Disparities Research for Pelvic Floor Disorders: A Systematic Review and Critique of Literature

Abstract

Importance: Understanding the status of pelvic floor disorder (PFD) disparities research will allow the opportunity to advance future pelvic floor equity efforts.

Objectives: The aims of the study were to (1) characterize the landscape of PFD disparities literature using the 3 phases of disparities research framework, (2) describe the characteristics of PFD disparities studies, and (3) identify critical knowledge gaps.

Study design: We performed a systematic review of peer-reviewed publications addressing disparities in PFDs among U.S. populations from PubMed, Embase, Scopus, or the Cochrane Database indexed between 1997 and 2022. Using the triphasic framework for advancing health disparities research by Kilbourne et al ( Am J Public Health . 2006;96(12):2113-21), we categorized the included studies into the detecting phase (identifies and measures disparities in historically marginalized populations), understanding phase (establishes disparity determinants), or reducing phase (conducts interventions to alleviate inequities). All screening, coding, and quality reviews were independently performed by at least 2 authors. We used descriptive analysis and the χ 2 test for comparisons.

Results: The initial search identified 10,178 studies, of which 123 were included. Of the included studies, 98 (79.7%), 22 (17.9%), and 3 (2.4%) studies were detecting, understanding, and reducing phase research, respectively. The most common disparity category investigated was race and ethnicity (104 studies), and one third of these studies attributed drivers of racial and ethnic differences to structural influences. Publications of detecting phase studies outpaced the growth of understanding and reducing phase research.

Conclusions: Most PFD disparities research focused on identifying historically marginalized populations with inadequate progression to understanding and reducing phases. We recommend progressing PFD disparities research beyond the detecting phase to advance health equity in PFD care.

FIGURE 1.

Relevant article identification progress in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines.

FIGURE 2.

Distribution of detecting, understanding, and reducing phase pelvic floor disorder disparities research between 1997 and 2022. There was a total of 123 studies included with 98 detecting phase studies (79.7%), 22 understanding phase studies (17.9%), and 3 reducing phase studies (2.4%).

FIGURE 3.

Trend of pelvic floor disorder (PFD) disparities research over time (1997–2022).