Racial disparities in the surgical management of stress incontinence among female Medicare beneficiaries

Purpose: The relationship between urinary incontinence and race/ethnicity is poorly understood. We analyzed Medicare claims data to identify racial differences in the diagnosis, treatment and outcomes of women with stress urinary incontinence. Materials and Methods: We analyzed the 1999 to 2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women 65 years or older with a diagnosis of stress urinary incontinence were identified on the basis of International Classification of Diseases, 9th revision codes. Those who underwent an autologous or synthetic sling procedure during the index period were identified on the basis of Physicians Current Procedural Terminology Coding System, 4th edition codes. Racial differences in diagnosis, treatment and outcomes were compared. Results: Of all female Medicare beneficiaries older than 65 years overall only 1.1% had a claim that listed a diagnosis of stress urinary incontinence. White women were more likely than nonwhite women to have a claim listing a diagnosis of stress urinary incontinence. Approximately 27,120 slings were performed on the Medicare population during the study period. Among women with a diagnosis of stress urinary incontinence white and Hispanic women were disproportionately more likely to undergo a sling than were black or Asian women (p <0.01). After controlling for age and comorbidities, nonwhite women undergoing sling surgery were twice as likely to develop nonurological complications, pelvic organ prolapse and urinary obstruction within 1 year postoperatively. Conclusions: We identified racial differences in the frequency of diagnosis of stress urinary incontinence, frequency of sling procedures and rate of postoperative complications after sling surgery. Further research is necessary to determine whether such differences are due to racial differences in incontinence incidence and severity or disparities in care for minorities.