Under-Investigated and Underestimated: Disparities in Toilet and Sanitation Insecurity in a Sample of United States Adults.

Introduction: Most estimates of toilet and sanitation access in the United States rely on limited data from the US Census that examine the presence or absence of plumbing. This study aims to understand the prevalence of toilet and sanitation insecurity using a broader definition that considers issues of accessibility and reliability.

Methods: We recruited from an electronic research database between September 2021 and January 2022 and identified participants at risk for toilet and sanitation insecurity.

Results: About 4218 participants completed the study and 725 (17%) were identified as at-risk for home toilet and sanitation insecurity. The at-risk population was more likely to be younger, be of nonwhite race and ethnicity, live in rural or urban communities, have lower socioeconomic status, have less education, be unemployed, use a septic sewage system, and be non-homeowners.

Conclusions: A significant percentage of people with toilets and plumbing experience home toilet and sanitation insecurity, demonstrating the inadequacy of measures that rely on the presence or absence of plumbing. Methods to estimate toilet and sanitation insecurity should account for accessibility and reliability. Understanding more about those affected by home toilet and sanitation insecurity using this broader definition may also have implications for managing bladder health and urinary symptoms.

Clinical trial registration: This study was not a clinical trial and did not require clinical trial registration.