title: Risk factors for prolapse development in white, black, and Hispanic women.
abstract: OBJECTIVE
  : 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/m, <30 kg/m) 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.
authors.affiliation: From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Washington Hospital Center, Washington, DC; †Department of Obstetrics and Gynecology, UT Health Science Center, San Antonio, TX; ‡Executive Director Designate, North American Menopause Society, Mayfield Heights, OH; §Department of Obstetrics and Gynecology, University of Miami, FL; ∥Central Controlling Center, Women's Health Initiative, Seattle, WA; ¶Department of Obstetrics and Gynecology, University of Buffalo, NY; and #MedStar Research Institute, Georgetown University, Washington, DC.
authors.forename: Bela I
authors.initials: BI
authors.lastname: Kudish
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gutman
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Sokol
authors.forename: Allison K
authors.initials: AK
authors.lastname: Rodgers
authors.forename: Marjery
authors.initials: M
authors.lastname: Gass
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Joseph
authors.initials: J
authors.lastname: Larson
authors.forename: Moeen
authors.initials: M
authors.lastname: Abu-Sitta
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard