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Merk K, Arpey NC, Gonzalez AM, Valdez KE, Cohen-Rosenblum A, Edelstein AI, Suleiman LI. Racial and Ethnic Minorities Underrepresented in Pain Management Guidelines for Total Joint Arthroplasty: A Meta-analysis. Clin Orthop Relat Res 2024:00003086-990000000-01533. [PMID: 38497759 DOI: 10.1097/corr.0000000000003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Total joint arthroplasty aims to improve quality of life and functional outcomes for all patients, primarily by reducing their pain. This goal requires clinical practice guidelines (CPGs) that equitably represent and enroll patients from all racial/ethnic groups. To our knowledge, there has been no formal evaluation of the racial/ethnic composition of the patient population in the studies that informed the leading CPGs on the topic of pain management after arthroplasty surgery. QUESTIONS/PURPOSES Using papers included in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines and comparing them with US National census data, we asked: (1) What is the representation of racial/ethnic groups in randomized controlled trials compared with their representation in the US national population? (2) Is there a relationship between the reporting of racial/ethnic groups and year of data collection/publication, location of study, funding source, or guideline section? METHODS Participant demographic data (study year published, study type, guideline section, year of data collection, study site, study funding, study size, gender, age, and race/ethnicity) were collected from articles cited by this guideline. Studies were included if they were full text, were primary research articles conducted primarily within the United States, and if they reported racial and ethnic characteristics of the participants. The exclusion criteria included duplicate articles, articles that included the same participant population (only the latest dated article was included), and the following article types: systematic reviews, nonsystematic reviews, terminology reports, professional guidelines, expert opinions, population-based studies, surgical trials, retrospective cohort observational studies, prospective cohort observational studies, cost-effectiveness studies, and meta-analyses. Eighty-two percent (223 of 271) of articles met inclusion criteria. Our original literature search yielded 27 papers reporting the race/ethnicity of participants, including 24 US-based studies and three studies conducted in other countries; only US-based studies were utilized as the focus of this study. We defined race/ethnicity reporting as the listing of participants' race or ethnicity in the body, tables, figures, or supplemental data of a study. National census information from 2000 to 2019 was then used to generate a representation quotient (RQ), which compared the representation of racial/ethnic groups within study populations to their respective demographic representation in the national population. An RQ value greater than 1 indicates an overrepresented group and an RQ value less than 1 indicates an underrepresented group, relative to the US population. Primary outcome measures of RQ value versus time of publication for each racial/ethnic group were evaluated with linear regression analysis, and race reporting and manuscript parameters were analyzed with chi-square analyses. RESULTS Two US-based studies reported race and ethnicity independently. Among the 24 US-based studies reporting race/ethnicity, the overall RQ was 0.70 for Black participants, 0.09 for Hispanic participants, 0.1 for American Indian/Alaska Natives, 0 for Native Hawaiian/Pacific Islanders, 0.08 for Asian participants, and 1.37 for White participants, meaning White participants were overrepresented by 37%, Black participants were underrepresented by 30%, Hispanic participants were underrepresented by 91%, Asian participants were underrepresented by 92%, American Indian/Alaska Natives were 90% underrepresented, and Native Hawaiian Pacific Islanders were virtually not represented compared with the US national population. On chi-square analysis, there were differences between race/ethnicity reporting among studies with academic, industry, and dual-supported funding sources (χ2 = 7.449; p = 0.02). Differences were also found between race/ethnicity reporting among US-based and non-US-based studies (χ2 = 36.506; p < 0.001), with 93% (25 of 27) of US-based studies reporting race as opposed to only 7% (2 of 27) of non-US-based studies. Finally, there was no relationship between race/ethnicity reporting and the year of data collection or guideline section referenced. CONCLUSION The 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines provide evidence-based recommendations that reflect the current standards in orthopaedic surgery, but the studies upon which they are based overwhelmingly underenroll and underreport racial/ethnic minorities relative to their proportions in the US population. As these factors impact analgesic administration, their continued neglect may perpetuate inequities in outcomes after TJA. CLINICAL RELEVANCE Our study demonstrates that all non-White racial/ethnic groups were underrepresented relative to their proportion of the US population in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines, underscoring a weakness in the orthopaedic surgery evidence base and questioning the overall external validity and generalizability of these combined CPGs. An effort should be made to equitably enroll and report outcomes for all racial/ethnic groups in any updated CPGs.
