The following is a summary of “Financial strain across 25 Years and women’s bladder health: A Life Course Perspective,” published in the January 2024 issue of Obstetrics and Gynecology by Brady, et al.

A few studies have hinted at a possible link between financial instability, a key aspect of social determinants of health, and lower urinary tract symptoms. For a study, researchers sought to explore whether women in the Coronary Artery Risk Development in Young Adult Study who experienced greater financial strain over 25 years starting in 1985–1986 were more likely to report lower urinary tract symptoms and their impact after a financial strain assessment in 2010–2011. Additionally, the study sought to investigate whether factors like healthcare access and comorbidities played a role in mediating these potential associations.

The prospective cohort study recruited Black and White participants aged 18 to 30 at baseline from four US cities. The analysis included women with complete data for financial strain trajectories across seven assessments and mediation tests conducted at four evaluations. The outcome variable was determined through a cluster analysis of urinary incontinence severity, urinary incontinence impact, and the severity and impact of other lower urinary tract symptoms. Financial strain was defined based on difficulties affording basics like food, heating, and medical care. Proportional odds logistic regression was used to examine the relationship between financial strain trajectory group and cluster categories of lower urinary tract symptoms and their impact, adjusting for relevant factors. For mediation analysis, separate financial strain variables were created as healthcare access indicators and a comorbidity index. Regression analyses and structural equation modeling were employed to explore whether healthcare access and comorbidities mediated the relationship between financial strain and lower urinary tract symptoms and their impact.

Women experiencing consistent financial strain, those transitioning into financial strain, or those with multiple shifts in financial strain had about twice the likelihood of reporting greater lower urinary tract symptoms and impact compared to women consistently not financially strained (odds ratio, 2.10; 95% CI, 1.13–3.91; odds ratio, 2.00; 95% CI, 1.29–3.10; odds ratio, 1.99; 95% CI, 1.46–2.71). The association between difficulty paying for medical care and lower urinary tract symptoms and the impact was influenced by underutilization of healthcare and comorbidities. In the structural equation model, significant associations were observed between difficulty paying for medical care and underutilization of care (β=.31; P<.01), underutilization of care and greater lower urinary tract symptoms and impact (β=.09; P<.01), difficulty paying for medical care and the comorbidity index (β=.34; P<.01), and the comorbidity index and greater lower urinary tract symptoms and impact (β=.24; P<.01). These mediation pathways collectively eliminated a direct link between difficulty paying for medical care and lower urinary tract symptoms and effects.

The underutilization of healthcare services and comorbidities clarified the relationship between financial strain, particularly difficulty affording medical care, and lower urinary tract symptoms and impact. Further research is essential to validate these findings and explore additional explanatory mechanisms. The cumulative evidence could shape future policies and practices to address healthcare access disparities and improve outcomes for individuals facing financial strain.

Reference: ajog.org/article/S0002-9378(23)00725-1/abstract