Pelvic floor disorders (PFDs) affect up to 25% of women and have significant impact on quality of life.^1-2 Prevalence and severity of PFDs vary by racial and ethnic group, with the most notable findings demonstrating lower treatment rates of PFDs among minority women.³ Southern Florida has a Hispanic minority-majority population with diverse socioeconomic backgrounds, creating a unique opportunity to explore racial/ethnic disparities. In our study, we aimed to characterize the prevalence and severity of PFDs among minority racial and ethnic groups in private clinics, public clinics, and in community outreach efforts.

Recruitment occurred from June-December 2022 in a private urogynecology clinic at our institution, a general urology clinic at our public safety net hospital (SNH), and a local community outreach mobile clinic (MC). Questionnaires were administered including the Urinary Distress Index-6 (UDI), Pelvic Organ Prolapse Distress Inventory-6 (POPDI), and the Female Genitourinary Pain Index (GUPI) to identify patients with stress urinary incontinence (SUI), overactive bladder (OAB), and chronic pelvic pain syndrome (CPPS). The questionnaires were administered in the patient’s chosen language which included English, Spanish, or Haitian Creole. Validated Spanish questionnaires were utilized, while the Haitian Creole questionnaires were translated with the help of a local community partner. The Table summarizes our study characteristics based on race/ethnicity. Disease severity was defined by using a standard cutoff UDI (>33.3 points) or greater than the third quartile for POPDI and GUPI. Means±standard deviations or medians [interquartile ranges] were calculated based on the data distribution. Comparison of numerical variables between groups was performed using the Mann-Whitney U, Student’s t-test, or ANOVA, as applicable. Categorical variables were analyzed using a Chi-squared test and odds ratios (ORs) were calculated for the univariate models. All statistical analysis and visualizations were performed using R (Version 4.1.1).

Table. Study Characteristics

A total of 131 patients were recruited with a median age of 52 [IQR 24 years]. Sixty-one (46.6%) women identified as Hispanic, 53 (40.4%) as Black, and 17 (12.9%) as Other. Fifty-three (40.5%) women were recruited from our private clinic, 30 (22.9%) from our SNH, and 48 (36.6%) from the MC. Overall, SUI was found in 45.8% of women, OAB in 74.8%, and CPPS in 24.4% (see Table).

In our study population, Hispanic women were more likely to report OAB symptoms (OR: 4.2, P < .01) and SUI (OR: 2.2, P = .04), as well as more likely to have severe UDI scores (OR: 6.2, P < .01) when compared to Black women (Figure 1). Patients recruited from our private urogynecology clinic were more likely to have severe UDI (OR: 9.7, P = .001), severe POPDI (OR: 3.4, P = .03), and severe GUPI (OR: 4.0, P = .02) scores compared to MC patients (Figure 2). SNH patients were more likely to report severe UDI (OR: 11.7, P = .001), severe POPDI (OR: 5.7, P < .01), and severe GUPI (OR: 7.2, P < .01) scores compared to MC patients (Figure 2). No significant differences in disease severity scores were noted between private patients and SNH patients.

In summary, Hispanic women were found to be significantly more likely to report OAB and severe urinary distress compared to Black women across all health care settings. As expected, certain PFDs were noted to be more severe among the urology clinics compared to the community MC setting: SNH patients had a higher prevalence of CPPS and more severe prolapse symptoms compared to MC patients, and patients from our private urogynecology clinic were more likely to report OAB and severe urinary distress compared to MC patients.

Reasons for racial/ethnic differences in self-reported PFDs are likely multifactorial; current hypotheses suggest cultural differences in symptom reporting may be a key factor.⁴ Although Hispanic and White women demonstrated a higher risk of pelvic organ prolapse symptoms when compared to African American women, objective findings of pelvic organ prolapse severity with the Pelvic Organ Prolapse Quantification/-Q system did not depict this difference.⁴ Other potential reasons may be differences in questionnaire interpretation and PFD symptom knowledge.^4-5 Furthermore, it is important to address that our Hispanic cohort did not differentiate specific Hispanic backgrounds (eg, Cuban, Mexican, South American, etc), which may also lead to important cultural reporting differences and attitudes.³

Our study highlights the importance of evaluating prevalence and severity of PFDs in the context of race/ethnicity and socioeconomic backgrounds based on health care access. Given the finding of similar prevalence of PFDs across health care settings, our next step is to analyze data on this sample’s health-related social needs and treatment-seeking attitudes and behaviors. Once barriers to treatment are characterized, future work should include approaching minority groups through community partners and trusted community leaders. Educational and culturally sensitive seminars, community events, and even approaching primary care offices and free community clinics may help direct patients toward specialized urogynecologic care.