J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://jcgo.elmerpub.com

Original Article

Volume 000, Number 000, August 2025, pages 000-000

Socioeconomic, Demographic, and Provider Determinants of Staged Versus Concomitant Surgery for Pelvic Organ Prolapse and Stress Urinary Incontinence

**Table 1.** Baseline Demographic and Clinical Characteristics of US Medicare Patients With POP and MUS
	Concomitant (n = 39,440)	Staged (n = 1,402)	P value
*Statistical significance at P < 0.05. ^aOther specialty include general surgery, unknown physician specialty, and others. CCI: Charlson Comorbidity Index; MUS: mid-urethral sling; POP: pelvic organ prolapse.
Age category
< 70	36.2%	33.2%	0.022*
70 - 74	31.0%	34.0%
75 - 79	20.6%	21.7%
≥ 80	12.3%	11.1%
Race
American Indian or Alaskan Native	0.5%	0.4%	0.003*
Asian	1.0%	0.4%
Black	2.9%	2.1%
Caucasian	91.6%	94.4%
Hispanic	1.8%	0.9%
Other	1.2%	0.6%
Unknown	1.2%	1.2%
Region
Midwest	22.8%	23.0%	< 0.001*
Northeast	16.6%	12.1%
South	39.9%	46.0%
West	20.6%	18.9%
Urban or rural
Rural	8.1%	7.5%	0.389
Urban	91.9%	92.5%
CCI
0	39.0%	36.7%	0.348
1 - 3	43.3%	45.2%
4 - 6	13.0%	13.3%
≥ 7	4.6%	4.9%
Specialty (POP)
Urology	15.7%	13.7%	0.024*
Obstetrics/gynecology	80.1%	81.0%
Other	4.2%	5.3%
Specialty (MUS)
Urology	15.7%	19.7%	< 0.001*
Obstetrics/gynecology	80.1%	75.5%
Other^a	4.2%	4.8%

Table 1. Baseline Demographic and Clinical Characteristics of US Medicare Patients With POP and MUS

Concomitant (n = 39,440)

Staged (n = 1,402)

P value

*Statistical significance at P < 0.05. ^aOther specialty include general surgery, unknown physician specialty, and others. CCI: Charlson Comorbidity Index; MUS: mid-urethral sling; POP: pelvic organ prolapse.

Age category

< 70

36.2%

33.2%

0.022*

70 - 74

31.0%

34.0%

75 - 79

20.6%

21.7%

≥ 80

12.3%

11.1%

Race

American Indian or Alaskan Native

0.5%

0.4%

0.003*

Asian

1.0%

0.4%

Black

2.9%

2.1%

Caucasian

91.6%

94.4%

Hispanic

1.8%

0.9%

Other

1.2%

0.6%

Unknown

1.2%

Region

Midwest

22.8%

23.0%

< 0.001*

Northeast

16.6%

12.1%

South

39.9%

46.0%

West

20.6%

18.9%

Urban or rural

Rural

8.1%

7.5%

0.389

Urban

91.9%

92.5%

CCI

39.0%

36.7%

0.348

1 - 3

43.3%

45.2%

4 - 6

13.0%

13.3%

≥ 7

4.6%

4.9%

Specialty (POP)

Urology

15.7%

13.7%

0.024*

Obstetrics/gynecology

80.1%

81.0%

Other

4.2%

5.3%

Specialty (MUS)

Urology

15.7%

19.7%

< 0.001*

Obstetrics/gynecology

80.1%

75.5%

Other^a

4.2%

4.8%

**Table 2.** County-Level AHRQ SDOH Characteristics of US Medicare Patients With POP and MUS
Total	Concomitant	Staged	P value
*P < 0.05. AHRQ: Agency for Healthcare Research and Quality; MUS: mid-urethral sling; POP: pelvic organ prolapse; SDOH: Social Determinants of Health.
% Foreign-born	11.6%	10.2%	< 0.001*
% Limited English-speaking	3.6%	3.1%	< 0.001*
Gini	0.457	0.454	0.007*
Median household income	$64,298	$61,906	< 0.001*
Per capita income ($)	$33,448	$32,296	< 0.001*
% With any postsecondary education (age ≥ 25)	60.30%	59.50%	0.003*
% Uninsured	8.70%	8.9%	0.098
% Uninsured < 64	10.30%	10.6%	0.038*
Number of non-federal obstetric gynecologists per 1,000 population	0.107	0.103	0.058
Median distance to nearest obstetrics department (miles)	5.13	5.22	0.488
Mean distance to nearest obstetrics department (miles)	5.86	6.00	0.258

