Unequal Utilization of Overactive Bladder Treatment: The Role of Socioeconomic and Insurance Disparities

To evaluate the association between neighborhood-level socioeconomic disadvantage (SED) and insurance type with pharmacologic and procedural treatment patterns in the management of overactive bladder (OAB).

We conducted a retrospective cohort study of patients diagnosed with OAB at a tertiary academic medical center between 2011 and 2023. Variables included receipt of pharmacotherapy, and minimally invasive therapy (MIT), corresponding to guideline-defined procedural interventions for OAB, such as sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and intravesical botulinum toxin (BTX). Neighborhood-level SED was measured using the area deprivation index (ADI), with patients stratified by national ADI quartile. Higher ADI scores indicate greater SED. Insurance type was recorded.

Among 6786 patients included in the study, higher ADI (greater SED) was associated with increased anticholinergic use and decreased β3-agonist use (p < 0.0001). Privately insured patients were less likely to receive therapy than Medicare patients, while Medicare patients experienced the longest delay to MIT (93.6 vs. 89.9 vs. 73.0 months, respectively; p = 0.002). On multivariable analysis, ADI and insurance status independently predicted OAB treatment. Higher rates of BTX were observed among Medicare patients compared with Medicaid and private insurance (17.8% vs. 11.9% vs. 10.4%, p < 0.0001), while lower rates of SNM were observed among Black patients (5.9% vs. 11.4%, p < 0.0001).

Socioeconomic and insurance disparities influence pharmacologic treatment of OAB, while procedural disparities are more strongly associated with insurance status and race. Using ADI as a validated measure of neighborhood-level SED, we found that patients from more disadvantaged areas were more likely to receive anticholinergic therapy and less likely to be prescribed β3-agonists.