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JU INSIGHT: Associations Between Unmet Social Needs and Overactive Bladder

By: Elisabeth M. Sebesta, MD; Stephanie Gleicher, MD, MPH; Melissa R. Kaufman, MD, MPH; Roger R. Dmochowski, MD, MMHC, FACS; W. Stuart Reynolds, MD, MPH | Posted on: 01 Nov 2022

Sebesta EM, Gleicher S, Kaufman MR, Dmochowski RR, Reynolds WS. Associations between unmet social needs and overactive bladder. J Urol. 2022; 208(5):1106-1115

Study Need and Importance

Increased attention to social determinants of health has helped to identify impacts on chronic medical conditions, although associations with noncancerous genitourinary conditions have been largely overlooked. A few prior studies have reported that lower socioeconomic status is associated with urge incontinence and that certain unmet social needs are associated with overactive bladder (OAB) in urban-dwelling women. The objective of this study was to expand on these prior findings and identify associations between OAB and a broad range of unmet social needs in a large, community-based sample of U.S. adult men and women, including those from a range of living communities and social backgrounds.

Figure. Adjusted odds ratios (95% confidence interval) for association between individual unmet social needs and overactive bladder. Models are adjusted for age, body mass index, gender, race/ethnicity, living community, education level, employment status, type of insurance, smoking status, and history of certain pelvic surgeries.

What We Found

We recruited 3,617 participants, of whom 40% had OAB. Those with OAB were significantly more likely to report unmet social needs, including housing instability and safety, food insecurity, concerns about transportation and social supports to attend medical appointments, health care cost, child/elder care, legal help, and worry about access to home toilets and working home plumbing. The Figure depicts the results of multivariable logistic regression as adjusted odds ratios for the associations between individual unmet needs and OAB. All social needs remained associated with OAB except for needing child/elder care.

Limitations

Participants were recruited via email advertisement to complete electronically administered questionnaires, and thus the study is subject to inherent limitations associated with design, including selection bias, recall bias, and uncertain causality, as the cross-sectional design prohibits causal inference. Likely there is a bidirectional relationship between urinary symptoms and conditions and unmet social needs. The results may not be generalizable to the U.S. population.

Interpretation for Patient Care

Our study reinforces the importance of understanding the impact of social determinants of health on health outcomes and the effects that unmet social needs may have on urinary conditions and bladder health. Addressing these factors will help providers improve care for OAB patients.

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