Biological factors only partly explain the prevalence of overactive bladder (OAB) within a community. Now a new study associates financial strain with more severe OAB.

Investigators asked 256 women (mean age 58.6 years; body mass index 30.4 kg/m2) visiting Montefiore Medical Center in the Bronx, New York, or Johns Hopkins Bayview Medical Center in Baltimore, Maryland, to complete the OAB-validated 8-question screening questionnaire. The OAB symptom level was characterized as none (score 0-8) in 21%, mild to moderate (score 9-30) in 53%, and severe (score more than 30) in 26%.

A higher OAB symptom level was associated with 2.5-, 1.9-, and 3.1-fold increased odds of food insecurity, financial strain, and difficulty finding or keeping employment, respectively, Laura Tellechea, MD, of Yeshiva University Albert Einstein College of Medicine in the Bronx, New York, and colleagues reported in The Journal of Urology. It was also associated with 2.5-fold increased odds of difficulty concentrating. Investigators adjusted for age, race, body mass index, pregnancies, and previous pelvic surgery. The study lacked data on comorbidities. Of the cohort, 33.6% of patients self-identified as White, 32% Black, 29.3% Hispanic, and 5.1% as “other.”

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“Difficulty finding or maintaining employment can limit access to employer-based health insurance and therefore limit access to health care, which may lead to delayed presentation when the condition is more severe,” Dr Tellechea’s team explained.

They also observed, “Diets that include bladder irritants such as caffeine, carbonated beverages, and aspartame and other artificial sweeteners are known contributors to OAB. Limited access to a diet rich in fruits and vegetables and soda alternatives in people of lower socioeconomic classes may explain how food insecurity contributes to severity of OAB.”

Previous studies have revealed an association between mental disorders such as depression and anxiety and urinary incontinence, they noted.

Providers should screen for social needs in the evaluation of at-risk patients with OAB or patients with OAB who have failed initial treatment, Dr Tellechea and colleagues concluded.

In an accompanying editorial, Sonya S. Brady, PhD, of the University of Minnesota School of Public Health in Minneapolis stated:

“Clinical care teams can screen for [Social Determinants of Health] and refer patients to services that may ameliorate social ecological obstacles to health (eg inadequate resources for nutrition, untreated mental health conditions).”


Tellechea L, Zuo S, Kohn JR, et al. The effect of social determinants of health on overactive bladder symptom severity. J Urol. 205(5):1415-1420. doi:10.1097/JU.0000000000001545