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Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children
Kristine L Griffin1, Jeremy M Lun2, Alexandra Bain3
1Nationwide Children's Hospital, Center for Colorectal and Pelvic Reconstruction, Columbus, OH.
Insights
Social determinants of health impact urological reconstruction choices in pediatric patients with neurogenic bladder. Factors like food insecurity and parental marital status influenced the type of urinary reconstruction selected.
Area of Science:
- Pediatric Urology
- Health Services Research
- Social Determinants of Health
Background:
- Neurogenic bladder in children often requires complex urological reconstruction.
- Myelomeningocele and anorectal malformations are common causes of neurogenic bladder.
- Understanding factors influencing surgical decisions is crucial for equitable care.
Purpose of the Study:
- To investigate the association between social determinants of health (SDH) and the type of urological reconstruction (incontinent urinary reconstruction [IUR] vs. continent urinary reconstruction [CUR]) in pediatric patients.
- To identify specific social factors that may influence surgical planning for neurogenic bladder.
Main Methods:
- Retrospective review of 208 pediatric patients undergoing urological reconstruction between 2014-2021.
- Data collected included diagnoses (myelomeningocele, anorectal malformations, etc.), reconstruction type (IUR/CUR), and SDH indicators.
- Statistical analysis using Fisher Exact Test and Cochran-Armitage Test for Trend.
Main Results:
- Continent urinary reconstruction (CUR) was performed in 74% of patients, while incontinent urinary reconstruction (IUR) was performed in 26%.
- Patients undergoing IUR were more likely to experience food insecurity, miss appointments, or have unmarried parents.
- Patients living out of state were more likely to undergo CUR.
Conclusions:
- Social determinants of health are associated with the type of urological reconstruction chosen for pediatric patients with neurogenic bladder.
- Preoperative planning for urinary reconstruction should incorporate consideration of social factors to ensure patient-centered care.
Objective:
To examine if social determinants of health (SDH) are associated with the type of urological reconstruction performed in patients with neurogenic bladder secondary to myelomeningocele and anorectal malformations.
Methods:
A single-institution retrospective review was performed in children with incontinent urinary reconstruction (IUR) or continent urinary reconstruction (CUR) and a diagnosis of myelomeningocele, anorectal malformation, or spinal cord pathology from years 2014-2021. Demographic, clinical, and SDH data were collected and compared to reconstruction type. Categorical variables were analyzed via Fisher Exact Test. Ordinal variables were analyzed using Cochran-Armitage Test for Trend.
Results:
From 2014 to 2021, 208 patients underwent urological reconstruction. Patients had a diagnosis of anorectal malformation (32.2%), myelomeningocele (30.8%), spinal cord pathology (18.8%), other diagnosis (18.3%), or cloacal exstrophy (4.8%). Of the cohort, 154 (74%) had a CUR, and 54 (26%) underwent IUR. Median age at reconstruction was higher in those who underwent CUR (6.7years [IQR 5.3, 9.8]) than for IUR (5.6 [IQR 1.5, 10.5]) (P=.01). There was no difference between insurance type for IUR vs CUR (P=.11). There was no association between Child Opportunity Index (COI) and reconstruction type (P=.5). Patients who underwent IUR were more likely to have experienced food insecurity (P=.02), missed at least one appointment (P=.02), or have unmarried parents (P=.03). Those who lived out of state more often pursued CUR (P=.01).
Conclusion:
There was an association between SDH and type of urologic reconstruction performed in pediatric patients. Social factors must be considered in preoperative planning for urinary reconstruction.
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