D. Schalk1,2, T. Walt1,2, X. Mao1,2, L. Herrera-Venegas1, K. Kieran1,2,3 1Seattle Children’s Hospital, Division Of Urology, Seattle, WA, USA 2University of Washington, School Of Medicine, Seattle, WA, USA 3University Of Washington, Department Of Urology, Seattle, WA, USA
Introduction:
Although bladder and bowel health (BBH) issues have been associated with stress and mental health concerns, the relationship between social determinants of health (SDOH) and BBH concerns has not been explored. We evaluated the association between level of neighborhood disadvantage and resolution rates, loss to follow-up, and age at first visit for children with BBH diagnoses. We hypothesized that children living in more disadvantaged areas would be older at first visit, more likely lost to follow-up, and less likely to experience symptom resolution at one year than children living in less disadvantaged areas.
Methods:
We reviewed the records of all patients aged 3 years and older with new visits for isolated BBH diagnoses between January 1 and December 31, 2022. Patient demographics (age, gender, language of care, and SDH), BBH diagnoses, recommended follow-up interval, return to clinic date, timing of symptom resolution, and resolution rate at 1 year were recorded. Level of neighborhood disadvantage was determined using the Area Deprivation Index (ADI) based on the patient’s home address. Demographics were described using measures of central tendency. Groups were compared using t-tests and odds ratios, as appropriate.
Results:
246 patients, 89 male (36.3%) and 157 female (63.8%), we referred for daytime incontinence (57), bedwetting (82), urinary urgency (8), urinary frequency (25), recurrent UTIs (72), and voiding dysfunction (48). Forty-two patients lived in ADI 1-2 (least disadvantaged; 17.5%) while 91 (37.0%) patients lived in ADI 9-10 (most disadvantaged). Patient age at initial appointment was similar for patients living in ADI 1-2 and ADI 9-10 (median 9.4 vs 7.4 years, p=0.26) overall, and for most BBH diagnoses: daytime incontinence (median 6.4 vs 7.2 years, p=0.90), bedwetting (median 9.1 vs 7.6 years, p=0.82), and urinary frequency (median 7.0 vs 5.1 years, p=0.99). Patients with recurrent UTIs living in ADI 9-10 younger at referral than those living in ADI 1-2 (median 6.4 vs 8.6 years, p=0.01). Patients in ADI 1-2 and 9-10 were equally likely to be lost to follow-up (55.6% vs 59.3%, OR=0.86, 95% CI: 0.42-1.76). Of patients who did return to clinic as scheduled, those living in ADI 9-10 were as likely as those living in ADI 1-2 to have complete or partial symptom resolution (41.7% vs 26.3%; OR 2.00, 95% CI: 0.74-5.45).
Conclusion:
Children urinary incontinence, urinary urgency/frequency, and nocturnal enuresis living in the most disadvantaged areas did not have delayed evaluation, increased loss to follow-up, or lower resolution rates than those living in the least disadvantaged areas. Children with recurrent UTIs living in the most disadvantaged areas were referred nearly two years earlier than those living in the least disadvantaged areas. The latter findings may reflect variable comfort of pediatricians with certain diagnoses, or differential timing of recurrent UTI development in children living in variably disadvantaged areas.