Objective
In 2001, we predicted a 45% increase in the demand for care of women with pelvic floor disorders (PFDs) between 2000 and 2030. However, in 2010, we observed that in our clinic demand for care had increased substantially more than expected. Using updated data, we sought to provide more accurate projections of future demand for care of pelvic floor disorders in the United States.
Study Design
Demographic data on all new female patients between 30 and 89 years of age seen for pelvic floor disorders in our Urogynecology Clinic between 2009 and 2011 were analyzed. These data were combined with United States Census Bureau projections for 2010 and 2030 stratified by 10-year age blocks.
Results
In 2010, our clinic saw a 116% increase in new patients per year compared with 2000. There was an 85% increase in new patient visits per 1000 women per year compared with 2000. We estimate that 1,218,371 new patient visits took place in the United States in 2010 and predict 1,644,804 visits will occur in 2030.
Conclusion
If the United States population increases 24% by 2030 as projected by the United States Census Bureau, we predict the demand for care for pelvic floor disorders will increase by 35% between 2010 and 2030. This new, more accurate projection for 2030 is based on improved baseline data from 2010 and is 72% higher than we predicted in 2000. Accurately quantifying this growing demand for care of pelvic floor disorders is important for public health planning and physician training.
Pelvic floor disorders (PFDs), which include pelvic organ prolapse, urinary incontinence, and fecal incontinence, affect over 20% of adult women, and the risk of developing PFDs increases with age. These disorders create substantial physical and emotional distress and generate a large financial burden. In 2010, an estimated 560,000 women underwent surgical repair of pelvic organ prolapse or stress urinary incontinence. The prevalence and demand for care of PFDs appear to be increasing more quickly than would be expected from simple population growth.
In 2001, we predicted that the number of new patients seen for PFDs in the United States (US) would increase by 45% by 2030 based on our experience in the San Diego Urogynecology Clinic in the Kaiser Permanente Health Care Program in Southern California. In this integrated managed care system, members almost exclusively receive care within Kaiser, so it is possible to measure the number and proportion of people who receive care. The comprehensive, integrated electronic medical record system makes it possible to extract information regarding patient ages and diagnoses, making it an ideal system in which to perform epidemiologic studies.
However, in 2010, we observed that our clinic was caring for a larger volume of patients than would have been expected based on our 2001 projections. The purpose of this analysis is to examine current demand for care and use these data to create more accurate projections of future demand. We hypothesized that our clinic cared for more new patients per unit of population in 2010 than in 1998. Based on these revised demand for care data, we hypothesized that the predicted number of patients seeking care in 2030 would be larger than our original projections, which were based on 1998 levels of demand for care.
We also sought to use these updated data and our projections to model the number of surgical cases and providers that will be needed to care for women with PFDs in the future. These projections will help us better prepare to care for these patients.
Materials and Methods
We collected demographic data on all women seen for new patient visits between age 30 and 89 in the Urogynecology Clinic during a 24-month period between July 2009 and June 2011 from the electronic medical record at Kaiser Permanente San Diego. Similar to the methods used in our previous population-based study, we stratified the number of women seen for new visits into 10-year age groups and compared these numbers with the entire female population of Kaiser San Diego. We then calculated a ratio of new patient visits per 1000 women in each age block over the course of 1 year (new patient visits per 1000 women per year). We multiplied the ratio of new patient visits in each age group of women by the number of women in that age group according to US Census Bureau estimates for 2010 and middle series projections for 2030 to estimate current demand and predict future demand for care of PFDs for the US population.
To improve on the methods used in 2001 and to ensure that the number of new patients seen in the Urogynecology Clinic captured approximately all of the women seeking care for pelvic floor disorders, we compared the number of new patients seen with the number of referrals placed during this same time period. In addition, the number of patients seen for PFDs in all Kaiser San Diego clinics during this time period was analyzed using PFD diagnosis codes to confirm that most were seen in the Urogynecology Clinic. A separate query was performed for operative procedures by all Urogynecologists in Kaiser San Diego to estimate the number of surgeries performed per new patient.
We compared the ratios of new patient visits per Kaiser population in each age group in 1998 to the ratios in 2010 using χ 2 comparisons in IBM SPSS version 20 (IBM, Armonk, NY).
This research was carried out with the approval and oversight of our institutional review board.
Results
During the 2-year period from 2009 to 2011, 4463 women between age 30 and 89 were seen for new patient visits for PFDs in the Urogynecology Clinic in Kaiser San Diego (average 2232 women per year). This was a 115.6% increase compared with the 2070 women seen between 1997 and 1999 (average 1035 women per year) ( Figure 1 ).
During this time, the total at-risk population in Kaiser San Diego increased 17.1%, from 145,094 women aged 30 to 89 in 1998 to 169,853 in 2010 ( Figure 2 ). This increase in the Kaiser San Diego population was similar to the US, with higher increases in the baby boomer age groups (50-70) and decreases in the younger age groups ( Figure 2 ).
Combining the number of new patients seen with the total at-risk population of women age 30-89 in Kaiser San Diego, the average demand for care per 1000 women age 30 to 89 per year was 13.1 in 2010 compared with 7.1 in 1998, an overall increase of 84.5%. A statistically significant increase in care per 1000 women was seen in every age group ( Figure 3 ).
Using models created from the number of new patient visits generated per 1000 women per 10-year age group per year and the US population estimate for 2010, we calculated the demand for care for PFDs in the US in 2010 to be approximately 1,218,371 new patient visits per year. Using population projections, we estimated an increase to 1,644,804 new patients annually by 2030 if demand for care per 1000 women per year remains constant in each age group ( Figure 4 ). The projected number of new patients that will be seen for PFDs in 2030 based on these updated, more accurate data from 2010 is 72% higher than the projection based on data from 2000 ( Figure 5 ).
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