Social Determinants of Health and UTIs in Females Aged 50 and Older

Objectives: Investigate the association between social determinants of health and UTIs in females aged 50 or older.

Methods: We contracted with Foresight 50+ Consumer Omnibus to administer items regarding UTIs during their monthly survey of US adults aged 50 or older in October 2023. This cross-sectional data is weighted to reflect the US population of adults aged 50 or older using current benchmarks established by the U.S. Census Bureau. We compared respondents who did and did not have a UTI diagnosed and treated in the last 12 months. Bivariate analysis between UTI and demographics, comorbidities, and social factors were analyzed among female respondents. Those variables considered marginally significant (p < 0.2) were included in a multivariable model with the outcome of UTI in the last 12 months. Independent associations evaluated for inclusion in a multivariable model for UTI included: age in deciles, race/ethnicity, marital status, body mass index (BMI), housing ownership (vs rental), metropolitan home location (vs non-metropolitan), regular access to care, hospitalizations, constipation, severity of urinary incontinence, and frequency of sexual activity. Statistical significance was set with a p-value of (p < 0.05) for bivariate and multivariate analysis.

Results: A UTI was reported by 15.9% (n=92) of 569 female respondents in the last 12 months. The odds of a UTI among females with an income < $30,000 was 2.7 times greater than that for those with an income of >$100,000 (aOR 2.7, 95% CI 1.1-6.5) but did not differ for those with an income of $30-60,000 or $60-100,000. The odds of a UTI was 2.1 times greater for females with a BMI > 30 kg/m² compared to those with a BMI < 25 kg/m² (aOR 2.1, 95% CI 1.1- 4.1). In the final multivariable model, age in deciles, BMI, housing ownership (vs rental), metropolitan home location (vs non-metropolitan), regular access to care, hospitalizations, constipation, severity of urinary incontinence, and frequency of sexual activity were not associated with UTI.

Conclusions: In this analysis weighted to the U.S. population using census data and adjusted for several common risk factors and social determinants of health, we have identified that income < $30,000 and BMI >30 kg/m² are associated with the risk of UTI. The health disparity in risk of UTI for low-income females aged 50 or older has limited published data. Larger population studies are needed to confirm this finding and understand the underlying cause of this disparity.