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Affiliation(s)
| | - Nicholas C Arpey
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Alba M Gonzalez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katia E Valdez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, USA
| | - Adam I Edelstein
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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Carter-Brooks CM, Brown OE, Ackenbom MF. Pelvic Floor Disorders in Black Women: Prevalence, Clinical Care, and a Strategic Agenda to Prioritize Care. Obstet Gynecol Clin North Am 2024; 51:157-179. [PMID: 38267125 PMCID: PMC11093648 DOI: 10.1016/j.ogc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Pelvic floor disorders are a group of common conditions affecting women of all racial and ethnic groups. These disorders are undertreated in all women, but this is especially magnified in Black people who have been historically marginalized in the United States. This article seeks to highlight the prevalence of pelvic floor disorders in Black women, evaluate the clinical care they receive, examine barriers they face to equitable care, and present a strategic agenda to prioritize the care of Black women with pelvic floor disorders.
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Affiliation(s)
- Charelle M Carter-Brooks
- The George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Suite 6A- 416, Washington, DC 20037, USA.
| | - Oluwateniola E Brown
- Northwestern University Feinberg School of Medicine, 250 East Superior Avenue Suite 05-2113, Chicago, IL 60601, USA
| | - Mary F Ackenbom
- Magee-Womens Research Institute, University of Pittsburgh, 3240 Craft Place, Suite 226, Pittsburgh, PA 15213, USA
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Mariner Gonzalez A, Reyes SG, Ho AA, Brown O, Franklin P, Suleiman LI. Underrepresentation of Non-White Participants in the American Academy of Orthopaedic Surgeons Guidelines for Surgical Management of Knee Osteoarthritis. J Arthroplasty 2024; 39:520-526. [PMID: 37572721 PMCID: PMC11210326 DOI: 10.1016/j.arth.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the racial and ethnic representation in studies included in the 2015 American Academy of Orthopaedic Surgeons Surgical Management of the Knee Evidence-Based Clinical Practice Guideline relative to their representation of the United States (US). METHODS The demographic characteristics reported in articles included in the 2015 American Academy of Orthopaedic Surgeons Surgical Management of the Knee Evidence-Based Clinical Practice Guideline were analyzed. The primary outcome of interest was the representation quotient, which is the ratio of the proportion of a racial/ethnic group in the guideline studies relative to their proportion in the US. There were 211 studies included, of which 15 (7%) reported race. There were 35 studies based in the US and 7 of the US-based studies reported race. RESULTS No US-based studies reported race and ethnicity separately, no studies reported American Indian/Alaska Native participants and no US-based studies reported Asian participants. The representation quotient of US-based studies was 0.66 for Black participants, 0.33 for Hispanic participants, and 1.30 for White participants, which indicates a relative over-representation of White participants compared to national proportions. CONCLUSION This study illustrated that the evidence base for the surgical management of knee osteoarthritis has been constructed from studies which fail to consider race and ethnicity. Of those US-based studies which do report race or ethnicity, study cohorts do not reflect the US population. These results illustrate a disparity in clinical orthopedic surgical evidence and highlight the need for improved research recruitment strategies.
