By year 2050, 40% of Americans aged 65 years and older will be from one of the following 5 racial/ethnic groups: Hispanic/Latino, non-Hispanic Black, Asian, American Indian, and Pacific Islander. The prevalence of pelvic organ prolapse (POP) is not well understood in women from underrepresented racial/ethnic populations. This is the first study with the aim to determine if there were differences in the pooled prevalence estimates of POP among underrepresented US racial populations from population-based epidemiologic studies.

A systematic search of MEDLINE, EMBASE, Cochrane, and Scopus was conducted to retrieve eligible studies. Studies were included if POP was identified by either physical exams or questionnaires, in population-based and non-care seeking settings, and with a representative sample of US community-dwelling women from more than one racial/ethnic groups with prevalence rates reported individually. Quality of the included articles were appraised with STROBE checklist. Meta-analysis was performed with the pooled estimates calculated, and chi-squared tests performed to examined association between race and POP prevalence.

Of the 2,604 studies reviewed, 5 were included. All 5 studies were deemed as high quality. Of the studies included, one used physical exam to determine the presence of POP (with WHI Prolapse Classification System grades 2 and 3 defined as prolapse to introitus or outside the vagina, respectively) while others used questionnaires to identify symptomatic POP or prior POP diagnoses (Table 1). Except Brazell et al (2013), all other studies demonstrated statistically significant differences in POP prevalence rates based on race/ethnicity (Figure 1). The overall pooled prevalence of POP for White, Hispanic, Black, and Asian American were 10.76% (95% CI 10.30-11.22%), 6.55% (95% CI 5.83-7.28%), 3.80% (95% CI 3.22-4.38%), and 3.40% (95% CI 2.09-4.71%), respectively. A significant difference in the pooled prevalence between these 4 racial/ethnic groups was found (p<0.01).

Our findings reflect the wide variation in POP prevalence among studies ranging from 1.1% to 14.6%. Our study found that White women had a higher POP pooled prevalence rate than Hispanic women; furthermore, these two populations each had greater pooled prevalence rates than Black women and Asian American women. Lastly, we also found women of American Indian and Pacific Island descents were absent from the current POP epidemiologic literature.

White women had the highest POP prevalence overall while Hispanic women experienced the highest POP burden compare to other minority groups. However, it is unclear from the current population-based literature to know if POP-related impacts on women’s quality of life also differed between racial and ethnic groups. Studies included in our meta-analysis have several inherent limitations due to the complexity and heterogeneity of racial/ethnic health disparities. Finally, there was no data on other underrepresented minority groups, specifically for Native Americans and Pacific Islanders. While awaiting for a better understanding and more effective treatments of POP, more studies are needed in order to accurately reflect the diversity of communities throughout the US and to identify women in underrepresented populations who may be at higher risk for POP. This information will guide clinicians and policy makers to tailor culturally appropriate services and deliver pelvic floor care to women from all backgrounds more efficiently and strategically.