TY - JOUR
T1 - National Trends in the Surgical Management of Urinary Incontinence among Insured Women, 2004 to 2013
T2 - The Urologic Diseases in America Project
AU - The Urologic Diseases in America Project
AU - Lee, Una J.
AU - Feinstein, Lydia
AU - Ward, Julia B.
AU - Matlaga, Brian R.
AU - Fwu, Chyng Wen
AU - Bavendam, Tamara
AU - Kirkali, Ziya
AU - Kobashi, Kathleen C.
N1 - Funding Information:
The Urologic Diseases in America project was funded by the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) through Contract HHSN276201500204U to Social & Scientific Systems.
Publisher Copyright:
© 2020 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Purpose:The objective of this study was to examine national trends in the surgical management of urinary incontinence in women in the United States from 2004 to 2013.Materials and Methods:We analyzed the CDM (Optum® de-identified Clinformatics® Data Mart) for women 18 to 64 years old and the CMS (Centers for Medicare and Medicaid Services) Medicare 5% Sample for women 65 years old or older. We created annual cross-sectional cohorts and assessed trends in the annual prevalence of urinary incontinence related surgical procedures overall and by age, race/ethnicity and geographic region.Results:We observed a decline in the percent of women with urinary incontinence who underwent surgical treatment according to the CMS (from 4.7% in 2004 to 2.7% in 2013) and the CDM (from 12.5% in 2004 to 9.1% in 2013). This trend persisted independently of age, race/ethnicity and geographic region. Slings were the most common procedure but started to decline in 2011, ultimately decreasing by about 50% during the study period. Compared to other groups the prevalence of urinary incontinence related surgical procedures, including slings, was highest among women 35 to 54 years old and White women, and lowest among women residing in the Northeast. These sociodemographic patterns persisted with time. During the study period injection procedures remained stable, sacral neuromodulation increased slightly but remained uncommon and suspension decreased to nearly 0% of all anti-incontinence procedures.Conclusions:Surgical management of female urinary incontinence experienced several shifts from 2004 to 2013, including a decline in sling procedures. Age, racial/ethnic and regional differences in treatment persisted with time. Improved understanding of the drivers of these trends may help direct future development of treatments of pelvic floor disorders.
AB - Purpose:The objective of this study was to examine national trends in the surgical management of urinary incontinence in women in the United States from 2004 to 2013.Materials and Methods:We analyzed the CDM (Optum® de-identified Clinformatics® Data Mart) for women 18 to 64 years old and the CMS (Centers for Medicare and Medicaid Services) Medicare 5% Sample for women 65 years old or older. We created annual cross-sectional cohorts and assessed trends in the annual prevalence of urinary incontinence related surgical procedures overall and by age, race/ethnicity and geographic region.Results:We observed a decline in the percent of women with urinary incontinence who underwent surgical treatment according to the CMS (from 4.7% in 2004 to 2.7% in 2013) and the CDM (from 12.5% in 2004 to 9.1% in 2013). This trend persisted independently of age, race/ethnicity and geographic region. Slings were the most common procedure but started to decline in 2011, ultimately decreasing by about 50% during the study period. Compared to other groups the prevalence of urinary incontinence related surgical procedures, including slings, was highest among women 35 to 54 years old and White women, and lowest among women residing in the Northeast. These sociodemographic patterns persisted with time. During the study period injection procedures remained stable, sacral neuromodulation increased slightly but remained uncommon and suspension decreased to nearly 0% of all anti-incontinence procedures.Conclusions:Surgical management of female urinary incontinence experienced several shifts from 2004 to 2013, including a decline in sling procedures. Age, racial/ethnic and regional differences in treatment persisted with time. Improved understanding of the drivers of these trends may help direct future development of treatments of pelvic floor disorders.
KW - epidemiology
KW - pelvic floor disorders
KW - suburethral slings
KW - urinary incontinence
KW - women's health
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UR - http://www.scopus.com/inward/citedby.url?scp=85077761255&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000000569
DO - 10.1097/JU.0000000000000569
M3 - Article
C2 - 31580194
AN - SCOPUS:85077761255
SN - 0022-5347
VL - 203
SP - 365
EP - 371
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -