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Urinary continence disparities in patients with anorectal malformations
Jennifer J Ahn1, Samuel E Rice-Townsend2, Lauren Nicassio2
1Department of Urology, Seattle Children's, University of Washington, 4800 Sand Point Way NE, M/S OA.9.220, Seattle, WA 98105, United States.
Insights
Urinary incontinence in children with anorectal malformations (ARM) is linked to insurance and adoption status, indicating potential disparities. Further research is needed to address these inequities and improve clinical outcomes for affected children.
Area of Science:
- Pediatric Urology
- Clinical Outcomes Research
- Health Disparities
Background:
- Urinary incontinence is a significant concern in children with anorectal malformations (ARM), alongside fecal incontinence.
- Previous studies noted racial, ethnic, and socioeconomic disparities in urinary continence for other conditions, but not specifically in ARM.
- Understanding these disparities in ARM is crucial for equitable care.
Purpose of the Study:
- To evaluate urinary continence in children with anorectal malformations (ARM).
- To identify demographic and socioeconomic factors associated with urinary continence in this population.
- To investigate potential disparities in urinary continence among ARM patients.
Main Methods:
- A multicenter retrospective study involving 525 patients with ARM aged 3 years and older.
- Urinary continence was categorized as complete, daytime, partial, or none.
- Associations between continence and race, sex, age, insurance, and adoption status were analyzed using Kruskal-Wallis and trend tests.
Main Results:
- Overall, 48% of patients with ARM achieved complete urinary continence, with continence increasing with age.
- In school-aged children (≥5 years), 58% had complete continence, while 30% had none.
- Public insurance and adoption status were associated with a lower likelihood of urinary continence.
Conclusions:
- This study identified novel disparities in urinary continence among children with ARM, specifically linked to insurance and adoption status.
- These findings highlight the need for further investigation into the causes of these inequities.
- Addressing these disparities is essential for improving clinical outcomes in children with ARM.
Purpose:
While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM.
Methods:
We performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant.
Results:
A total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence.
Conclusions:
We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.
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