Differences in Advanced Therapeutic Modalities for Overactive Bladder or Urgency Urinary Incontinence in the US by Race

P. Agrawal, G. Chen, M. Clifton

Johns Hopkins University School of Medicine, Baltimore, MD, USA

Introduction and Objective: Significant disparities exist in the diagnosis & treatment of overactive bladder (OAB). Our objective was thus to analyze if race influences prescription of advance therapies for urgency urinary incontinence (UUI) or OAB.

Methods: The TriNetX Diamond network was queried to identify adult females with a diagnosis of UUI or OAB, excluding those with stress incontinence or mixed incontinence. Propensity-score matching was conducted for several covariates. Treatments were categorized according to AUA guidelines: 1st line therapies included biofeedback training or physical therapy; 2nd line included oxybutynin, darifenacin, solifenacin, tolterodine, fesoterodine, trospium chloride, or mirabegron; 3rd line included percutaneous tibial nerve stimulation, sacral neuromodulation, or OnabotulinumtoxinA injection in 1, 3, or 5 years from diagnosis.

Results: We identified 1,534,042 adult females with OAB or UUI; 437,213 identified as white & 57,443 identified as black. The number of individuals receiving treatment & advancement in treatment over the years are listed in Table 1. 57,443 Black females were then compared to an equivalent number of propensity-score matched White females. Significant difference was observed in advanced treatment prescriptions between race at 1-, 3-, 5- years, and any point thereafter from diagnosis (Table 2).

Conclusions: Though initial 1st line treatment prescription is similar by race; our results demonstrate a significantly lower rate of prescription of 2nd or 3rd line therapies for Black individuals. These results highlight the need for further research to understand these differences.