Residential Segregation and Prolapse Surgery Complications in Older Black Women

Abstract

Importance: Residential segregation influences health outcomes.

Objective: The objective of this study was to examine the relationship between residential segregation and prolapse surgery complications and readmissions among older Black women.

Study design: This retrospective study included non-Hispanic Black women who underwent prolapse surgery from 2011 to 2018 in the Medicare 5% Limited Dataset. The primary outcome was 90-day complications. Other outcomes of interest were 30- and 90-day readmissions. We calculated the Index of Concentration at the Extremes (ICE) for each beneficiary's U.S. county of residence to measure geographic segregation by race, income, and both combined. We stratified the cohort into quintiles based on the ICE measures. Descriptive and comparative analyses were used to compare the demographic and clinical characteristics for each group. Poisson regression models were used to test the association between ICE measures and complications and readmissions.

Results: There were 872 Black women included in the analysis. Black women living in counties with the highest concentrations of Black residents had a 44% and 55% increased relative risk of 90-day complications compared to those in counties with the highest concentrations of White residents. Conversely, Black women living in the least segregated counties by race and income combined experienced 70% and 57% decreased risk of 30- and 90-day readmissions, respectively.

Conclusions: The findings support our hypothesis that structural racism (measured by levels of residential racial and economic segregation) is associated with poorer outcomes after pelvic organ prolapse surgery. Further research is needed to identify neighborhood-level factors that contribute to and protect against inequities in postoperative outcomes after prolapse surgery.