Sociodemographic Factors Associated with Use of Interventions to Prevent UTIs

Objectives: Investigate the association between sociodemographic factors and the use of interventions to prevent urinary tract infections (UTIs).

Methods: This is a cross-sectional study. Partnering with NORC Foresight 50+ Omnibus, a national survey was administered to adults aged 50 years or older. The survey included questions related to a history of UTI in the last year and non antibiotic interventions used to prevent UTI. It was weighted to represent the US population. Interventions queried were: cranberry juice, cranberry pill, probiotic (e.g. lactobacillus), vaginal estrogen, oral estrogen, transdermal estrogen, and any other unspecified medication/supplement. We compared those who used and did not use any interventions. Respondents were also asked if they had ever experienced a UTI. Chi-squared test with Rao and Scott’s second order correction were performed. A multivariable logistic regression model was developed, adjusting for characteristics significant in the bivariate analysis. The outcome of interest was use of at least one interventions to prevent UTI.

Results: We limited the analysis to 515 female respondents. Among all respondents, non-antibiotic interventions to prevent urinary tract infections were used by 34.5% (n=177). Those in order of use were: cranberry juice by 23.5% (n=121), probiotics by 7.6% (n=39), a cranberry supplement by 5.5% (n=28), vaginal estrogen by 3.6% (n=19), oral estrogen by 0.8% (n=4) and transdermal estrogen by 0.5% (n=3). A history of UTI in the last year was reported by 85 women (16.5%). Among these 85 women, 68.6% (n=58) used interventions to prevent UTI but only 10.8% (n=10) used a form of estrogen. In an adjusted analysis to identify associations with use of interventions, obese women were statistically less likely to utilize interventions (OR = 0.46, 95% CI 0.25 – 0.86). Women were significantly more likely to use interventions to prevent UTI if they did not have access to care or tests in last 6 months (OR 3.2, 95% CI 1.4-7.6), if they had had a UTI in last year (OR 11, 95% CI 5.4-22.4) or if they “sometimes” experienced symptomatic urinary leakage (OR 1.9, 95% CI 1.1-3.3). However, women who experienced urinary incontinence “often” or “always” were no more likely than those who experienced it “never” or “always” to use interventions.

Conclusions: Among women 50 years and older who were diagnosed with a UTI in the last year estrogen is an underutilized intervention to prevent UTIs. Individuals who lack access to care appear to be interested in interventions that could mitigate their risk for UTIs. Additional research is needed to better understand the barriers preventing increased utilization of estrogen as a UTI prevention strategy.