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Overactive Bladder Linked to Multiple Unmet Socioeconomic Needs

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Unmet socioeconomic needs had a significant association with overactive bladder (OAB), adding to evidence of a complex interaction between social determinants of health and OAB, researchers said.

Stressors such as housing and food insecurity and concerns about personal health as much as tripled the odds of reported OAB symptoms. The stressors remained significant predictors for OAB after adjustment for multiple demographic and medical factors. Unmet socioeconomic needs had a stronger association with OAB with urge urinary incontinence (UUI, “wet” OAB), reported Elisabeth M. Sebesta, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, and co-authors in the Journal of Urology.

“Specifically, we found that home toilet access, fear of losing utilities, and transportation to healthcare appointments had the strongest associations with OAB,” the authors wrote. “However, social needs from multiple domains including housing safety and quality, food insecurity, healthcare costs, needing legal help, stress about home plumbing, and lacking support to go to medical appointments were also associated with OAB.”

“It is important for providers to consider these unmet social needs of patients, as highlighting and addressing these factors hopefully can improve care of individuals with OAB,” they added.

OAB affects about 15% to 20% of men and women in the U.S. and arises from both biological and social/psychosocial factors, Sebesta and team noted in their introduction. Lower socioeconomic status has been associated with more severe UUI, and OAB severity in women has been linked to food insecurity, financial strain, employment status, and difficulty concentrating.

Conversely, OAB may adversely affect an individual’s social and personal life, as in the case of lack of toilet facilities at schools or places of employment, which could potentially affect productivity or concentration. OAB has been linked to higher rates of unemployment, including unemployment because of disability.

The findings add to a small but growing body of literature examining relationships between social environment and OAB and other lower urinary tract symptoms (LUTS) and raise a number of “intriguing questions” for future research, wrote Sonya S. Brady, PhD, of the University of Minnesota School of Public Health in Minneapolis, in an accompanying editorial comment.

“Might unmet social needs lead to LUTS across the life course, and if so, through what mechanisms? Through what mechanisms might unmet social needs exacerbate existing LUTS?” she posed.

“Practitioners must ask themselves how they can better serve patients whose OAB and other LUTS may be a function of unmet social needs, at least in part,” Brady added. “Interprofessional care might include social workers and other professionals who can enhance patients’ self-efficacy to address unmet social needs. Referrals might include resources outside of the healthcare system to provide direct assistance in resolving unmet social needs.”

“For urology treatments to reach their full potential for success, screening and referral for unmet social needs may be essential,” she concluded.

In a second editorial comment, Ariana L. Smith, MD, of the University of Pennsylvania in Philadelphia, noted that “this under-investigated area has the potential to identify novel, personalized treatment and management strategies for OAB through identification of the social constructs at play in an individual’s life. Furthermore, it highlights the importance of looking beyond the purely biological risk factors for multifactoral conditions such as OAB.”

Sebesta and colleagues sought to examine a broader range of potential social factors associated with OAB. They hypothesized that social needs such as stable access to utilities, concerns about working toilets at home, and issues with home plumbing specifically affect bladder health and urinary conditions.

The analysis included 3,617 adults identified through a recruitment database and enrolled from September 2021 to January 2022. Participants completed questionnaires about their clinical and demographic background, urinary symptoms, and unmet social needs.

The study population comprised 1,391 (38.5%) individuals who met criteria for OAB, 1,153 (82.9%) of whom were women. Three-fourths of the OAB group had wet OAB.

Median age was 55 in the OAB group versus 41 in the non-OAB group (P<0.001), and both groups were mostly white (86.3% and 81.7%). The OAB group was less likely to live in urban areas or large cities (21.5% vs 26.6%, P=0.001), less educated (P=0.01), less likely to be working full time (43.1% vs 52.9%, P<0.001), and less likely to have private insurance and more likely to have Medicare or Medicaid (P<0.001).

After adjustments, the data revealed multiple statistically significant associations between OAB and unmet social needs:

  • Housing insecurity: OR 2.06, P<0.001
  • Worry that their home made them sick: OR 1.46, P=0.006
  • Food insecurity: OR 1.59, P=0.001
  • Loss of utilities: OR 2.27, P<0.001
  • Loss of transportation: OR 2.45, P<0.001
  • Skipped medication/medical appointments: OR 2.00, P<0.001
  • Legal help: OR 1.99, P<0.001
  • Worry about a place to urinate at home: OR 2.90, P<0.001
  • Stress about home plumbing: OR 1.57, P<0.001
  • Lack of support to get to medical appointments: OR 1.25, P=0.03

Help with child/elder care, stressful personal relationships, and feeling threatened or unsafe were not significantly associated with OAB.

  • Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow

Disclosures

Sebesta and co-authors and the authors of the editorial commentaries had no relevant relationships with industry.

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