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

doi:10.3233/PRM-180556

Comparative Study

. 2019;12(4):361-368.

doi: 10.3233/PRM-180556.

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

Kathryn A Smith^{1

2}, Tiebin Liu³, Kurt A Freeman⁴, Cecily Betz^{1

2}, Gerald H Clayton^{5

6}, Heidi Castillo^{7

8}, Jonathan Castillo^{7

8}, Duong Tu^{9

8}, Alexander Van Speybroeck^{1

2}, William O Walker^{10

11}

Affiliations

¹ Children's Hospital Los Angeles, Los Angeles, CA, USA.
² Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
³ 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.
⁴ Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
⁵ Children's Hospital Colorado, Aurora, CO, USA.
⁶ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.
⁸ Baylor College of Medicine, Houston, TX, USA.
⁹ Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
¹⁰ Division of Developmental Medicine, Seattle Children's Hospital, Seattle, WA, USA.
¹¹ University of Washington School of Medicine, Seattle, WA, USA.

PMID: 31744028
PMCID: PMC7875209
DOI: 10.3233/PRM-180556

Comparative Study

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

Kathryn A Smith et al. J Pediatr Rehabil Med. 2019.

. 2019;12(4):361-368.

doi: 10.3233/PRM-180556.

Authors

Affiliations

¹ Children's Hospital Los Angeles, Los Angeles, CA, USA.
² Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
³ 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.
⁴ Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
⁵ Children's Hospital Colorado, Aurora, CO, USA.
⁶ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.
⁸ Baylor College of Medicine, Houston, TX, USA.
⁹ Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
¹⁰ Division of Developmental Medicine, Seattle Children's Hospital, Seattle, WA, USA.
¹¹ University of Washington School of Medicine, Seattle, WA, USA.

PMID: 31744028
PMCID: PMC7875209
DOI: 10.3233/PRM-180556

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: Hispanic; Latino; Spina bifida; continence; health disparities; myelomeningocele.

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Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Freeman KA, Liu T, Smith K, Castillo H, Castillo J, Joseph D, Wang Y, Tanaka S. Freeman KA, et al. J Pediatr Urol. 2022 Oct;18(5):614.e1-614.e10. doi: 10.1016/j.jpurol.2022.08.022. Epub 2022 Sep 5. J Pediatr Urol. 2022. PMID: 36163222 Free PMC article.

References

1. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al. Updated national birth prevalence estimates for selected birth defects in the united states, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010; 88(12): 1008–16. doi: 10.1002/bdra.20735. Epub 2010 Sep 28. - DOI - PubMed
1. Agopian AJ, Canfield MA, Olney RS, Lupo PJ, Ramadhani T, Mitchell LE, et al. Spina bifida subtypes and sub-phenotypes by maternal race/ethnicity in the national birth defects prevention study. Am J Med Genet A. 2012; 158A: 109–115. doi: 10.1002/ajmg.a.34383. - DOI - PubMed
1. Cragan JD, Roberts HE, Edmonds LD, Khoury MJ, Kirby RS, Shaw GM, et al. Surveillance for anencephaly and spina bifida and the impact of prenatal diagnosis – United States, 1985–1994. MMWR. Centers for Disease Control. 1995; 44: 1–13. - PubMed
1. Shaw GM, Velie EM, Wasserman CR. Risk for neural tube defect-affected pregnancies among women of mexican descent and white women in california. Am J Public Health. 1997; 87: 1467–71. - PMC - PubMed
1. Canfield MA, Mai CT, Wang Y, O’Halloran A, Marengo LK, Olney RS, et al. The association between race/ethnicity and major birth defects in the united states, 1999–2007. Am J Public Health. 2014; 104(9): e14–23. doi: 10.2105/AJPH.2014.302098. - DOI - PMC - PubMed

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[1] Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al. Updated national birth prevalence estimates for selected birth defects in the united states, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010; 88(12): 1008–16. doi: 10.1002/bdra.20735. Epub 2010 Sep 28. - DOI - PubMed

[2] Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al. Updated national birth prevalence estimates for selected birth defects in the united states, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010; 88(12): 1008–16. doi: 10.1002/bdra.20735. Epub 2010 Sep 28. - DOI - PubMed

[3] Agopian AJ, Canfield MA, Olney RS, Lupo PJ, Ramadhani T, Mitchell LE, et al. Spina bifida subtypes and sub-phenotypes by maternal race/ethnicity in the national birth defects prevention study. Am J Med Genet A. 2012; 158A: 109–115. doi: 10.1002/ajmg.a.34383. - DOI - PubMed

[4] Agopian AJ, Canfield MA, Olney RS, Lupo PJ, Ramadhani T, Mitchell LE, et al. Spina bifida subtypes and sub-phenotypes by maternal race/ethnicity in the national birth defects prevention study. Am J Med Genet A. 2012; 158A: 109–115. doi: 10.1002/ajmg.a.34383. - DOI - PubMed

[5] Cragan JD, Roberts HE, Edmonds LD, Khoury MJ, Kirby RS, Shaw GM, et al. Surveillance for anencephaly and spina bifida and the impact of prenatal diagnosis – United States, 1985–1994. MMWR. Centers for Disease Control. 1995; 44: 1–13. - PubMed

[6] Cragan JD, Roberts HE, Edmonds LD, Khoury MJ, Kirby RS, Shaw GM, et al. Surveillance for anencephaly and spina bifida and the impact of prenatal diagnosis – United States, 1985–1994. MMWR. Centers for Disease Control. 1995; 44: 1–13. - PubMed

[7] Shaw GM, Velie EM, Wasserman CR. Risk for neural tube defect-affected pregnancies among women of mexican descent and white women in california. Am J Public Health. 1997; 87: 1467–71. - PMC - PubMed

[8] Shaw GM, Velie EM, Wasserman CR. Risk for neural tube defect-affected pregnancies among women of mexican descent and white women in california. Am J Public Health. 1997; 87: 1467–71. - PMC - PubMed

[9] Canfield MA, Mai CT, Wang Y, O’Halloran A, Marengo LK, Olney RS, et al. The association between race/ethnicity and major birth defects in the united states, 1999–2007. Am J Public Health. 2014; 104(9): e14–23. doi: 10.2105/AJPH.2014.302098. - DOI - PMC - PubMed

[10] Canfield MA, Mai CT, Wang Y, O’Halloran A, Marengo LK, Olney RS, et al. The association between race/ethnicity and major birth defects in the united states, 1999–2007. Am J Public Health. 2014; 104(9): e14–23. doi: 10.2105/AJPH.2014.302098. - DOI - PMC - PubMed

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

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

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