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Impact of Race, Gender, and Socioeconomic Status on the Severity of Lower Urinary Tract Symptoms at Time of Presentation to a Pediatric Urologist
Joan S. Ko, MD, Christopher Corbett, MD, Amanda Berry, PhD, MSN, CPNP, Dana A. Weiss, MD, Christopher J. Long, MD, Stephen A. Zderic, MD, Jason P. Van Batavia, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.

BACKGROUND: The Dysfunctional Outpatient Voiding Education (DOVE) score, a minor modification of the Dysfunctional Voiding and Incontinence Symptom Score, is a validated tool to evaluate lower urinary tract and bowel symptoms in children. A quantitative score (0-35) is provided with higher values indicating more/worse symptoms. Racial and gender disparities have been observed in lower urinary tract symptom (LUTS) severity at the time of presentation to a pediatric urology. This study aims to determine how socioeconomic status factors in to this association. METHODS: We reviewed all urology encounters at a single institution with a completed DOVE score between 6/2015-3/2018. Initial visits for patients 5-21 years old with a primary complaint related to non-neurogenic LUTD (ie, urgency, incontinence, frequency, constipation) were included. Patients with neurologic disorders (e.g. spina bifida) or other genitourinary tract anomalies were excluded. Race, gender, estimated median household income (as determined by zip code according to the 2013-2017 American Community Survey), and insurance payer types (self-pay, financial assistance/Medicaid/CHIP, private/military, and international) were ascertained for these patients. International patients (n=16) were excluded from our analysis. Multiple regression models were used to determine how these factors affected LUTS severity at time of presentation to urology. Statistics were done with Stata 15. RESULTS: The addition of estimated median household income to our model did not eliminate the significant impact of race and gender on LUTS severity at the time of presentation to a pediatric urologist. Even after factoring in income status, black or African American patients had significantly higher symptom scores than white or Caucasian patients (p<0.001), and females had significantly higher symptom scores than males (p=0.002). Lower estimated income also independently was associated with high symptom scores (p<0.001). When insurance payer types were added to the model, estimated income was no longer significant (p=0.262). Patients with financial assistance/Medicaid/CHIP had significantly higher symptom scores when compared to both self-pay patients (p<0.001) and when compared to patients with private or military insurance (p<0.001). CONCLUSIONS: Race, gender, and socioeconomic status all significantly impact the severity of LUTS in patients who are initially seen by pediatric urology. While socioeconomic status clearly appears to play an important role in this patient population's access to pediatric urology, it does not negate the role of race and gender as demonstrated by our model.


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