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Affiliation(s)
- Alba Mariner Gonzalez
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samuel G Reyes
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alisha A Ho
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Oluwateniola Brown
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patricia Franklin
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lim SI, Geynisman-Tan J, Dong S, Brown O, Mou T. Surgical versus nonsurgical treatment selection patterns among Asian American patients with pelvic floor disorders: a matched cohort study. Int Urogynecol J 2023; 34:2587-2592. [PMID: 37392228 DOI: 10.1007/s00192-023-05588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/28/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to determine if Asian racial identity was associated with the selection of surgical versus nonsurgical treatments for pelvic floor disorders (PFDs). Secondarily, we aimed to determine if there were other demographic or clinical characteristics associated with treatment selection patterns. METHODS This was a retrospective matched cohort study that examined new patient visits (NPVs) of Asian patients at an academic urogynecology practice in Chicago, IL, USA. We included NPVs with primary diagnoses of anal incontinence, mixed urinary incontinence, stress urinary incontinence, overactive bladder, or pelvic organ prolapse. We identified Asian patients with self-identified racial identity recorded in the electronic medical records. Every Asian patient was age matched to white patients in a 1:3 ratio. The primary outcome was surgical versus nonsurgical treatment selection for their primary PFD diagnosis. Comparison of demographic and clinical variables between the two groups and multivariate logistic regression models were performed. RESULTS A total of 53 Asian patients and 159 white patients were included in this analysis. Asian patients were less likely to be English speaking (92% vs 100%, p=0.004), endorse history of anxiety (17% vs 43%, p<0.001), and report history of any pelvic surgery (15% vs 34%, p=0.009) than white patients. When controlling for race, age, history of anxiety, depression, prior pelvic surgery, sexual activity, Pelvic Organ Prolapse Distress Inventory, Colorectal-Anal Distress Inventory, and Urinary Distress Inventory scores, Asian racial identity (adjusted odds ratio 0.36 [95% CI 0.14-0.85]) was independently associated with decreased likelihood of choosing surgical treatments for PFDs. CONCLUSIONS Asian patients with PFDs were less likely than white patients to undergo surgical treatment for their PFDs despite similar demographic and clinical characteristics.
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Affiliation(s)
- Szu-In Lim
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL, USA
| | - Siyuan Dong
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL, USA
| | - Tsung Mou
- Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center, 800 Washington Street, Box #324, Boston, MA, 02111, USA.
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Steinberg JR, DiTosto JD, Turner BE, Roque DR, Yee LM. Obstetric Clinical Trial Diversity: Analysis of Trial Focus and Representation From 2007 to 2020. Obstet Gynecol 2023; 142:840-843. [PMID: 37678886 PMCID: PMC10510814 DOI: 10.1097/aog.0000000000005330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 09/09/2023]
Abstract
Inclusive clinical trials are necessary to improve maternal health equity. We aimed to analyze the current state of race and ethnicity reporting and representation in obstetric trials and the association with trial focus for all U.S.-based obstetric trials between 2007 and 2020. In this cross-sectional, multivariable regression analysis, the exposure variable was clinical trial focus (eg, prematurity), and the outcomes were race and ethnicity reporting and representation of diverse cohorts. Obstetric anesthesia trials reported race and ethnicity the least frequently of all trial foci (adjusted odds ratio 0.2, 95% CI 0.08-0.48). Hypertension and obstetric anesthesia trials enrolled the lowest proportion of Black participants, and prematurity trials enrolled the lowest proportion of Latinx and Asian participants. All researchers should strive to improve measurement and reporting of demographic data as well participation of diverse cohorts.
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Affiliation(s)
- Jecca R Steinberg
- Department of Obstetrics Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and the Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, Massachusetts
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Mou T, Nelson L, Lewicky-Gaupp C, Brown O. Opportunities to Advance Postpartum Pelvic Floor Care With a Health Equity-based Conceptual Framework. Clin Obstet Gynecol 2023; 66:86-94. [PMID: 36657047 DOI: 10.1097/grf.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An essential part of postpartum care includes the evaluation and treatment of pelvic floor disorders (PFDs). Postpartum PFDs are common and occur in over 40% of postpartum women. Despite significant advancements in urogynecology to understand postpartum PFDs and their treatments, there has been a lack of attention to addressing equity in postpartum pelvic floor care. In this article, we address the current scientific understanding of postpartum PFDs while adapting a health equity-based conceptual framework to highlight areas of opportunity in optimizing postpartum pelvic floor care.
