The Association Between Social Determinants of Health and Overactive Bladder in US Adults: Depression as a Potential Explanatory Factor.

INTRODUCTION AND HYPOTHESIS: To investigate the association between a composite measure of adverse social determinants of health (SDOH) and overactive bladder (OAB) among US adults, and to assess the potential role of depression in this relationship.

METHODS

We conducted a cross-sectional analysis of adult participants (≥ 18 years) from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). A composite SDOH score (range 0-8) was derived from eight adverse conditions across economic, educational, healthcare, housing, and social domains. OAB was defined using the Overactive Bladder Symptom Score (OABSS ≥ 3). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9 ≥ 10). Survey-weighted multivariable logistic regression models were used to examine associations, adjusting for covariates. Mediation analysis quantified the proportion of the SDOH-OAB association explained by depression.

RESULTS

Among 27,429 participants (weighted n = 191.7 million), the prevalence of OAB was 19.3%. In the fully adjusted model, each 1-unit increase in the SDOH score was associated with 16% higher odds of OAB (OR 1.16; 95% CI 1.14-1.18). A clear dose-response relationship was observed across SDOH categories (P for trend < 0.01). Key individual SDOH components, including unemployment, poverty, and food insecurity, were independently associated with OAB. Depression accounted for a substantial proportion of the total association between SDOH and OAB. The positive SDOH-OAB association was consistent across most subgroups, and findings were robust in sensitivity analyses.

CONCLUSIONS

A greater burden of adverse social determinants of health is associated with an increased prevalence of OAB in US adults. This relationship may be partially explained by depression.