overactive bladder (OAB) care is common and inadequately understood. Objectives The objective of this study was to estimate the association between race, ethnicity, socioeconomic advantage, and loss to follow-up in women initiating OAB treatment. Secondary objectives included comparing treatment patterns. Study Design This study included a retrospective cohort of patients initiating OAB treatment at an academic, tertiary referral center, September 1, 2016, to March 1, 2022. Women with baseline OAB symptom severity data who self-reported language, race, and ethnicity were included. The underrepresented cohort was defined as those self-identifying as Black or Spanish-speaking, Hispanic. Socioeconomic advantage was quantified using the area deprivation index (ADI). To detect a relative risk of 1.3 for loss to follow-up (no follow-up within 13 months of initiating treatment, α= 0.05, β=0.2, 1:3 ratio), 632 patients were needed. Results Six hundred thirty-two patients (mean age 60.48 ± 15.57 y) were included; 159/632 (25%) were underrepresented. Underrepresented patients had an increased risk of loss to follow-up on regression analysis adjusted for socioeconomic advantage, insurance, symptom impact, and menopause status (adjusted risk ratio [aRR] 6.91, 95% CI: 1.69–28.26). The ADI was associated with loss to follow-up on models adjusted for insurance, prolapse stage, symptoms and menopause status (aRR 1.03, 95% CI: 1.004–1.07, P =0.03). There were differences related to initial treatment with anticholinergic medication (34.1% Black, 50.7% Hispanic, 24.9% White, P <0.01), first follow-up (26.3 + 40.9 wk Black, 12.8 + 19.3 wk Hispanic, and 17.1 + 17 wk White, P <0.01), and receipt of advanced therapies (8.0% Black, 2.8% Hispanic, 12.9% White, P =0.02). Conclusion Sociodemographic variables may be associated with treatment patterns after initiating care for OAB.