BACKGROUND: Completion of voiding diaries is a critical component in managing pediatric patients with non-neurogenic lower urinary tract symptoms (LUTS), aiding in symptom evaluation, diagnosis, and treatment planning. Despite their importance, patients/families may perceive diaries as burdensome and return without them. To enhance completion rates, understanding the impact of social determinants of health on voiding diary completion is essential. We hypothesized that patients with primary language other than English, non-white race/ethnicity, government insurance, and lower Child Opportunity Index (COI) would have lower rates of diaries completion.
METHODS: We retrospectively reviewed our IRB approved registry over a 3 year period to identify patients seen for LUTS who were assigned a voiding diary at initial visit. Patients with neurogenic bladder or urologic abnormalities were excluded. Patient demographics, follow up status and whether diaries were completed were abstracted. The COI (Childhood Opportunity Index) was used as a measure of the quality of resources and conditions present in a community necessary for a child to develop in a healthy way; this was calculated based on patient’s residential address. The primary outcome was the association between primary language, race/ethnicity, insurance payor group, COI, and diary completion status. Patients lost to follow-up were considered separately.
RESULTS: We identified 680 patients: 375 (55.1%) were female and 420 (61.8%) returned for follow-up of which 164 (39%) brought diaries. Primary language was not associated with completion. Patients with commercial insurance had significantly higher completion rates (44% vs. 27%) (p= 0.0029). Race/ethnicity were significantly associated with completion (p= 0.009): Compared to Non-Hispanic White patients, Non-Hispanic Black patients completed fewer diaries (-18%), while Hispanic/ Latino patients completed more (+13%). Patients completing diaries had a significantly higher COI (65.6) than non-completers (57.6) (p= 0.014), with notable under completion among patients from "Very Low" compared to “High” and “Very High” COI areas (21% vs. 49% and 41 %). There was no significant association with follow up and race/ethnicity, insurance payor group or COI.
CONCLUSIONS: Social determinants of health, including race/ethnicity, insurance type, and COI, are associated with voiding diary completion rates. Recognizing and addressing these determinants can inform strategies to either improve voiding diary completion or identify alternative approaches to patient care that better serve these groups. We hope to incorporate these findings in a future quality improvement initiative to improve the return of diaries.
