Despite an increased risk of cognitive decline associated with anticholinergic medications, Black patients are 54% less likely than White patients to fill the alternative β3-agonist prescription to treat overactive bladder (OAB). Black women are 90% less likely than White women to fill a β3-agonist prescription.

The findings are from a cross-sectional analysis of the 2019 Medical Expenditure Panel Survey including 2,971,449 individuals (mean age, 66.4 years) filling prescriptions for OAB medications. The sample was nationally representative of US households. The study population was 78.3% White, 8.8% Black, 5.6% Hispanic, 2.0% Asian, and 5.3% other races.

“Given comparable efficacy among anticholinergic and β3-agonist medications for both objective and subjective disease measures, initial treatment of OAB with a β3-agonist medication is prudent,” Oluwateniola Brown, MD, of Northwestern University Feinberg School of Medicine in Chicago, Illinois, and colleagues wrote in JAMA Network Open.

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Overall, 75% of patients filled anticholinergic prescriptions, 19.9% filled β3-agonist prescriptions, and 5.1% filled prescriptions for both medication classes. The median out-of-pocket cost for anticholinergics was much lower ($9.78) compared with β3-agonists ($45.00).

Dr Brown’s team adjusted analyses for income, insurance coverage, education, and potential medical contraindications, such as hypertension or preexisting cognitive impairment, but the race disparity persisted. They could not control for disease severity or prior treatment.

Dr Brown’s team emphasized that multiple guidelines discourage use of anticholinergics. The American Urologic Association advises caution in the use of anticholinergic medications to treat elderly and frail individuals with OAB. The American Geriatrics Society Beers Criteria lists anticholinergics as “potentially inappropriate” for older adults in light of interactions. The 2020 consensus update from the American Urogynecologic Society recommended avoiding anticholinergics in adults older than 70 years.


Luchristt D, Bretschneider CE, Kenton K, Simon M, Brown O. Inequities in filled overactive bladder medication prescriptions in the US. Published online May 24, 2023. JAMA Netw Open. doi:10.1001/jamanetworkopen.2023.15074