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Affiliation(s)
- Tsung Mou
- Division of Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
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Creating an Inclusive Urology Practice. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:131-138. [PMID: 36817083 PMCID: PMC9925931 DOI: 10.1007/s11884-023-00694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 02/16/2023]
Abstract
Purpose of Review Patients seeking urologic care come from diverse backgrounds. Therefore, clinics should strive for inclusivity to make all patients feel comfortable seeing a urologist. This review aims to outline and analyze literature relevant to the care of LGTBQIA+ (lesbian, gay, transgender/transexual, queer/questioning, intersex, asexual/allies, nonbinary/genderqueer +), racial and ethnic minorities, those who have disabilities, and those with a high body mass index (BMI). Although this review article presents the care of diverse communities separately, there is an overlap of the various social axes influencing healthcare outcomes. Healthcare workers should be open-minded to learning about evolving community needs. Recent Findings Creating a safe space for LGTBQIA+ requires understanding terminology, awareness of community-specific challenges and health risks, and changing heteronormative behaviors built into medicine. Specific clinical care delivery structural processes and patient-physician-centered practices can make a clinic welcoming for patients from underrepresented backgrounds and with disabilities. BMI surgical requirements may pose barriers to care, and if implemented, there should be assistance to reach specified weight goals. Summary Creating an inclusive urology clinical practice takes time, but it can be achieved by building a collaborative team. Treating patients with consideration of their personal identities and social determinants of health will lead to better patient-center care and health outcomes.
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Steinberg JR, Turner BE, DiTosto JD, Weeks BT, Young AMP, Lu CF, Wolgemuth T, Holder K, Laasiri N, Squires N, Zhang N, Richardson MT, Magnani CJ, Anderson JN, Roque DR, Yee LM. Race and Ethnicity Reporting and Representation in Obstetrics and Gynecology Clinical Trials and Publications From 2007-2020. JAMA Surg 2023; 158:181-190. [PMID: 36542396 PMCID: PMC9856739 DOI: 10.1001/jamasurg.2022.6600] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022]
Abstract
Importance Clinical trials guide evidence-based obstetrics and gynecology (OB-GYN) but often enroll nonrepresentative participants. Objective To characterize race and ethnicity reporting and representation in US OB-GYN clinical trials and their subsequent publications and to analyze the association of subspecialty and funding with diverse representation. Design and Setting Cross-sectional analysis of all OB-GYN studies registered on ClinicalTrials.gov (2007-2020) and publications from PubMed and Google Scholar (2007-2021). Analyses included logistic regression controlling for year, subspecialty, phase, funding, and site number. Data from 332 417 studies were downloaded. Studies with a noninterventional design, with a registration date before October 1, 2007, without relevance to OB-GYN, with no reported results, and with no US-based study site were excluded. Exposures OB-GYN subspecialty and funder. Main Outcomes and Measures Reporting of race and ethnicity data and racial and ethnic representation (the proportion of enrollees of American Indian or Alaskan Native, Asian, Black, Latinx, or White identity and odds of representation above US Census estimates by race and ethnicity). Results Among trials with ClinicalTrials.gov results (1287 trials with 591 196 participants) and publications (1147 trials with 821 111 participants), 662 (50.9%) and 856 (74.6%) reported race and ethnicity data, respectively. Among publications, gynecology studies were significantly less likely to report race and ethnicity than obstetrics (adjusted odds ratio [aOR], 0.54; 95% CI, 0.38-0.75). Reproductive endocrinology and infertility trials had the lowest odds of reporting race and ethnicity (aOR, 0.14; 95% CI, 0.07-0.27; reference category, obstetrics). Obstetrics and family planning demonstrated the most diverse clinical trial cohorts. Compared with obstetric trials, gynecologic oncology had the lowest odds of Black representation (ClinicalTrials.gov: aOR, 0.04; 95% CI, 0.02-0.09; publications: aOR, 0.06; 95% CI, 0.03-0.11) and Latinx representation (ClinicalTrials.gov: aOR, 0.05; 95% CI, 0.02-0.14; publications: aOR, 0.23; 95% CI, 0.10-0.48), followed by urogynecology and reproductive endocrinology and infertility. Urogynecology (ClinicalTrials.gov: aOR, 0.15; 95% CI, 0.05-0.39; publications: aOR, 0.24; 95% CI, 0.09-0.58) had the lowest odds of Asian representation. Conclusions and Relevance Race and ethnicity reporting and representation in OB-GYN trials are suboptimal. Obstetrics and family planning trials demonstrate improved representation is achievable. Nonetheless, all subspecialties should strive for more equitably representative research.
