Differences in Advanced Therapeutic Modalities for Overactive Bladder in the United States by Race

To investigate the impact of race on prescription patterns of therapies for overactive bladder (OAB).

The TriNetX Diamond network was queried to identify adult females with a diagnosis of urinary urgency incontinence (UUI) or OAB, excluding those with stress incontinence or mixed incontinence. Treatments were defined as behavioral, medical, or minimally invasive in accordance with American Urological Association (AUA) guidelines. Propensity-score matching for multiple covariates was performed using the greedy nearest-neighbor algorithm. Cox proportional hazards regression analysis was employed to compare the matched cohorts. Rates of treatment by 3-digit zip codes were compared through chi-square tests or Fisher's exact tests and geographic distribution maps were generated via STATA 17.0.

We identified 2,687,316 adult females diagnosed with OAB; 767,159 identified as White and 108,464 as Black. Within these cohorts, 16.6% of Black patients and 20.4% of White patients received OAB treatment. Twenty-six-point three percent of US zip codes contained data for both White and Black patients, and in all these zip codes, White patients received significantly higher rates of prescriptions compared to Black patients. After propensity-score matching, significant differences in prescriptions persisted between the 2 groups with White patients exhibiting higher rates of any prescription.

Our results demonstrate a significantly lower rate of prescriptions of medical and minimally invasive therapies for Black women. These racial differences in prescription of advanced therapeutic modalities for OAB may not be secondary to diagnosis but are likely secondary to prescribing disparities. Further research is needed to understand these differences.