Table 2. County-Level AHRQ SDOH Characteristics of US Medicare Patients With POP and MUS

Total

Concomitant

Staged

P value

(N = 39,440)

(N = 1,402)

*P < 0.05. AHRQ: Agency for Healthcare Research and Quality; MUS: mid-urethral sling; POP: pelvic organ prolapse; SDOH: Social Determinants of Health.

% Foreign-born

11.6%

10.2%

< 0.001*

% Limited English-speaking

3.6%

3.1%

< 0.001*

Gini

0.457

0.454

0.007*

Median household income

$64,298

$61,906

< 0.001*

Per capita income ($)

$33,448

$32,296

< 0.001*

% With any postsecondary education (age ≥ 25)

60.30%

59.50%

0.003*

% Uninsured

8.70%

8.9%

0.098

% Uninsured < 64

10.30%

10.6%

0.038*

Number of non-federal obstetric gynecologists per 1,000 population

0.107

0.103

0.058

Median distance to nearest obstetrics department (miles)

5.13

5.22

0.488

Mean distance to nearest obstetrics department (miles)

5.86

6.00

0.258

**Table 3.** Multivariable Analysis of Factors Associated With Staged Versus Concomitant Surgery
	Staged (vs. concomitant)
Significant at 0.05. *Significant at 0.01. CCI: Charlson Comorbidity Index; MUS: mid-urethral sling; OBGYN: obstetrics and gynecology; POP: pelvic organ prolapse.
Race (reference Caucasian)
American Indian or Alaskan Native	0.989	0.924	0.97	0.975	0.943	0.967	0.985
	(0.437, 2.242)	(0.407, 2.095)	(0.427, 2.201)	(0.429, 2.214)	(0.415, 2.145)	(0.426, 2.196)	(0.433, 2.236)
Asian	0.363**	0.393**	0.393**	0.388**	0.418	0.411**	0.387**
	(0.150, 0.880)	(0.162, 0.954)	(0.162, 0.953)	(0.160, 0.942)	(0.172, 1.015)	(0.169, 0.997)	(0.159, 0.939)
Black	0.681**	0.682**	0.678**	0.669**	0.680**	0.676**	0.668**
	(0.469, 0.990)	(0.469, 0.991)	(0.467, 0.986)	(0.460, 0.973)	(0.468, 0.990)	(0.465, 0.983)	(0.459, 0.972)
Hispanic	0.487**	0.491**	0.502**	0.497**	0.554**	0.561	0.493**
	(0.274, 0.865)	(0.276, 0.873)	(0.282, 0.893)	(0.279, 0.884)	(0.310, 0.990)	(0.314, 1.004)	(0.277, 0.877)
Other	0.52	0.542	0.545	0.54	0.572	0.568	0.538
	(0.258, 1.050)	(0.268, 1.094)	(0.270, 1.100)	(0.267, 1.091)	(0.283, 1.157)	(0.281, 1.149)	(0.266, 1.087)
Unknown	1.06	1.105	1.105	1.099	1.119	1.114	1.097
	(0.651, 1.727)	(0.678, 1.800)	(0.678, 1.802)	(0.674, 1.792)	(0.686, 1.824)	(0.683, 1.816)	(0.673, 1.789)
Region (reference South)
Midwest	0.878	0.888	0.820**	0.821**	0.818**	0.836**	0.815**
	(0.765, 1.008)	(0.773, 1.021)	(0.700, 0.960)	(0.701, 0.962)	(0.697, 0.959)	(0.712, 0.981)	(0.694, 0.956)
Northeast	0.629***	0.724***	0.657***	0.652***	0.673***	0.695***	0.645***
	(0.529, 0.748)	(0.600, 0.874)	(0.534, 0.810)	(0.529, 0.803)	(0.544, 0.832)	(0.560, 0.862)	(0.522, 0.796)
West	0.813***	0.812***	0.773***	0.782***	0.855	0.85	0.776***
