TY - JOUR
T1 - Urinary continence disparities in patients with anorectal malformations
AU - Pediatric Colorectal and Pelvic Learning Consortium (PCPLC)
AU - Ahn, Jennifer J.
AU - Rice-Townsend, Samuel E.
AU - Nicassio, Lauren
AU - Glazer, Debra
AU - Avansino, Jeffrey R.
AU - Lewis, Katelyn E.
AU - Durham, Megan M.
AU - Frischer, Jason
AU - Calkins, Casey M.
AU - Rentea, Rebecca M.
AU - Ralls, Matthew
AU - Fuller, Megan
AU - Wood, Richard J.
AU - Rollins, Michael D.
AU - Lee, Justin
AU - Reeder, Ron W.
AU - Dickie, Belinda H.
AU - Saadai, Payam
AU - Cain, Mark P.
AU - Merguerian, Paul
AU - Smith, Caitlin A.
N1 - Funding Information:
All authors participated in study conception and design, analysis and interpretation of data, and critical revision of manuscript. Acquisition of data was performed by D. Glazer, L. Nicassio, K. Lewis and R. Reeder. Manuscript was drafted by J. Ahn, K. Lewis, and C. Smith. None of the authors has relevant This may be Funding Agency. Please check.financial disclosures.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021
Y1 - 2021
N2 - Purpose: While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM. Methods: We performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant. Results: A total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence. Conclusions: We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.
AB - Purpose: While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM. Methods: We performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant. Results: A total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence. Conclusions: We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.
KW - Anorectal malformation
KW - Disparities
KW - Urinary continence
KW - Urinary incontinence
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U2 - 10.1016/j.jpedsurg.2021.09.029
DO - 10.1016/j.jpedsurg.2021.09.029
M3 - Article
C2 - 34688492
AN - SCOPUS:85118771148
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
ER -