"We really have to think beyond just the individual health impact to understand what's underlying these disparities," says Raveen Syan, MD, FPMRS.
In this video, Raveen Syan, MD, FPMRS, discusses the need for broad thinking regarding disparities in receipt of overactive bladder care. Syan is an assistant professor in clinical urology at the University of Miami Desai Sethi Urology Institute in Miami, Florida.
A wonderful colleague of mine, Dr. Yaw Nyame, does a great job of describing this conceptual model for racial disparities. A lot of us have this understanding that there are disparities that are influenced by age, race, insurance, access, and physician density and location where you live. But we have to start thinking broader. What are the other impacts patients have on their health? [There are] social impacts. So we think about things like economic stability, education, other things such as food sources, community context. And overarching all of this is systemic racism, institutional racism, laws and policies, and economic systems. So we really have to think beyond just the individual health impact to understand what's underlying these disparities. I really like this cycle of transformative equity research that Fleming et al described. Basically, the way I like to think about it is, what do we know? What are we learning? What do we need to continue to learn? So in this aspect, I consider this what we've done in the past; we understand that there are disparities in disease incidence, prevalence, and intervention utilization, which to me is the most concerning disparity. And what we're doing now and continue to need to do is determine, what are these underlying causes of disparities? We then identify and adapt interventions, and then we test this to see if by addressing these other disparities, can we improve utilization of care? As I mentioned, we know that there are differences in prevalence among minorities, although generally they're not that pronounced. Overall, we see Hispanic [patients] are more likely to have urinary incontinence on a weekly basis and multiple studies have supported this. When we look at urge urinary incontinence, we see that among Chinese patients, they're much more likely to report severe bother. So again, we're not seeing that severity and prevalence is less; that doesn't explain why they're less likely to receive care. And here's some of the evidence just to support this; this is a study I have done that looked at minority [patients] receiving oral therapies and advanced therapies, and Asian women were significantly less likely to receive oral therapy or advanced therapy. When I describe advanced therapy, I include Botox, PTNS, and sacral nerve stimulation.
This transcript was edited for clarity.