Risk factors for prolapse development in white, black, and hispanic women

Bela I. Kudish, Cheryl B. Iglesia, Robert E. Gutman, Andrew I. Sokol, Allison K. Rodgers, Marjery Gass, Mary Jo O'Sullivan, Joseph Larson, Moeen Abu-Sitta, Barbara V. Howard

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Objectives: This study aimed to examine the risk factors for prevalence and incidence of pelvic organ prolapse (POP) in whites, Hispanics, and blacks. Methods: This is a secondary analysis of the Women's Health Initiative (WHI) Estrogen plus Progestin Clinical Trial (E + P). Of the original E + P trial population of 16,608, 12,667 women (78.3%; 11,194 whites, 804 blacks, and 669 Hispanics) were included in the final study sample and evaluated during the 5-year period. The outcomes evaluated were any prolapse (WHI prolapse grades 1-3) and WHI prolapse grade 2 or 3. Descriptive analyses, logistic regression, and proportional hazard modeling were performed. Results: Increasing parity correlates with increasing WHI prolapse grades (0-3) in whites and blacks but not Hispanics. The incidence of grade 2 or 3 POP increased by 250% in white women with 1 child (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.68-3.71) in comparison to nulliparous women and grew with higher parity. For blacks, a weak association between the parity and grade 2 or 3 POP was noted only in women who had 5 or more kids (HR, 10.41; 95% CI, 1.38-78.77). Blacks were less likely (HR, 0.53; 95% CI, 0.40-0.71) to develop grade 2 or 3 POP compared with whites. For grade 2 or 3 POP, age was found to be a risk factor in whites (odds ratio [OR], 1.03; 95% CI, 1.02-1.04) only and body mass index (≥25 kg/m2, <30 kg/m2) in whites (OR, 1.64; 95% CI, 1.34-2.02) and Hispanics (OR, 2.87; 95% CI, 1.03-2.02). Conclusions: White women are at a much greater risk for developing grade 2 or 3 POP compared with blacks. Parity correlates most strongly with the risk of prolapse development in whites and possibly in grand multiparous blacks.

Original languageEnglish (US)
Pages (from-to)80-90
Number of pages11
JournalFemale Pelvic Medicine and Reconstructive Surgery
Issue number2
StatePublished - 2011
Externally publishedYes


  • Ethnicity
  • Parity
  • Prolapse development
  • Prolapse incidence
  • Race

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Surgery
  • Urology


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