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Affiliation(s)
| | | | - Julia D. DiTosto
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brannon T. Weeks
- Integrated Residency Program in Obstetrics and Gynecology, Brigham and Women’s Hospital/Massachusetts General Hospital, Boston
| | - Anna Marie P. Young
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Connie F. Lu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tierney Wolgemuth
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kai Holder
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nora Laasiri
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Natalie Squires
- Department of Obstetrics and Gynecology, NewYork-Presbyterian/Weill Cornell Medical Center, New York
| | - Naixin Zhang
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis
| | | | - Christopher J. Magnani
- Division of Urological Surgery, Brigham & Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jill N. Anderson
- Department of Obstetrics and Gynecology, NewYork-Presbyterian/Weill Cornell Medical Center, New York
| | - Dario R. Roque
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:89-103. [PMID: 36735420 DOI: 10.1097/spv.0000000000001302] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Studies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding of barriers to care specific to racial/ethnic minority populations. OBJECTIVES We aimed to report identified barriers to urogynecologic care (eg, care for symptoms/diagnoses of urinary incontinence [UI], accidental bowel leakage [ABL], and pelvic organ prolapse [POP]) for underrepresented racial and ethnic minority (URM) women in the United States. STUDY DESIGN We conducted a systematic search for studies through 5 electronic bibliographic databases. Inclusion criteria for eligible studies included the following: (1) studies reporting barriers to care for those with urogynecologic symptoms/diagnoses, (2) publication date year 2000 or later. Exclusion criteria included study cohorts with children, exclusively non-U.S. populations, cohorts without URM participants, and studies without qualitative research methodology. Study methodology, characteristics, as well as barriers and facilitators to urogynecologic care were captured using a thematic synthesis approach. RESULTS There were 360 studies identified. Twelve studies met criteria: 6 had study populations with UI, 3 with POP, 2 on UI and/or POP, and 1 on ABL. There were 7 focus group studies (total 44 groups, n = 330), 4 interview studies (total 160 interviews, n = 160), and 1 had both (10 interviews, 6 groups, n = 39). Most studies reported on patient-associated barriers (n = 10/12) and physician/provider-associated barriers (n = 10/12), whereas only half reported system-associated barriers (n = 6/12). CONCLUSION Identified barriers to urogynecologic care for URM populations were examined. Findings likely do not fully reflect barriers to urogynecologic care for URM populations. Comprehensive evaluation of social determinants of health and systemic racism within studies is needed to understand the unique barriers present for racially/ethnically diverse populations.
