Financial strain across 25 years and women’s bladder health: A life course perspective

A small number of cross-sectional studies have found that financial insecurity – a social determinant of health (SDOH) – is associated with lower urinary tract symptoms (LUTS). (s): To examine (1) whether women in the Coronary Artery Risk Development in Young Adults study with higher levels of financial strain, assessed at seven time points across 25 years beginning in 1985-86, were more likely to report LUTS and impact after the 2010-11 financial strain assessment, and (2) whether healthcare access and comorbidities mediate potential associations. This prospective cohort study recruited Black and White participants aged 18-30 years at baseline (1985-86) from the populations of four United States cities. The analytic sample was comprised of women with complete data for analyses involving financial strain trajectories across 7 assessments (n=841) and mediation tests of data collected at 4 assessments (n=886). The outcome variable was previously developed through a cluster analysis of urinary incontinence severity, urinary incontinence impact, other LUTS severity, and their impact at 2012-13, which yielded four LUTS/impact cluster categories: women with no or very mild symptoms and no impact versus mild, moderate, or severe symptoms and impact. Financial strain was defined as finding it “very hard,” “hard,” or “somewhat hard” (versus “not very hard”) to pay for the very basics like food, heating, and medical care. Using proportional odds logistic regression, cluster categories were regressed on financial strain trajectory group, adjusting for age, race, education, and parity. For mediation analyses, separate financial strain variables (difficulty paying for the very basics like food and heating, difficulty paying for medical care) were created by combining 1995-96 and 2000-01 values. Two healthcare access variables (difficulty receiving care, underutilization of care) and a single comorbidity index (smoking, physical inactivity, body mass index, hypertension, diabetes, depressive symptoms) were created by combining 2005-06 and 2010-11 values. Regression analyses and structural equation modeling were used to test whether healthcare access and comorbidities mediated associations between financial strain and LUTS/impact cluster categories. In comparison to women who were consistently not financially strained, women who were consistently strained (OR=2.10, 95% CI: 1.13,3.91), shifted into being strained (OR=2.00, 95% CI: 1.29,3.10), or experienced more than one