A recent study, which was presented at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction 2022 Winter Meeting,1 investigated the relationship between social needs and urologic conditions. During this presentation, Elisabeth M. Sebesta, MD, reported that patients who experienced more unmet social needs were at increased risk of multiple urologic conditions, such as overactive bladder (OAB), interstitial cystitis, or urge incontinence. She discusses these results further in the following interview, emphasizing the important role of the urologist to consider these needs when providing care. Sebesta is a female pelvic medicine and reconstructive surgery fellow in the department of urology at Vanderbilt University Medical Center in Nashville, Tennessee.
There is a growing awareness and body of health that various social factors and social determinants of health and unmet social needs are significantly [affecting] health outcomes. And so, there's some literature demonstrating links between individual unmet social needs and chronic conditions. More specifically, [there is] a smaller amount of literature looking specifically at urologic conditions. The objective of our study was to investigate the association between individual unmet social needs and non-cancerous urologic conditions that we frequently see in our pelvic health clinics. This specific study was part of a larger investigation on social determinants of health and urinary symptoms, in which we recruited, electronically, a community-based sample of US adults to complete questionnaires regarding urinary symptoms and social needs. We included over 4000 participants in this study. The urologic outcomes that we assessed included incontinence, overactive bladder, recurrent urinary tract infections, interstitial cystitis, and neurogenic bladder. And then, we assessed social needs across multiple different domains, including food insecurity, issues with utilities, transportation to medical appointments, relationships, health care costs, legal issues, and housing quality and insecurity.
We found that reporting an increasing number of these unmet social needs was positively associated with an increased risk in all of the various conditions that we assessed to some varying degree. We also saw a cumulative relationship, so more unmet needs resulted in a higher risk of these urologic conditions. For example, participants reporting 3 or more unmet social needs had a nearly 25% increased risk [of] interstitial cystitis, and about a 20% increased risk of urge incontinence and overactive bladder. When we looked more closely at these individual needs, having issues with utilities was the most strongly associated to a variety of these different conditions. Other such needs included housing instability and quality, food insecurity, and lack of transportation. These were all ones that were very strongly associated with a urologic condition. So, like I said, we were able to demonstrate that unmet social needs are associated with an increased incidence of these benign urologic conditions, and multiple needs display that cumulative effect.
This was a large, investigational, exploratory analysis with the goal of really getting more information about potential association between social factors and social determinants of health and the urologic conditions that affect the patients we see in our clinic. This study is really an overview that suggests that these relationships exist. And so, that's really the take-home message for urologists—to understand and consider that these non-medical factors also affect our patients lives when they come in to see us, and that these things can have influence on their health outcomes. You can't practice medicine in a bubble or treat their conditions in a bubble. You have to be aware of and understanding of the fact that things outside your office influence patients' medical conditions and outcomes. For example, you could be seeing a patient for overactive bladder who doesn't come reliably to follow-up visits [and] doesn't pick up their medication from the pharmacy, [but] this isn't necessarily them being non-compliant. They might not have reliable transportation, or they can't afford the cost of the medications, or the same patients may be worried about housing issues, safe housing for them and their family, and this causes stress and anxiety. We know [that] different psychosocial factors propagate OAB symptoms, so it's important to not have tunnel vision and to understand that not every patient is the same. Not every aspect of their health can be fixed in your office, but for the time being, we can try our best to be sensitive of these things, hear our patients when they tell us what else is going on in their lives, and try to offer counseling management, follow-up schedules, and that kind of stuff that may take into account these factors is the best we can.
It's hard. As more research and more attention is brought to social determinants of health, the role of the physician, specifically in this domain, is something that probably deserves more attention. It's still our primary goal as urologists and as physicians to care for patients' medical conditions. The social needs aren't medical conditions that can be alleviated in a doctor's office, and they shouldn't be medicalized or viewed in that way. So, I think, like I said, the role of the urologist is to be very acutely aware that these factors exist, even if they're out of our control, and to be understanding and empathetic, and try our best to care for patients as individuals who come from vastly different backgrounds and conditions. The purpose of conducting this large study is that the goal in our own clinic is to start an effort towards screening patients for some of these unmet social needs by asking about them during office visits. With this information, we hope we can at least bridge the gap to get patients plugged into social services or mental health support services that they might also need, which may seem like a daunting task, especially in a subspecialty like urology. We think that these things are reserved for primary care physicians and social workers, but I think we have to remember that urologists sometimes have unique roles and sometimes serve as de facto primary care doctors for patients or be the only physician that a patient sees. So, we do think that it deserves at least some attention in urology practices, but we certainly don't have all the answers yet. Our goal is just to draw attention to these associations that may not have been previously considered in our specialty.
Social determinants of health and the roles that they play in various health conditions is becoming an increasingly hot topic over the last several years, which is a good thing. Hopefully, this is the first step of many [that will] draw awareness to it. I think that moving forward, we'll see a lot more attention being paid to social needs in the context of patient health conditions at the specialty level, the hospital system level, and hopefully, the nationwide level. But I think we'll see a changing conversation around health and health outcomes. Mostly, I hope that each new generation of physicians will be better equipped than the last to practice medicine in the context of the social factors, just by drawing awareness and promoting physician education around these kinds of issues.
1. Sebesta E, Gleicher S, Kaufman M, et al. Patients with urologic conditions are more likely to have unmet social needs. Paper presented at: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction 2022 Winter Meeting; San Diego, California. February 22-26, 2022. Poster #NM55