The Effect of Social Determinants of Health on Overactive Bladder Symptom Severity

Abstract

Social determinants of health may significantly impact overall health and drive health disparities. We evaluated the association between social determinants of health and overactive bladder severity. Materials and Methods: We conducted a multicenter, cross-sectional study of patients presenting to outpatient female pelvic medicine and reconstructive surgery clinics at Montefiore Medical Center (Bronx, New York) and Johns Hopkins Bayview Medical Center (Baltimore, Maryland) from November 2018 to November 2019. Surveys were administered to screen for overactive bladder (Overactive Bladder-Validated 8-Question Screener) and to evaluate social determinants of health. Ordinal logistic regression models were used to examine the association between overactive bladder symptom level and social determinants of health items, while adjusting for age, race, body mass index, parity, history of pelvic surgery and clinical site. Results: A total of 256 patients with a meanAESD age of 58.6AE14.2 years and body mass index of 30.4AE7.5 kg/m 2 were recruited over a 12-month period. Our sample was 33.6% White, 32% Black and 29.3% Hispanic, with 5.1% categorized as other. A higher overactive bladder symptom level was associated with food insecurity (OR 2.51, 95% CI 1.03e6.11), financial strain (OR 1.94, 95% CI 1.06e3.53), difficulty finding or keeping employment (OR 3.14, 95% CI 1.01e9.72) and difficulty concentrating (OR 2.48, 95% CI 1.25e4.95), after adjusting for site, age, race, body mass index, parity and previous pelvic surgery. Conclusions: In this cross-sectional study, certain social determinants of health were associated with greater overactive bladder severity. Unmet social needs may impact the success of overactive bladder treatment. Urologists should consider collaborating with social work and mental health specialists to better serve patients with overactive bladder and social determinants of health needs.

Health disparities and access to advanced therapy for overactive bladder

“… 19,20 These factors help to explain the relationship between social–ecological conditions and individual health. The effects of unmet social needs on OAB were recently reported by Tellechea et al 16 . Women with increasing OAB severity reported higher rates of worry with respect to food insecurity, transportation issues, financial issues, prescription drug use, and employment issues.…”

“…Women with increasing OAB severity reported higher rates of worry with respect to food insecurity, transportation issues, financial issues, prescription drug use, and employment issues. Even after adjusting for race and ethnicity, these associations persisted in women with food insecurity, financial strain, and difficulty finding employment 16 . These findings suggest that unmet social needs and ultimately SDOH contribute to disease burden and may impact the success of OAB treatment.…”

“…Even after adjusting for race and ethnicity, these associations persisted in women with food insecurity, financial strain, and difficulty finding employment. 16 These findings suggest that unmet social needs and ultimately SDOH contribute to disease burden and may impact the success of OAB treatment. Certainly, further study in this area may offer greater clarity and improved multimodal/systemic approaches to the comprehensive care of individuals with OAB.…”

“…Smaller studies have demonstrated similar results, with prevalence rates ranging between 25% and 46% in Black/AA women, 30%–41% in White women, 19%–28% in Asian women, and 30‐36% in Hispanic and Latina women. Most data entirely neglect the Indigenous American population, thus it is difficult to estimate OAB burden in this group 6,9,12–16 . Furthermore, most OAB prevalence data are based on relatively small cohorts of non‐White participants, potentially painting an incomplete picture of true disease burden.…”

“…Most data entirely neglect the Indigenous American population, thus it is difficult to estimate OAB burden in this group. 6,9,[12][13][14][15][16] Furthermore, most OAB prevalence data are based on relatively small cohorts of non-White participants, potentially painting an incomplete picture of true disease burden. As an example to illustrate this discrepancy, multiple trials suggest that OAB prevalence is similar amongst Hispanic and Black women with lower prevalence in Asian women.…”