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Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S20-S39. [PMID: 36548637 DOI: 10.1097/spv.0000000000001274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT This article outlines an evidence-informed, interdisciplinary, multidimensional, comprehensive action plan for the American Urogynecologic Society to improve care of women with overactive bladder (OAB) while minimizing treatment-related adverse events, including cognitive impairment. It is a "call to action" to advance basic, translational, and clinical research and summarizes initiatives developed at the State-of-the-Science Conference on OAB and Cognitive Impairment to (1) develop framework for a new OAB treatment approach in women, (2) define research gaps and future research priorities, (3) champion health equity and diversity considerations in OAB treatment, (4) foster community and promote education to remove stigma surrounding OAB and urinary incontinence, and (5) elevate visibility and impact of OAB, by creating partnerships through education and engagement with health care professionals, industry, private and public payers, funding agencies, and policymakers.
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Battle CR, Rubin RS, Kingsberg SA, Alzweri L. Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. J Sex Med 2022; 19:1824-1838. [PMID: 36272968 DOI: 10.1016/j.jsxm.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Female sexual dysfunction (FSD) is a significant cause of distress for an estimated 12-24% of women, and over the past 5 decades several questionnaires have been developed for clinical practice. AIM The purpose of this scoping review is to evaluate the ethnic representation of sample populations used in the studies to validate FSD questionnaires. METHODS A scoping review was performed using electronic databases, including PubMed and Scopus, to identify FSD questionnaires validated between 1976 and 2021. Weighted averages from the combined ethnicity data were compared to population data from 2019 US census data and 2018 healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were also investigated longitudinally to evaluate trends in representation over the past 50 years. OUTCOMES Our outcome of interest was comparison of the weighted averages for ethnicity categories from validation populations to the US female general population, US female health care workforce, and US census data. RESULTS 48 validation studies were reviewed and showed that the average ethnic representation of the study populations relative to the US general population and US female health care workforce, respectively, was: Caucasian (83.7% vs 62.7% and 68.5%), Black (7.8% vs 13.3% and 8.3%), Hispanic (3.6% vs 16.0% and 9.6%), Native American (0.1% vs 0.8% and 0.3%), Asian (0.6% vs 6.4% and 6.2%), and Other (3.1% vs 0.7% and 1.4%). CLINICAL IMPLICATIONS FSD questionnaires are relied upon in research and clinical settings, so lack of diversity in validation populations could lead to under recognition and undertreatment in ethnic minority women. STRENGTHS & LIMITATIONS Our results are dependent on the quality of data available from previously published validation studies. We attempted to account for biases in lack of data and size of validation populations by using weighted averages for making comparisons. We chose the US general population and female healthcare workforce for comparison and analyzed validation populations across multiple decades and geographic locations. Many of the validation studies were performed at least 10 years ago and may not reflect the current state of FSD and potential of questionnaire responses of ethnic minority women. This manuscript raises critical awareness regarding the lack of validated instruments for FSD in ethnically diverse women. CONCLUSION Study populations used to validate FSD questionnaires demonstrate a trend of ethnic minority underrepresentation relative to the US female general and healthcare workforce populations. Battle CR, Rubin RS, Kingsberg SA, et al. Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. J Sex Med 2022;19:1824-1838.
