The Effect of Primary Spoken Language on Stage of Pelvic Organ Prolapse at Initial Presentation and Modality of Treatment

INTRODUCTION: The 2019 US Census Bureau report identified 67.8 million people in the United States who spoke a language other than English at home. Individuals with non-English primary spoken language (PSL) have difficulty accessing subspecialty care, and communication barriers can result in suboptimal counseling. Pelvic organ prolapse (POP) is a slowly progressing quality-of-life disorder that can be managed surgically or conservatively. Clear and complete counseling on treatment options empowers the patient to select their treatment modality through shared decision making. There is a paucity of data investigating the relationship of non-English PSL to treatment modality or degree of POP at initial presentation. OBJECTIVE: The primary objective of our study is to evaluate if non-English PSL is associated with advanced stage (stage 3–4) POP at the time of initial consultation. The secondary objective was to investigate if PSL impacts the rate of corrective surgical management. METHODS: This study is a retrospective cohort analysis of patients evaluated for POP between 2015 and 2023 at an academic tertiary care center (n=114). Chart review identified patients with a non-English PSL (n=57) and a cohort of English PSL patients were randomly selected (n=57). Demographic information, POP-Q exam, and treatment within 6 months of initial presentation were collected. Degree of prolapse was dichotomized as early (stages 0–2) or advanced (stages 3–4). Categorical variables were compared between the two language groups via chi-square tests. Continuous variables were compared via Student’s t-test. A p-value of <0.05 was used to determine statistical significance. RESULTS: The two cohorts were overall well-matched demographically with the exception that the non-English PSL group had a significantly higher mean gravidity and parity (4.6 vs 2.8, p=<0.001; 3.8 vs 2.4, p=<0.001). The rate of advanced-stage POP was similar between the English and non-English groups (49.1% vs 56.1%, p=0.453). The non-English group had statistically significant higher rates of apical (78.6% vs 59.6%, p=0.03), anterior (90.9% vs 66.7%, p=0.002), and posterior prolapse (81.8% vs 45.6%, p=<0.001) when comparing only compartments. The English PSL group had statistically significant higher rates of surgical management (43.9% vs 22.8%, p=0.017). There were 6 patients lost to follow-up, all of whom were in the non-English PSL group. Four of these patients had documented plans for surgery. CONCLUSIONS: This study highlights inequity in the treatment of POP in our non-English primary spoken language population. Non-English PSL patients seeking POP evaluation have lower rates of surgical intervention compared to English PSL patients in spite of similar stage of prolapse at presentation. Non-English PSL patients also have significantly higher rates of all subtypes of prolapse, indicating their disease is multi-compartment. Additionally, there were four non-English PSL patients who expressed interest in surgery but were lost to follow-up. Further studies are needed to evaluate factors contributing to this inequity including biases of counseling and barriers to access (Tables 1 and 2).