Minorities Less Likely than Whites to Receive Advanced Therapies for Overactive Bladder

Minority patients with overactive bladder are less likely than white patients to receive advanced therapies to treat their symptoms, according to a study by University of Miami Miller School of Medicine and Stanford University researchers published in Urology.

Overactive bladder, which results in frequency or an urge to urinate, impacts 11% to 16% of the general population. Epidemiological studies suggest overactive bladder is more common among Blacks and Latinos than whites, according to the paper.

Dr. Raveen Syan, left, with Dr. Paul Rizk, a urology resident.

Urologists and other providers treating overactive bladder generally first treat patients with behavioral therapies, like pelvic floor exercises, followed by medications. For patients who do not respond well to medications, there are widely accepted and recommended advanced treatments, including neurotoxin injections to relax muscles, as well as nerve stimulating procedures such as sacral nerve stimulation or percutaneous tibial nerve stimulation.

“The key takeaway from our work is that even among patients who have insurance coverage and accounting for things like income, education and age, we still found that minority populations were less likely to get any of the three advanced treatments for overactive bladder,” said study author Raveen Syan, M.D., assistant professor of urology at the Miller School. “Traditionally, many have believed that health disparities like this one might be an access issue, and an obvious access issue in the U.S. is insurance coverage. This paper clearly shows that insurance coverage alone doesn’t explain these findings.”

The study, according to Dr. Syan, is the largest and most ethnically diverse population-based study of overactive bladder treatment patterns.

“We need to better understand why certain populations are not receiving these important therapy options,” she said. “This study opened the door to further research. It shows there are other factors influencing why minorities, whether insured or not, do not receive advanced treatment.”

Dr. Syan hopes to pursue research looking at factors that might cause health disparities in overactive bladder care, including patients’ awareness and education about options, lack of access to specialized physicians, trust in providers, as well as provider bias against offering these treatments.

The Miller School is the perfect setting for those studies, she said.

“The University of Miami is an institution that supports health disparities research; we have a unique population to do this kind of work,” Dr. Syan said. “This is a minority-majority population, which is one of the only such populations in the U.S. The opportunity to explore these issues is right here in Miami.”

Coauthors of the study, which was published in August, are Chiyuan A. Zhang, biostatician at Stanford University, and Ekene A. Enemchukwu, M.D., M.P.H., assistant professor of urology at the Stanford University Medical Center.

Tags: Dr. Raveen Syan, overactive bladder, Urology journal