Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse


      We sought to evaluate the prevalence of pelvic organ prolapse (POP) among a diverse group of women and to determine if race/ethnicity and/or socioeconomic status (SES) are factors in treatment-seeking behavior.

      Study Design

      All data were collected from the National Institutes of Health–supported Boston Area Community Health Survey. SES was calculated by a 2-factor index that combined household income with years of education. Inferential statistics comprised 1-way analysis of variance, with a post hoc Scheffé test performed to evaluate whether there were differences between individual groups. A χ2 test was used to evaluate whether distributions were equal among the various questions by race/ethnicity and SES category.


      A total of 3205 women were included in the analysis. Hispanic ethnicity and younger age were associated with POP (P < .002 and P < .001, respectively) as well as with seeking treatment for prolapse (P = .007 and P < .001, respectively). These factors were also associated with subsequent surgical repair (P = .027 and P = .019, respectively). A regression model showed that women were 4.9% more likely to seek treatment for every year younger they were, across the range of age. Although women of a higher SES were more likely to have POP, SES was neither associated with a higher likelihood of seeking treatment nor with the surgical management of prolapse.


      Hispanic ethnicity and younger age were associated with seeking treatment for POP. Hispanics were more likely than whites or blacks to proceed with surgical management. There was no correlation of SES with any of the above factors.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rortveit G.
        • Brown J.S.
        • Thom D.H.
        • Van Den Eeden S.K.
        • Creasman J.M.
        • Subak L.L.
        Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort.
        Obstet Gynecol. 2007; 109: 1396-1403
        • Whitcomb E.L.
        • Rortveit G.
        • Brown J.S.
        • et al.
        Racial differences in pelvic organ prolapse.
        Obstet Gynecol. 2009; 114: 1271-1277
        • Woodman P.J.
        • Swift S.E.
        • O'Boyle A.L.
        • et al.
        Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study.
        Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17: 340-345
        • Bump R.C.
        Racial comparisons and contrasts in urinary incontinence and pelvic organ prolapse.
        Obstet Gynecol. 1993; 81: 421-425
        • Graham C.A.
        • Mallett V.T.
        Race as a predictor of urinary incontinence and pelvic organ prolapse.
        Am J Obstet Gynecol. 2001; 185: 116-120
        • Nygaard I.
        • Barber M.D.
        • Burgio K.L.
        • et al.
        Prevalence of symptomatic pelvic floor disorders in US women.
        JAMA. 2008; 300: 1311-1316
      1. NIDDK Central Repository. BACH Metadata. Available at: Accessed March 4, 2012.

        • McKinlay J.B.
        • Link C.L.
        Measuring the urologic iceberg: design and implementation of the Boston Area Community Health (BACH) survey.
        Eur Urol. 2007; 52: 389-396
        • Green L.W.
        Manual for scoring socioeconomic status for research on health behavior.
        Public Health Rep. 1970; 85: 815-827
        • Hendrix S.L.
        • Clark A.
        • Nygaard I.
        • Aragaki A.
        • Barnabei V.
        • McTiernan A.
        Pelvic organ prolapse in the women's health initiative: gravity and gravidity.
        Am J Obstet Gynecol. 2002; 186: 1160-1166
        • Materia E.
        • Rossi L.
        • Spadea T.
        • et al.
        Hysterectomy and socioeconomic position in Rome, Italy.
        J Epidemiol Community Health. 2002; 56: 461-465
        • Thom D.H.
        • van den Eeden S.K.
        • Ragins A.I.
        • et al.
        Differences in prevalence of urinary incontinence by race/ethnicity.
        J Urol. 2006; 175: 259-264
        • Jelovsek J.E.
        • Barber M.D.
        Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life.
        Am J Obstet Gynecol. 2006; 194: 1455-1461
      2. Urban Institute. Health insurance coverage and the uninsured in Massachusetts: an update based on 2005 current population survey data in Massachusetts, 2007. Available at: Accessed April 17, 2013.