目标:经济压力和未满足的社会需求与下尿路症状的更大风险相关。很少有研究研究与更全面的膀胱健康概念有关的财务压力和未满足的社会需求。这项研究利用了健康上升的基线数据:一项美国膀胱健康研究,以检查是否存在财务压力,未满足的社会需求,达到特定的联邦贫困水平阈值水平与下尿路症状和较差的膀胱健康状况有关,幸福,和功能。
方法:参与者年龄在18岁以上,出生女性或目前被认定为女性,从平民那里,居住在美国50个县的非制度化人口,其中包括或包围了9个招聘中心。数据是通过邮寄或基于互联网的调查收集的。为了解决研究问题,10个项目的下尿路功能障碍研究网络症状指数和选定的下尿路症状预防研究联盟膀胱健康评分分别根据每个财务压力进行回归,未满足的社会需求,和联邦贫困水平变量,使用线性回归调整协变量(年龄,种族/民族,教育,和阴道产次)和置信区间的稳健方差估计。纳入了给定分析没有缺失数据的参与者(范围为n=2,564至3,170)。在单独的敏感性分析中,身体质量指数,高血压,将糖尿病作为协变量加入,并对缺失数据进行估算.
结果:参与者的平均年龄为51.5岁(标准差=18.4)。没有足够的钱来维持生计,住房不安全,粮食不安全,交通不可靠,300%或更低的联邦贫困率与更多报告的下尿路症状和较差的膀胱健康状况相关。例如,与粮食安全参与者相比,担心食物在月底耗尽的女性,其尿路功能障碍研究网络-症状指数得分高3.4分(95%CI:2.5,4.3),平均而言。他们在不同的膀胱健康测量中的平均得分也较低,每个使用100点量表进行评估:全球膀胱健康状况(-8.2,95%CI:-10.8,-5.7),频率(-10.2,95%CI:-13.8,-6.7),感觉(-11.6,95%CI:-15.1,-8.2),尿失禁(-13.3,95%CI:-16.7,-9.9),和膀胱健康状况的情绪影响(-13.2,95%CI:-16.5,-9.9)。在整个分析中,在对体重指数进行额外调整后,关联在很大程度上仍然显著,高血压,和糖尿病。估算缺失数据时的结果模式与完整案例分析中观察到的结果相似;所有显着的关联在估算中仍然很重要。
结论:经济压力和未满足的社会需求与更差的LUTS和更差的膀胱健康相关。需要进行纵向研究,以检查财务压力和未满足的社会需求是否会影响发展,维护,和下尿路症状恶化;经济压力和未满足的社会需求可能影响症状的不同机制;以及症状导致经济压力的程度。如果有病因学研究的支持,可以实施预防研究,以确定是否改善财务压力和社会需求,包括加强预防性护理,可以促进整个生命周期的膀胱健康。
OBJECTIVE: Financial strain and unmet social needs are associated with greater risk for lower urinary tract symptoms. Little research has examined financial strain and unmet social needs in relation to the more holistic concept of bladder health. This study utilizes baseline data from RISE FOR HEALTH: A U.S. Study of Bladder Health to examine whether financial strain, unmet social needs, and meeting specific federal poverty level threshold levels are associated with lower urinary tract symptoms and poorer perceived bladder health, well-being, and function.
METHODS: Participants were 18 years or older, born female or currently identified as a woman, and from the civilian, noninstitutionalized population residing in 50 counties in the United States that included or surrounded nine recruitment centers. Data were collected through mailed or internet-based surveys. To address research questions, the 10-item Lower Urinary Tract Dysfunction Research Network Symptom Index and selected Prevention of Lower Urinary Tract Symptoms Research Consortium bladder health scores were separately regressed on each financial strain, unmet social need, and federal poverty level variable, using linear regression adjusting for covariates (age, race/ethnicity, education, and vaginal parity) and robust variance estimation for confidence intervals. Participants with no missing data for a given analysis were included (range of n=2,564 to 3,170). In separate sensitivity analyses, body mass index, hypertension, and diabetes were added as covariates and missing data were imputed.
RESULTS: The mean age of participants was 51.5 years (standard deviation=18.4). Not having enough money to make ends meet, housing insecurity, food insecurity, unreliable transportation, and percent federal poverty levels of 300% or less were consistently associated with more reported lower urinary tract symptoms and poorer perceived bladder health. For example, compared to food secure participants, women who worried that their food would run out at the end of the month had a Lower Urinary Tract Dysfunction Research Network - Symptom Index score that was 3.4 points higher (95% CI: 2.5, 4.3), on average. They also had lower mean scores across different bladder health measures, each assessed using a 100-point scale: global bladder health (-8.2, 95% CI: -10.8,-5.7), frequency (-10.2, 95% CI: -13.8,-6.7), sensation (-11.6, 95% CI: -15.1,-8.2), continence (-13.3, 95% CI: -16.7,-9.9), and emotional impact of bladder health status (-13.2, 95% CI: -16.5,-9.9). Across analyses, associations largely remained significant after additional adjustment for body mass index, hypertension, and diabetes. The pattern of results when imputing missing data was similar to that observed with complete case analysis; all significant associations remained significant with imputation.
CONCLUSIONS: Financial strain and unmet social needs are associated with worse LUTS and poorer bladder health. Longitudinal research is needed to examine whether financial strain and unmet social needs influence the development, maintenance, and worsening of lower urinary tract symptoms; different mechanisms by which financial strain and unmet social needs may impact symptoms; and the degree to which symptoms contribute to financial strain. If supported by etiologic research, prevention research can be implemented to determine whether the amelioration of financial strain and social needs, including enhanced access to preventative care, may promote bladder health across the life course.