Differences in continence rates in individuals with spina bifida based on ethnicity

Issue title: Immigration and Transition: Emerging Trends in Spina Bifida Care

Guest editors: Timothy Brei and Jonathan Porter Castillo

Article type: Research Article

Authors: Smith, Kathryn A.^{a; b; *} | Liu, Tiebin^c | Freeman, Kurt A.^d | Betz, Cecily^{a; b} | Clayton, Gerald H.^{e; f} | Castillo, Heidi^{g; h} | Castillo, Jonathan^{g; h} | Tu, Duong^{k; h} | Speybroeck, Alexander Van^{a; b} | Walker, William O.^{i; j}

Affiliations: [a] Children’s Hospital Los Angeles, Los Angeles, CA, USA | [b] Keck School of Medicine, University of Southern California, Los Angeles, CA, USA | [c] Rare Disorders and Health Outcomes Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA | [d] Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA | [e] Children’s Hospital Colorado, Aurora, CO, USA | [f] University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [g] Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Houston, TX, USA | [h] Baylor College of Medicine, Houston, TX, USA | [i] Division of Developmental Medicine, Seattle Children’s Hospital, Seattle, WA, USA | [j] University of Washington School of Medicine, Seattle, WA, USA | [k] Division of Pediatric Urology, Department of Surgery, Texas Children’s Hospital, Houston, TX, USA

Correspondence: [*] Corresponding author: Kathryn A. Smith, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop 53, Los Angeles, CA 90027, USA. Tel.: +1 323 361 8301; Fax: +1 323 361 8305; E-mail: [email protected].

Abstract: BACKGROUND: Ethnic disparities in continence rates in spina bifida (SB) have been studied regionally but not nationally. National SB Patient Registry (NSBPR) data were analyzed to explore differences in prevalence of bowel and bladder continence and interventions between Hispanics/Latinos and others. METHODS: Participants 5 to 21 years were categorized into Hispanic/Latino and non-Hispanic/non-Latino. Bladder/bowel continence was defined as dry/no involuntary stool leakage during the day or none/⩽ monthly incontinence. Chi-square test, Wilcoxon Two Sample Test, and generalized estimating equation (GEE) were used for statistical analysis. RESULTS: Twenty-five percent of the 4,364 patients were Hispanic/Latino. At their most recent clinic visit, Hispanics/Latinos demonstrated lower rates of urinary continence (38.6% vs. 44.9%; p= 0.0003), bowel continence (43.9% vs. 55.8%, p< 0.0001), private insurance (p< 0.0001), bowel (p< 0.0001) or bladder surgeries (p= 0.0054), and more vesicostomies (p= 0.0427) compared to others. In multiple GEE models, Hispanic/Latino participants demonstrated lower odds of bowel continence as compared to non-Hispanic/non-Latino participants (estimated odds ratio, 0.82, 95% CI, 0.72–0.94, p= 0.0032). CONCLUSIONS: After controlling for covariates, Hispanics/Latinos with SB are less likely to report bowel continence. Clinicians are encouraged to consider the risk of negative health disparities for Hispanic patients with SB and work to mitigate this risk.

Keywords: Spina bifida, myelomeningocele, health disparities, continence, Hispanic, Latino

DOI: 10.3233/PRM-180556

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 12, no. 4, pp. 361-368, 2019