Studying Disparities in Care for Pelvic Floor Disorders

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A fourth-year medical student is helping a research team discover disparities in treatment for minority women with pelvic floor disorders (PFDs) such as pelvic organ prolapse, urinary incontinence, and bladder pain.

Aaron Gurayah, ’23, M.D. candidate
Aaron Gurayah, ’23, M.D. candidate

“Many Hispanic and Black women are unaware of their treatment options,” said Aaron Gurayah, M.D. ’23 candidate at the University of Miami Miller School of Medicine. “Others are uncomfortable talking with a doctor about their symptoms or find it difficult to access care.”

Gurayah is a key member of a student-resident research team guided by Raveen Syan, M.D., assistant professor of clinical urology at the Miller School’s Desai Sethi Urology Institute.

“Many studies suggest that there are no truly significant racial-ethnic differences in disease prevalence or severity for patients in pelvic floor disorders,” said Dr. Syan, who received a Urology Care Foundation Research Scholar Award for 2021-22. “However, minority women are significantly less likely to receive treatment for these conditions. We need to better understand why minority women are less likely to receive care, as these conditions can seriously affect their quality of life.”

This spring, Gurayah will be presenting three abstracts on disparities in PFD care at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) annual meeting in March, and at the American Urological Association annual meeting in April.

Their findings are based on a study involving 131 women seen by Dr. Syan at three locations: her UHealth clinic, the Jackson Memorial Hospital urology clinic, and the Miller School’s Game Changer mobile clinic. Of those women, 47% were Hispanic, 40 % were Black, and 13 %identified as “other.”

Dr. Syan said that preliminary results of the study suggest no differences in disease severity among minority women. However, less than half the women with PFD symptoms received treatment. “Lack of awareness and unmet health-related social needs appear to be the key reasons for these care disparities,” she said. “To address these challenges, physicians should discuss treatment options for all patients with PFD and provide educational materials in the patient’s primary language. Our urology team also plans to partner with trusted community leaders to raise awareness and understanding of these conditions.”

A Future Physician-Scientist
Raveen Syan, M.D.
Raveen Syan, M.D.

A native of New York, Gurayah earned his undergraduate degree at Princeton University and spent a year conducting research at the National Institutes of Health before enrolling at the Miller School. “As a future physician-scientist with a background in biostatistics, I am constantly thinking about ways to improve patient care by using big data,” he said. “I really appreciate the opportunity to conduct urology research as a student alongside fantastic mentors at the Miller School of Medicine.”

Gurayah was also the lead author on a recent study, “Racial and Socioeconomic Disparities in Cost and Postoperative Complications Following Sacrocolpopexy in a U.S. National Inpatient Database,” published in the World Journal of Urology. Miller School co-authors were medical students Matthew M. Mason and Meghan R. Grewal; resident Sirpi Nackeran, M.D., M.P.H.; urogynecology specialist Laura E. Martin, D.O.; urologist Katherine Amin, M.D.; and Dr. Syan.

This national study involved 4,439 women who underwent sacrocolpopexy, a surgical procedure used to correct pelvic organ prolapse. “We found that patients with private insurance undergoing a laparoscopic approach or concurrent hysterectomy were less likely to have postoperative complications,” said Gurayah. “However, minority women were less likely to undergo a laparoscopic procedure.”

The researchers also found that procedures in an urban teaching hospital, conducted laparoscopically/robotically or in the Western United States, were associated with significantly higher costs of surgical management. Hispanic patients received significantly higher procedure charges and costs, possibly resulting from their large numbers in the Western U.S.

Looking ahead, Dr. Syan said that future studies should incorporate strategies to address clinical trial enrollment barriers facing racial and ethnic minorities. Noting the importance of student participation in urology research, she added, “Our goal at the Miller School of Medicine is to train the next generation of physicians and provide opportunities for them to develop scientific skills as well. It’s an exciting time to start building a career in urology.”