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Affiliation(s)
- Carissa R Battle
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rachel S Rubin
- Department of Urology, Georgetown University Hospital, Washington, DC, USA
| | | | - Laith Alzweri
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
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MacNevin W, Bitcon C, Cox A. Social Disparities in the Diagnosis and Care of Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shinnick JK, Siddique M, Jarmale S, Raker C, Brown O, Sung VW, Carberry CL. Underrepresentation in Pelvic Floor Disorder Patient-Reported Outcomes: Whose Outcomes Are We Measuring? UROGYNECOLOGY (PHILADELPHIA, PA.) 2022; 28:770-777. [PMID: 36288116 DOI: 10.1097/spv.0000000000001248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Patient-reported outcome (PRO) instruments measure the patient's perspective. It is unclear whether commonly used PRO measures were tested in populations that had racial and ethnic distributions comparable with those reported in U.S. census data. OBJECTIVE The aim of this study was to compare the proportion of non-White race and Hispanic ethnicity participants with their expected proportion based on U.S. census data for PRO instruments with U.S.-based validation studies. STUDY DESIGN This was a retrospective review of PRO measures considered by the Pelvic Floors Disorders Consortium Working Group on Patient-Reported Outcomes in their 2020 consensus publication. Study and participant information were abstracted from PRO validation studies. Racial and ethnic representation in U.S.-based studies were compared with U.S. census data. The primary outcome was the representation quotient of reported races and ethnicities, calculated as the reported percentage of the study population identifying with a race and/or ethnicity divided by the proportion of the U.S. population identifying with that race and/or ethnicity when the study was published. RESULTS Forty-five studies with 21,080 total participants were included. Race was reported in 17 of 45 studies (37.8%), and ethnicity was reported in 7 of 45 (15.6%). Most studies did not specify how race and ethnicity information was collected. For U.S.-based studies, the representation quotient of White participants from 1995 to 2019 was 1.15. Indigenous American/Native American/American Indian/Alaska Natives had the lowest representation quotient (0.22). Reporting of ethnicity increased over time (P = 0.001), although there was no significant change in the reporting of race or the representation of various races and ethnicities (P > 0.05). CONCLUSION Non-White and Hispanic patients may be underrepresented in U.S.-based validation studies for PRO instruments in pelvic floor disorders.
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Affiliation(s)
- Julia K Shinnick
- From the Division of Female Pelvic Medicine and Reconstructive Surgery
| | - Moiuri Siddique
- From the Division of Female Pelvic Medicine and Reconstructive Surgery
| | - Spandana Jarmale
- From the Division of Female Pelvic Medicine and Reconstructive Surgery
| | - Christina Raker
- Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Vivian W Sung
- From the Division of Female Pelvic Medicine and Reconstructive Surgery
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Gaines JM, Macdonald EJ, Smith AJ, Diefenbach MA, Paduch DA. Race and Ethnicity Have a Significant Effect on the Disclosure of Erectile Function: An Analysis of NHANES Response Patterns. Urology 2022; 167:138-143. [DOI: 10.1016/j.urology.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/17/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
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15
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Brown O, Mou T, Tate M, Miller E, Debbink M. Considerations for the Use of Race in Research in Obstetrics and Gynecology. Clin Obstet Gynecol 2022; 65:236-243. [PMID: 35348530 DOI: 10.1097/grf.0000000000000705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The race variable in research has been the topic of debate in both research and clinical realms. The tension surrounding the discourse of the use of race in research stem from the difficulties in defining race, the limitations of the variable, and the implications for health and racial equity. In this review, we dissect the challenges faced when incorporating race into research and offer a guide for incorporating race in research in a manner that promotes racial and health equity.
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Affiliation(s)
- Oluwateniola Brown
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Tsung Mou
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Mary Tate
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Edward Miller
- Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michelle Debbink
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
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Roselli N, Mckay E, Nauheim J, Halani PK, Abraham NE. Health disparities and access to advanced therapy for overactive bladder. Neurourol Urodyn 2022; 41:1940-1947. [PMID: 35544745 DOI: 10.1002/nau.24949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
AIMS Refractory overactive bladder (OAB) is among the most common reasons for referral to specialists in voiding dysfunction. Significant racial and ethnic disparities exist in prevalence, severity, and management of OAB, presenting care barriers for marginalized patients. We aim to explicate these disparities and explore the factors that led to their existence and persistence. We will additionally offer suggestions to mitigate such disparities and approach equitable care for our patients. METHODS This is a narrative review of pertinent articles related to health disparities in OAB. Articles on OAB prevalence stratified by race and ethnicity, and variations in treatment patterns for patients of marginalized backgrounds were identified from the PubMed database. We also included a review of evidence from governmental and historical sources to provide sociocultural context. RESULTS Patients from marginalized backgrounds are underrepresented in OAB literature. There appear to be differences in symptom severity and prevalence based on race. OAB severity seems closely entwined with social determinants of health. Patients from marginalized populations experience numerous care barriers impeding the treatment of OAB. Finally, White patients are more likely to receive advanced management for OAB. CONCLUSIONS Numerous health disparities exist in the diagnosis and management of OAB. This review is grounded in societal context: health injustice in the United States ultimately stems from systemic racism. Improving our understanding of care disparities and the systems that allow them to persist will bring us closer to equity and allow our patients from marginalized backgrounds to obtain the evidence-based care they deserve.
