Background The potential connection between social determinants of health (SDoH), cardiovascular health, and overactive bladder (OAB) remains unclear. This study aimed to investigate the associations between cumulative and individual unfavorable SDoH and OAB, and to evaluate the extent to which cardiovascular health was statistically associated with these associations. Methods This cross-sectional study utilized data from the NHANES 2005–2018 cycles. Unemployment, low income, low education, food insecurity, lack of healthcare access, lack of health insurance, housing instability, and being unmarried or not living with a partner were defined as unfavorable SDoH. OAB was defined based on self-reported urge urinary incontinence and nocturia. Cardiovascular health was assessed using Life’s Crucial 9 (LC9) and history of cardiovascular diseases (CVD). Multivariable logistic regression, linear regression, restricted cubic splines, subgroup analysis, and mediation analysis were used. Models were adjusted for age, sex, and race. Results Among 23,683 participants, 4729 were diagnosed with OAB. Per 1-unit increase in the SDoH score, higher odds of OAB (OR = 1.273, 95%CI: 1.239–1.308, p < 0.001), a lower LC9 score (β = -2.037, 95%CI: -2.182– -1.893, p < 0.001), and higher odds of CVD (OR = 1.288, 95%CI: 1.250–1.327, p < 0.001) were observed. These relationships were linear (all p-nonlinear > 0.05). Unemployment, low income, food insecurity, low education, lack of health insurance, and housing instability were independently associated with higher OAB risk. LC9 and CVD mediated 29.3% (p < 0.001) and 3.7% (p < 0.001) of the association between cumulative unfavorable SDoH and OAB. LC9 mediated the relationship between individual unfavorable SDoH and OAB, with varying mediation proportions: unemployment (15.8%; p < 0.001), low income (41.5%; p < 0.001), food insecurity (23.2%; p < 0.001), low education (30.6%; p < 0.001), lack of health insurance (16.4%; p < 0.001), and housing instability (14.3%; p = 0.008). Conclusions Unfavorable SDoH were positively associated with both CVD and OAB risk. Cardiovascular health statistically accounted for a proportion of the association between SDoH and OAB.

Association between social determinants of health and overactive bladder: exploring the role of cardiovascular health in a cross-sectional analysis

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2026年2月6日

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Haojie Du,
Chengxin Xie,
Jinhu Ni

摘要

Background

The potential connection between social determinants of health (SDoH), cardiovascular health, and overactive bladder (OAB) remains unclear. This study aimed to investigate the associations between cumulative and individual unfavorable SDoH and OAB, and to evaluate the extent to which cardiovascular health was statistically associated with these associations.

Methods

This cross-sectional study utilized data from the NHANES 2005–2018 cycles. Unemployment, low income, low education, food insecurity, lack of healthcare access, lack of health insurance, housing instability, and being unmarried or not living with a partner were defined as unfavorable SDoH. OAB was defined based on self-reported urge urinary incontinence and nocturia. Cardiovascular health was assessed using Life’s Crucial 9 (LC9) and history of cardiovascular diseases (CVD). Multivariable logistic regression, linear regression, restricted cubic splines, subgroup analysis, and mediation analysis were used. Models were adjusted for age, sex, and race.

Results

Among 23,683 participants, 4729 were diagnosed with OAB. Per 1-unit increase in the SDoH score, higher odds of OAB (OR = 1.273, 95%CI: 1.239–1.308, p < 0.001), a lower LC9 score (β = -2.037, 95%CI: -2.182– -1.893, p < 0.001), and higher odds of CVD (OR = 1.288, 95%CI: 1.250–1.327, p < 0.001) were observed. These relationships were linear (all p-nonlinear > 0.05). Unemployment, low income, food insecurity, low education, lack of health insurance, and housing instability were independently associated with higher OAB risk. LC9 and CVD mediated 29.3% (p < 0.001) and 3.7% (p < 0.001) of the association between cumulative unfavorable SDoH and OAB. LC9 mediated the relationship between individual unfavorable SDoH and OAB, with varying mediation proportions: unemployment (15.8%; p < 0.001), low income (41.5%; p < 0.001), food insecurity (23.2%; p < 0.001), low education (30.6%; p < 0.001), lack of health insurance (16.4%; p < 0.001), and housing instability (14.3%; p = 0.008).

Conclusions

Unfavorable SDoH were positively associated with both CVD and OAB risk. Cardiovascular health statistically accounted for a proportion of the association between SDoH and OAB.