(105) Variation in Healthcare Access by Hormonal Therapy Status Among Patients with Genitourinary Syndrome of Menopause: Insights from the All of Us Database

Abstract Introduction Genitourinary syndrome of menopause (GSM) encompasses vulvovaginal, urinary, and sexual symptoms resulting from hormonal changes during the menopausal transition. Local vaginal estrogen, vaginal dehydroepiandrosterone, and oral ospemifene are hormonal therapies indicated for vulvovaginal dryness, dyspareunia, and genitourinary symptoms (e. g. incontinence) associated with GSM, yet these therapies may be underutilized. Objective This study evaluates the prevalence of hormonal therapy among patients with GSM and identifies disparities in healthcare access between those with and without treatment. Methods We identified 10, 789 patients with GSM from the NIH-funded All of Us database, which emphasizes recruitment of underrepresented populations in research. Participants with contraindications to hormonal therapy, including history of/active estrogen-dependent neoplasia, abnormal genital bleeding, or thromboembolic disease, were excluded. Demographic, socioeconomic, and healthcare access variables were compared between treated and untreated patients using Pearson's Chi-squared test. Results Among eligible participants (n=7486), 4148 (55. 4%) received hormonal therapy following GSM diagnosis. Relative to untreated patients, those receiving therapy were more frequently White (75. 8% vs 68. 7%, P 0. 001), non-Hispanic or Latino (88. 8% vs 84. 8%, P 0. 001), college or advanced degree graduates (60. 0% vs 50. 2%, P 0. 001), and earning incomes 100, 000 (33. 5% vs 23. 2%, P 0. 001). As detailed in Table 1, patients without treatment were more frequently uninsured and reporting delayed care secondary to rural location or transportation barriers compared to treated patients. Untreated patients were less likely to have seen a women’s health specialist (OB/GYN, urogynecologist) within the past year. No differences were observed in age, ability to afford a prescription, visiting any provider within the past year, and rejection of insurance coverage by provider. Conclusions Socioeconomic and healthcare access-related disparities are evident among patients with varying management of GSM. Provider education regarding hormonal and non-hormonal therapies, expansion of specialist availability, improved insurance coverage, and reduced logistical barriers to care are all possible targets for intervention to improve equitable therapy access and quality of life for individuals with GSM. Disclosure No