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Affiliation(s)
- Nicole Roselli
- Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, New York, USA
| | - Elishia Mckay
- Deparment of Obstetrics & Gynecology, Maimonides, Brooklyn, New York, USA
| | - Jennifer Nauheim
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Priyanka K Halani
- Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
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Grimes CL, Clare CA, Meriwether KV, Geynisman-Tan J, Lozo S, Antosh DD, Brown HW, LeBrun EEW, Raman SV, Iglesia CB, Keltz J, Kim-Fine S, Brennand EA, Rogers R. Reporting Race and Ethnicity In Research Presented at the Society of Gynecologic Surgeons' Annual Meeting. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cara L. Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Camille A. Clare
- Department of Obstetrics and Gynecology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kate V. Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Svjetlana Lozo
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Medical Center, Houston, Texas, USA
| | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Emily E. Weber LeBrun
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sonali V. Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, Kentucky, USA
| | - Cheryl B. Iglesia
- Department of Obstetrics and Gynecology, MedStar Health and Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Julia Keltz
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Shunaha Kim-Fine
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York, USA
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Racial and ethnic representation in primary research contributing to pelvic organ prolapse treatment guidelines. Int Urogynecol J 2021; 32:2959-2967. [PMID: 34570246 DOI: 10.1007/s00192-021-04983-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate whether the studies contributing to the national treatment guidelines on pelvic organ prolapse adequately represent the racial and/or ethnic makeup of the American population. METHODS This analysis examines the racial and ethnic makeup of all primary study cohorts contributing to the American College of Obstetricians and Gynecologists/American Urogynecologic Society Practice Bulletin No. 214 on pelvic organ prolapse. References were excluded if they lacked a primary patient population or were from outside the US. Mean proportional representation of racial/ethnic groups was compared to the 2018 United States Census data on race/ethnicity. The representation quotient was also calculated to evaluate for relative representation of each group. Descriptive statistics were used. RESULTS Of the 110 references, 53 primary studies were included in the final analysis with 30 studies reporting on race/ethnicity. On average, 82% (SD = 15%) of study populations were White, while Blacks, Hispanics, and Asians represented 67% (SD = 7%), 4% (SD = 8%), and < 1% (SD = 1%), respectively, differing significantly from the 2018 US Census (p < 0.01.) The representation quotients for White women was 1.36, demonstrating a 36% overrepresentation, while Black, Hispanic, and Asian women were underrepresented among studies of all evidence levels, with representative quotients of 0.50, 0.23, and 0.09, respectively. CONCLUSIONS Our study demonstrates a significant underrepresentation of non-White populations in primary cohorts of studies contributing to the ACOG/AUGS Practice Bulletin No. 214 on POP. This analysis reinforces that more efforts are required to include and report on racial and ethnically diverse cohorts to better serve all patients.
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Abstract
Health equity is attained when everyone has the opportunity achieve the health they envision; however, health disparities are a barrier to health equity. As health disparities specific to urogynecology exist, it is critical to examine and contextualize them in a framework that improves understanding of what factors may drive these disparities to craft effective solutions. This article will review what we currently know about urinary incontinence disparities and provide a framework for evaluation as well as a framework for advancing health equity in the care of diverse patient populations with urinary incontinence.
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Affiliation(s)
- Oluwateniola Brown
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
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