Racial Disparities in Sacral Neuromodulation for Idiopathic Fecal Incontinence

Area of Science:

• Urogynecology
• Surgical innovation
• Health equity

Background:

• Sacral neuromodulation (SNM) is a recognized treatment for fecal incontinence (FI).
• Previous research indicates racial disparities in SNM use for urinary incontinence.
• Limited data exists on racial disparities in SNM for FI.

Purpose of the Study:

• To investigate racial disparities in the treatment of fecal incontinence (FI) between Black and White patients.
• To compare the rates of sacral neuromodulation (SNM) counseling and treatment between Black and White women with FI.
• To identify differences in diagnostic testing and specialist referrals for FI based on race.

Main Methods:

• Retrospective cohort study of adult non-Hispanic Black and White patients treated for FI between 2011 and 2021.
• Analysis of medical records for treatments, diagnostic tests, and managing specialties.
• Age-matched cohort (2:1 White:Black patients) to control for age-related treatment variations.

Main Results:

• Black women received significantly less SNM counseling (14.8% vs. 29.2%) and SNM treatment (2.7% vs. 6.4%) compared to White women.
• Black patients were less likely to be referred for physical therapy, sphincter imaging, and defecography.
• Black patients were less likely to be managed by urogynecology and colorectal surgery specialists, who were more likely to discuss SNM.

Conclusions:

• Significant racial disparities exist in the treatment of fecal incontinence (FI), particularly concerning sacral neuromodulation (SNM) counseling and utilization.
• Differences in specialist referrals and management contribute to these disparities.
• Multidisciplinary efforts are essential to promote equitable education and treatment for FI.