Unmet social needs linked to overactive bladder

Some social needs that are not properly addressed may contribute to the presence of overactive bladder (OAB) in adults, and these unmet needs can affect the overall management of OAB patients, suggests a recent study.

“Specifically, we found that home toilet access, fear of losing utilities, and transportation to healthcare appointments had the strongest associations with OAB,” the researchers said.

“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, even when adjusting for multiple covariates,” they added.

An electronic recruitment was carried out on community-based adults, who then completed questionnaires on clinical and demographic information, urinary symptoms, and unmet social needs. The researchers assessed the association between OAB and several unmet social needs using multivariable logistic regression.

A total of 3,617 adults (mean age 47.9 years) participated in the study, most of whom were White, non-Hispanic (83.5 percent) and female (77.6 percent), while 1,391 (38.5 percent) had an OAB. [J Urol 2022;208:1106-1115]

The presence of OAB correlated with the following unmet social needs: housing instability, food insecurity, worry about utilities, lack of transportation, skipping medical appointments, needing legal help, stress in personal relationship, worry about toilet access and plumbing at home, as well as lack of social support.

Multivariable analysis, adjusted for several covariates, confirmed the significant associations of these social needs with OAB.

“Additionally, for most unmet social needs, the association was significantly greater in those with OAB wet as compared to OAB dry, possibly indicating an increased burden of unmet social needs with increasing severity of urinary conditions and/or that the incontinence component of OAB is the driving factor in these pathways,” the researchers said.

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

Primary care studies

An earlier prospective study exploring the link between social needs and OAB severity in 265 racially and ethnically diverse women found that food insecurity, healthcare costs, difficulty concentrating, and difficulty finding or keeping a job were the strongest predictors of OAB and increasing OAB severity. [J Urol 2021;205:1415-1420]

Another prospective study examining unmet social needs in at least 33,000 patients from primary care clinics also found an association between certain social needs and several chronic medical conditions. [Prev Med 2021;153:106752]

Of note, transportation to healthcare appointments showed the most robust association with multiple medical conditions examined, which was consistent with other studies. [J Community Health 2013;38:976-993; Transportation Res Rec 2005;1924:76-84]

“The present study also identified transportation to healthcare appointments as one of the needs with a strong association to OAB,” the researchers said.

“While these studies from the primary care literature were conducted by a single group at a large, urban medical centre, our study represents participants living in a variety of different community types, suggesting transportation affects healthcare access, care, and outcomes across the country and across multiple different diseases,” they added.