Dose‐Response Relationship Between Household Food Insecurity Severity and Lower Urinary Tract Symptom Subtypes: A Nationally Representative Cross‐Sectional Study

PURPOSE: To determine whether household food insecurity severity is associated with lower urinary tract symptom subtypes in a dose-response manner and to evaluate mediating pathways, in a nationally representative sample of US adults. MATERIALS AND METHODS: We analyzed pooled data from the National Health and Nutrition Examination Survey, 2005-2020, comprising 36 713 adults aged 20 years or older. Household food security (full, marginal, low, or very low) was defined by the United States Department of Agriculture Household Food Security Survey Module. Nocturia and urgency, stress, and mixed incontinence were ascertained by self-report. Survey-weighted logistic regression estimated adjusted odds ratios across four sequential models, with a test for linear trend. Secondary analyses evaluated mediation by systemic inflammation, cardiometabolic comorbidity, dietary intake, and depressive symptoms. RESULTS: In fully adjusted models, very low food security was associated with higher odds of nocturia (odds ratio 1.52; 95% confidence interval, 1.31-1.77), urgency incontinence (1.60; 1.37-1.87), stress incontinence (1.37; 1.16-1.62), and mixed incontinence (1.86; 1.52-2.27), with a significant dose-response trend for all (all p for trend < 0.0001). Gradients were steepest for the overactivity-associated subtypes and persisted after adjustment for income. Inflammation and diet showed essentially no mediation; cardiometabolic comorbidity and depressive symptoms accounted for 9% to 18% and 24% to 30%, respectively. CONCLUSIONS: Household food insecurity was independently and dose-responsively associated with all subtypes examined, partly explained by depressive symptoms and cardiometabolic comorbidity but not inflammation or diet. These findings support recognizing food insecurity as a modifiable social determinant relevant to bladder health.