	(0.701, 0.943)	(0.696, 0.947)	(0.659, 0.909)	(0.665, 0.920)	(0.718, 1.018)	(0.715, 1.010)	(0.659, 0.914)
Urban (reference rural)	1.153	1.238**	1.237**	1.234	1.280**	1.286**	1.23
	(0.938, 1.416)	(1.003, 1.529)	(1.002, 1.527)	(0.999, 1.523)	(1.035, 1.582)	(1.040, 1.591)	(0.996, 1.519)
Specialty POP
Urology	0.840**	0.833**	0.838**	0.839**	0.838**	0.838**	0.838**
	(0.717, 0.985)	(0.710, 0.976)	(0.715, 0.983)	(0.716, 0.984)	(0.715, 0.983)	(0.715, 0.982)	(0.715, 0.982)
Obstetrics/gynecology	1	1	1	1	1	1	1
	(1.000, 1.000)	(1.000, 1.000)	(1.000, 1.000)	(1.000, 1.000)	(1.000, 1.000)	(1.000, 1.000)	(1.000, 1.000)
Other	1.245	1.25	1.254	1.259	1.275	1.275	1.258
	(0.974, 1.591)	(0.977, 1.598)	(0.981, 1.604)	(0.985, 1.610)	(0.997, 1.631)	(0.997, 1.631)	(0.984, 1.609)
Per capita income (in $1,000)		0.981***	0.979***	0.979***	0.988	0.984**	0.979***
		(0.969, 0.993)	(0.967, 0.991)	(0.967, 0.991)	(0.975, 1.002)	(0.971, 0.997)	(0.967, 0.991)
% Households with post-secondary education (age ≥ 25)		1.005	1.004	1.002	0.999	0.998	1.002
		(0.996, 1.015)	(0.995, 1.014)	(0.993, 1.012)	(0.989, 1.009)	(0.988, 1.009)	(0.992, 1.012)
% Households with < 64 years uninsured			0.985**	0.984**	0.994	0.995	0.984**
			(0.971, 0.999)	(0.970, 0.999)	(0.978, 1.009)	(0.979, 1.011)	(0.970, 0.999)
OBGYN density				1.651	1.802	1.873	1.445
				(0.669, 4.074)	(0.683, 4.758)	(0.707, 4.963)	(0.548, 3.813)
Median distance to nearest obstetrics department					0.99	0.99	0.995
					(0.977, 1.004)	(0.977, 1.004)	(0.982, 1.008)
% Households foreign-born					0.986***
					(0.978, 0.995)
% Households limited English-speaking						0.969***
						(0.949, 0.989)
_cons	0.038***	0.048***	0.065***	0.071***	0.065***	0.073***	0.077***
	(0.031, 0.046)	(0.033, 0.069)	(0.041, 0.105)	(0.043, 0.116)	(0.038, 0.112)	(0.043, 0.125)	(0.045, 0.130)
N	39,991	39,921	399,21	39,921	39,921	39,921	39,921

Table 3. Multivariable Analysis of Factors Associated With Staged Versus Concomitant Surgery

Staged (vs. concomitant)

-1

-2

-3

-4

-5

-6

-7

**Significant at 0.05. ***Significant at 0.01. CCI: Charlson Comorbidity Index; MUS: mid-urethral sling; OBGYN: obstetrics and gynecology; POP: pelvic organ prolapse.

Race (reference Caucasian)

American Indian or Alaskan Native

0.989

0.924

0.97

0.975

0.943

0.967

0.985

(0.437, 2.242)

(0.407, 2.095)

(0.427, 2.201)

(0.429, 2.214)

(0.415, 2.145)

(0.426, 2.196)

(0.433, 2.236)

Asian

0.363**

0.393**

0.388**

0.418

0.411**

0.387**

(0.150, 0.880)

(0.162, 0.954)

(0.162, 0.953)

(0.160, 0.942)

(0.172, 1.015)

(0.169, 0.997)

(0.159, 0.939)

Black

0.681**

0.682**

0.678**

0.669**

0.680**

0.676**

0.668**

(0.469, 0.990)

(0.469, 0.991)

