Unveiling the link between financial strain and lower urinary tract symptoms | Image Credit: © jirsak - © jirsak - stock.adobe.com.
The association between financial strain and lower urinary tract symptoms LUTS and impact is caused by a lack of health care utilization and comorbidities, according to a recent study published in the American Journal of Obstetrics & Gynecology.
- The study establishes a connection between financial strain and lower urinary tract symptoms (LUTS), including urinary incontinence, frequent urination, and other difficulties. Financial strain is identified as a social determinant of health influencing the risk of LUTS.
- Social determinants such as housing insecurity, food insecurity, financial insecurity, difficulty finding employment, and unreliable transportation are linked to an increased risk of LUTS. These factors may create barriers to healthcare access and contribute to stress responses impacting biological systems.
- The research emphasizes the importance of a life course perspective in understanding the association between financial strain and LUTS. The study, conducted over 25 years, examines the impact of financial strain on women's bladder health, providing insights into how this association evolves over time.
- The findings indicate that underutilization of health care, along with financial strain and comorbidities, plays a role in exacerbating LUTS and their impact. Difficulty paying for medical care is identified as a variable associated with LUTS, and underutilization of healthcare is suggested as a mediator in the relationship between financial strain and LUTS.
- The study highlights racial disparities, with Black women more likely to report consistent financial strain and shifts in strain compared to White women. Despite similar LUTS rates between Black and White women, the frequency of reporting financial strain is higher among Black women, suggesting a need for further exploration of these disparities.
LUTS such as urinary incontinence (UI), nocturia, frequent urination, or difficulties with bladder emptying often adversely impact quality of life and increase the risks of depression and anxiety. Data has indicated the risk of LUTS is increased by social determinants of health (SDOH) such as housing insecurity, food insecurity, financial insecurity, difficulty finding employment, and unreliable transportation.
SDOH may increase LUTS risks because of financial and time barriers, as well as increased stress response. Therefore, financial strain may be an SDOH that damages biological systems because of poor health behaviors which may be categorized as behavioral stress responses.
There is little research on how life course perspective impacts the association between financial strain and LUTS. Investigators conducted a study to determine whether financial strain among women enrolled in the Coronary Artery Risk Development in Young Adults Study (CARDIA) was associated with increased LUTS impact after the 2010 to 2011 financial strain assessment.
There were 5115 participants aged 18 to 30 years included in the initial CARDIA cohort. At 2-, 5-, 7-, 10-, 15-, 20-, and 25-year follow-ups, 91%, 86%, 81%, 79%, 74%, 72%, and 72% of these participants remained.
Data about LUTS and their impact was collected after the year 25 examination at 2010 to 2011 using questionnaires mailed from March 2012 to February 2013. Of the remaining participants at this time, 74% completed the questionnaires, leading to 1465 individual responses.
Outcomes included UI severity, UI impact, other LUTS severity, and other LUTS impact. Questionnaire responses were used to determine UI severity, while UI impact was measured using the Incontinence Impact Questionnaire.
Other LUTS severity and impact were determined using the American Urologic Association Symptom Index (AUASI) score. The AUASI score included 7 LUTS: frequency, urgency, nocturia, intermittency, hesitancy, incomplete emptying, and weak stream.
Questions evaluating financial strain were measured dichotomously, with “not very hard” recorded as 0 and all other responses recorded as 1. Financial strain was evaluated at years 10, 15, 20, and 25. Responses were categorized into 5 groups: consistently not strained, consistently strained, a shift into being strained, a shift into not being strained, and more than 1 shift in strain.
Difficulty receiving care was also measured dichotomously, with “not too hard” and “not too hard at all” recorded as 0 and other responses recorded as 1. Covariates were measured at 10, 15, 20, and 25 years, and included physical activity, smoking, hypertension, body mass index, diabetes mellitus, and depressive symptoms.
Complete data was reported for 1302 women, 44% of whom were categorized into the bladder health cluster while 31% had mild symptoms, 20% moderate symptoms, and 5% severe symptoms.
LUTS and impact cluster groups reported increased rates of financial strain in the 2012 to 2013 period. Women with difficulty receiving and underutilization of health care were more likely to report severe LUTS and impact in 2012 to 2013.
While LUTS and impact cluster group membership did not differ between Black and White women, Black women were more likely to report consistent financial strain, a shift to being financially strained, and more than 1 shift in strain. Financial strain was also reported at more sessions from Black women than White women.
The risk of reporting greater LUTS and impact was increased approximately 2-fold among women consistently strained, shifted into being strained, or experienced over 1 shift in strain. The risk increased by 19% for each additional analysis where strain was reported.
Associations were found between financial strain, underutilization of health care, and comorbidities with increased LUTS and impact. Additionally, underutilization of health care was reported as a mediator for the association between difficulty paying for medical care with LUTS and impact.
Financial strain variables associated with LUTS and impact in the adjusted analysis include difficulty paying for medical care and underutilization of care. An association was also found between difficulty paying for care and comorbidities.
These results indicated underutilization of health care and comorbidities impact the association between financial strain and LUTS and impact. Investigators recommended further research to determine other factors that may influence this association.
Brady SS, Arguedas A, Huling JD, et al. Financial strain across 25 years and women’s bladder health: a life course perspective. Am J Obstet Gynecol. 2024;230:77.e1-12.doi:10.1016/j.ajog.2023.09.096