Social Determinants and Time to Surgery for Pelvic Floor Disorders

Area of Science:

• Urogynecology
• Health Services Research
• Health Equity

Background:

• Patients facing social determinants of health (SDoH) barriers experience reduced access to care for pelvic floor disorders (PFDs).
• The influence of SDoH on the time to surgical decision-making for PFDs remains understudied.

Purpose of the Study:

• To investigate the association between various social determinants of health (SDoH) and the time to surgical decision-making in patients undergoing surgery for PFDs.

Main Methods:

• A retrospective cross-sectional study analyzed 115 patients who underwent PFD surgery (overactive bladder, stress urinary incontinence, pelvic organ prolapse) between 2013-2023.
• Patients were stratified by residence, and associations between demographic, clinical, and SDoH variables and time to surgical decision were assessed using nonparametric tests and multivariable linear regression.
• Comparisons were made for the pandemic period using nonparametric and categorical tests.

Main Results:

• Public insurance (exp[β]=2.9; P=0.03), residence in Wayne County (P=0.01), and treatment during the COVID-19 pandemic (exp[β]=2.9; P=0.03) were significantly associated with longer time to surgical decision.
• The study included diverse patient demographics, with 14.8% identifying as Arab, 17.4% as Asian, 31.3% as Black, and 36.5% as White.

Conclusions:

• Specific social determinants of health, such as public insurance status and county of residence, appear to influence the timing of surgical decisions for pelvic floor disorders.
• These findings highlight potential disparities in PFD treatment timelines related to socioeconomic and geographic factors.