(0.467, 0.986)

(0.460, 0.973)

(0.468, 0.990)

(0.465, 0.983)

(0.459, 0.972)

Hispanic

0.487**

0.491**

0.502**

0.497**

0.554**

0.561

0.493**

(0.274, 0.865)

(0.276, 0.873)

(0.282, 0.893)

(0.279, 0.884)

(0.310, 0.990)

(0.314, 1.004)

(0.277, 0.877)

Other

0.52

0.542

0.545

0.54

0.572

0.568

0.538

(0.258, 1.050)

(0.268, 1.094)

(0.270, 1.100)

(0.267, 1.091)

(0.283, 1.157)

(0.281, 1.149)

(0.266, 1.087)

Unknown

1.06

1.105

1.099

1.119

1.114

1.097

(0.651, 1.727)

(0.678, 1.800)

(0.678, 1.802)

(0.674, 1.792)

(0.686, 1.824)

(0.683, 1.816)

(0.673, 1.789)

Region (reference South)

Midwest

0.878

0.888

0.820**

0.821**

0.818**

0.836**

0.815**

(0.765, 1.008)

(0.773, 1.021)

(0.700, 0.960)

(0.701, 0.962)

(0.697, 0.959)

(0.712, 0.981)

(0.694, 0.956)

Northeast

0.629***

0.724***

0.657***

0.652***

0.673***

0.695***

0.645***

(0.529, 0.748)

(0.600, 0.874)

(0.534, 0.810)

(0.529, 0.803)

(0.544, 0.832)

(0.560, 0.862)

(0.522, 0.796)

West

0.813***

0.812***

0.773***

0.782***

0.855

0.85

0.776***

(0.701, 0.943)

(0.696, 0.947)

(0.659, 0.909)

(0.665, 0.920)

(0.718, 1.018)

(0.715, 1.010)

(0.659, 0.914)

Urban (reference rural)

1.153

1.238**

1.237**

1.234

1.280**

1.286**

1.23

(0.938, 1.416)

(1.003, 1.529)

(1.002, 1.527)

(0.999, 1.523)

(1.035, 1.582)

(1.040, 1.591)

(0.996, 1.519)

Specialty POP

Urology

0.840**

0.833**

0.838**

0.839**

0.838**

(0.717, 0.985)

(0.710, 0.976)

(0.715, 0.983)

(0.716, 0.984)

(0.715, 0.983)

(0.715, 0.982)

Obstetrics/gynecology

(1.000, 1.000)

Other

1.245

1.25

1.254

1.259

1.275

1.258

(0.974, 1.591)

(0.977, 1.598)

(0.981, 1.604)

(0.985, 1.610)

(0.997, 1.631)

(0.984, 1.609)

Per capita income (in $1,000)

0.981***

0.979***

0.988

0.984**

0.979***

(0.969, 0.993)

(0.967, 0.991)

(0.975, 1.002)

(0.971, 0.997)

(0.967, 0.991)

% Households with post-secondary education (age ≥ 25)

1.005

1.004

1.002

0.999

0.998

1.002

(0.996, 1.015)

(0.995, 1.014)

(0.993, 1.012)

(0.989, 1.009)

(0.988, 1.009)

(0.992, 1.012)

% Households with < 64 years uninsured

0.985**

0.984**

0.994

0.995

0.984**

(0.971, 0.999)

(0.970, 0.999)

(0.978, 1.009)

(0.979, 1.011)

(0.970, 0.999)

OBGYN density

1.651

1.802

1.873

1.445

(0.669, 4.074)

(0.683, 4.758)

(0.707, 4.963)

(0.548, 3.813)

Median distance to nearest obstetrics department

0.99

0.995

(0.977, 1.004)

(0.982, 1.008)

% Households foreign-born

0.986***

(0.978, 0.995)

% Households limited English-speaking

0.969***

(0.949, 0.989)

_cons

0.038***

0.048***

0.065***

0.071***

0.065***

0.073***

0.077***

(0.031, 0.046)

(0.033, 0.069)

(0.041, 0.105)

(0.043, 0.116)

(0.038, 0.112)

(0.043, 0.125)

(0.045, 0.130)

39,991

39,921

399,21

39,921