Pediatric Bladder Health Concerns: Does Where You Live Matter?

INTRODUCTION: The relationship between social determinants of health (SDOH) and bladder health (BH) 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 BH 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 y than children living in less disadvantaged areas.

METHODS: We reviewed the records of all patients aged ≥3 y with new visits for isolated BH diagnoses between January 1 and December 31, 2022. Patient demographics (age, gender, language of care, and SDOH), BH diagnoses, recommended follow-up interval, return to clinic date, timing of symptom resolution, and resolution rate at 1 y 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 parametric and nonparametric tests, odds ratios (ORs), and multivariate linear regression, as appropriate.

RESULTS: A total of 245 patients, 88 male (36.3%) and 157 female (63.8%), were referred for daytime incontinence (n = 57), bedwetting (n = 82), urinary urgency (n = 8), urinary frequency (n = 25), recurrent urinary tract infections (UTIs; n = 72), and voiding dysfunction (n = 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). On multivariate analysis, age and presence of SDOH barriers were not associated with differential age at evaluation but males were older than females (median 7.0 versus 5.0 y, P = 0.016). Patients in ADI 1-2 and 9-10 were equally likely to be lost to follow-up (55.6% versus 59.3%, OR = 0.86, 95% confidence interval: 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% versus 26.3%; OR 2.00, 95% confidence interval: 0.74-5.45).

CONCLUSIONS: Children with BH concerns 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.