Nocturia, the most prevalent lower urinary tract symptom in middle-aged and elderly people, significantly affects quality of life and imposes a substantial healthcare burden. While social determinants of health (SDoH) are recognized as key drivers of health inequities, their association with nocturia remains understudied. This cross-sectional study utilized data from 31,384 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Eight SDoH indicators were assessed, including employment status, income-to-poverty ratio (PIR), food security, educational level, access to healthcare, type of health insurance, home ownership, and marital status. A cumulative adverse SDoH score was calculated to assess whether the combined burden of unfavorable social determinants was associated with a graded increase in nocturia risk. Weighted logistic regression and mediation analyses were conducted to explore associations and underlying pathways. Unemployment (AOR = 1.51; 95% CI 1.40–1.62), low PIR (AOR = 1.29; 95% CI 1.18–1.42), food insecurity (AOR = 1.39; 95% CI 1.27–1.52), low educational level (AOR = 1.35; 95% CI 1.25–1.46), and non-private insurance (AOR = 1.33; 95% CI 1.23–1.44) were significantly associated with an increased risk of nocturia. The cumulative burden of unfavorable SDoH demonstrated a dose–response relationship, with higher nocturia risk and severity observed as the number of unfavorable SDoH increased (P for trend < 0.0001). Subgroup analyses showed that the associations between cumulative unfavorable SDoH and nocturia were stronger among women, individuals classified as “Other” racial groups, and adults aged 40–59 years, suggesting potential heterogeneity across subgroups. Mediation analyses further indicated that depression, obesity, diabetes, and cardiovascular disease may be statistical mediators of these associations. Among these factors, depression played the most prominent role. This study highlights significant associations between unfavorable SDoH and nocturia risk and severity, underscores the importance of considering the accumulation of multiple adverse social factors, and suggests that depression, obesity, diabetes, and cardiovascular disease may help explain part of these associations. Addressing these disparities and incorporating the five SDoH domains outlined in Healthy People 2030 into health policy and clinical strategies is essential to potentially address the burden of nocturia and promote health equity.
Wei et al. (Thu,) studied this question.