Urinary Incontinence in Community-Dwelling Older Women: Does Socioeconomic Status Affect Help Seeking and Treatment?

Urinary incontinence (UI) afflicts 17% to 55% community-dwelling older women. Although simple and effective treatments are available, many incontinent women do not seek professional treatment. Possible barriers to their help seeking include embarrassment and lack of knowledge and access to care. This study aims to examine how socioeconomic status – measured by education level and annual household income – can affect (1) UI care seeking behaviors and (2) receipt of UI treatment in a national cohort of non-institutionalized, older women with self-reported UI problem. The data were obtained from 2003 and 2004 Medicare Health Outcomes Survey. Multivariate logistic regression models were estimated on (1) all patients with UI problem (n=20727), to determine the independent impact of socioeconomic measures on the likelihood of discussing the UI problem with a health care practitioner; and on (2) patients with UI and having had such an consultation (n=9565), to determine the independent impact of socioeconomic measures on the likelihood of receiving UI treatment. Forty-six percent incontinent women sought professional help in the past 6 months, among whom 55% received a treatment. Compared to those with education<12 years, those with 16+ years education were more likely to discuss the UI problem with their healthcare provider (adjusted odds ratio [AOR]=1.29, p=0.000), and subsequently, to receive a treatment (AOR=1.35, p=0.000). Compared to patients with income<20k, patients with income>80k were more likely to receive UI treatment (AOR=1.51, p=0.018). These results suggest the need of targeted interventions to promote access to appropriate UI care among older women of low socioeconomic status.