Neighborhood-level socioeconomic status impacts the severity of lower urinary tract symptoms in men

Objectives: Social determinants of health (SDOH) impact whether a patient will report lower urinary tract symptoms (LUTS). Since management of benign prostatic hyperplasia is guided by symptoms, it is important to understand the drivers of symptom severity. This study investigated the relationship between neighborhood-level SDOH and the severity of LUTS in men. Materials and Methods: Men who completed the International Prostate Symptom Score (IPSS) at a single institution from October 25, 2018, to July 31, 2024, were retrospectively analyzed. High social vulnerability index (SVI) neighborhoods were defined as those in the 75 th percentile or above. IPSS scores were compared between high and low SVI groups. Results were stratified into storage, voiding, or quality of life (QOL) domains. Adjustment for confounding was achieved with linear regression models adjusting for age, race, ethnicity, and number of medical comorbidities. Results: The study included 20,795 patients, with 1351 (6.5%) from high SVI communities. The high SVI group reported worse overall (10.5 vs. 9.6; P < 0.001), storage (5.4 vs. 5.0; P < 0.001), voiding (5.1 vs. 4.6; P < 0.001), and QOL (2.8 vs. 2.5; P < 0.001) scores. Age and number of comorbidities were independently associated with worse AUA-SI scores, while nonwhite race and Latinx ethnicity showed no association on multivariable analysis. Conclusions: High SVI patients report more severe LUTS at initial urologic referral. Delayed access to primary and urologic care in high SVI patients may lead to worse symptoms. Our findings highlight the importance of lowering barriers to urologic care for underserved groups.