From American Journal of Epidemiology

Prevalence of and Risk Factors for Urine Leakage in a Racially and Ethnically Diverse Population of Adults

Posted 05/08/2008

Sharon L. Tennstedt; Carol L. Link; William D. Steers; John B. McKinlay
Author Information

Abstract and Introduction

Abstract

Most epidemiologic studies of urine leakage in the United States report on women and White populations. In this study, the authors determined the prevalence of urine leakage across genders and racial/ethnic groups in a population-based sample of 5,506 adults aged 30–79 years and identified factors related to leakage within genders and racial/ethnic groups. The prevalence of weekly urine leakage was 8% overall, 10.4% in women, and 5.3% in men. White women (11.7%) were more likely than Black (9.4%) and Hispanic (7.3%) women to report weekly leakage and to report stress-type (35.4% vs. 9.4% and 14.5%, respectively) and urge-type (13.4% vs. 3.3% and 10.8%, respectively) leakage. Rates and leakage types for men did not vary by race/ethnicity. For women, central obesity, asthma, and arthritis increased the odds of weekly leakage. For men, the odds of leakage increased for Blacks and Whites at ages 50 and 60 years, respectively, and for Hispanics of higher social class. For both genders, various comorbid conditions, including heart disease, asthma, and depression, increased the odds of leakage in varying racial/ethnic groups. The authors conclude that types of and risk factors for urine leakage vary by gender and racial/ethnic group.

Introduction

Concern about the psychosocial and economic burden of involuntary urine leakage fuels the need for a more complete understanding of the scope of this health problem in the US population, which is becoming increasingly diverse. Available data on both men and women have established involuntary urine leakage as a health problem that differs by gender in prevalence, type, age distribution, and etiology.[1] In the few studies that have compared urine leakage in one or more racial/ethnic groups, investigators have reported that differences across groups warrant further investigation.[2–9] However, most comparative studies have been limited to women and clinical samples, and relatively little is known about racial/ethnic differences in men.

Our objectives in this study were 1) to determine the prevalence of urine leakage across genders and racial/ethnic groups in a population-based sample of adults aged 30–79 years and 2) to investigate risk factors for urine leakage within genders and racial/ethnic groups. The analysis focused on rates of and risk factors for urine leakage experienced at least weekly. This level of frequency has high clinical relevance, is likely to be associated with bother, help-seeking, and reduced quality of life, and is more relevant for estimating the relevant burden on the health care system.[10,11]

 
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References

  1. Hunskaar S, Arnold EP, Burgio K, et al. Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct (2000) 11:301-19.
  2. Thom DH, van den Eeden SK, Ragins AI, et al. Differences in prevalence of urinary incontinence by race/ethnicity. J Urol (2006) 175:259-64.
  3. Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing (1997) 26:367-74.
  4. Thom DH, van den Eeden SK, Brown JS. Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life. Obstet Gynecol (1997) 90:983-9.
  5. Sze EH, Jones WP, Ferguson JL, et al. Prevalence of urinary incontinence symptoms among black, white, and Hispanic women. Obstet Gynecol (2002) 99:572-5.
  6. Fultz NH, Herzog AR, Raghunathan TE, et al. Prevalence and severity of urinary incontinence in older African American and Caucasian women. J Gerontol A Biol Sci Med Sci (1999) 54:M299-303.
  7. Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol (1991) 146:1255-9.
  8. Burgio KL, Locher JL, Zyczynski H, et al. Urinary incontinence during pregnancy in a racially mixed sample: characteristics and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct (1996) 7:69-73.
  9. Bump RC. Racial comparisons and contrasts in urinary incontinence and pelvic organ prolapse. Obstet Gynecol (1993) 81:421-5.
  10. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet (2003) 82:327-38.
  11. Thom DH, Nygaard IE, Calhoun EA. Urologic Diseases in America Project: urinary incontinence in womennational trends in hospitalizations, office visits, treatment and economic impact. J Urol (2005) 173:1295-301.
  12. McKinlay J, Link C. Measuring the urologic iceberg: design and implementation of the Boston Area Community Health (BACH) Survey. Eur Urol (2007) 52:389-96.
  13. McKinlay SM, Kipp DM, Johnson P, et al. A field approach for obtaining physiological measures in surveys of general populations: response rates, reliability, and costs. In: Health survey research methods: proceedings of the Fourth Conference on Health Survey Research Methods. (1984) Washington, DC: US Public Health Service. 195-204. (DHHS publication no. (PHS) 84-3346).
  14. Green LW. Manual for scoring socioeconomic status for research on health behavior. Public Health Rep (1970) 85:815-27.
  15. Washburn RA, Smith KW, Jette AM, et al. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol (1993) 46:153-62.
  16. Turvey CL, Wallace RB, Herzog R. A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. Int Psychogeriatr (1999) 11:139-48.
  17. Kaufert P, Lock M, McKinlay S, et al. Menopause research: the Korpilampi workshop. Soc Sci Med (1986) 22:1285-9.
  18. Connolly TJ, Litman HJ, Tennstedt SL, et al. The effect of mode of delivery, parity, and birth weight on risk of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct (2007) 18:1033-42.
  19. Cochran W. Sampling techniques. 3rd ed. (1977) New York, NY: John Wiley and Sons, Inc.
  20. Kish L. Survey sampling. (1965) New York, NY: John Wiley and Sons, Inc.
  21. Rubin DB. Multiple imputation for nonresponse in surveys. (1987) New York, NY: John Wiley and Sons, Inc.
  22. Schafer J. Analysis of incomplete multivariate data. (1997) New York, NY: Chapman and Hall, Inc.
  23. Andersson G, Johansson JE, Garpenholt O, et al. Urinary incontinenceprevalence, impact on daily living and desire for treatment: a population-based study. Scand J Urol Nephrol (2004) 38:125-30.
  24. Vandoninck V, Bemelmans BL, Mazzetta C, et al. The prevalence of urinary incontinence in community-dwelling married women: a matter of definition. BJU Int (2004) 94:1291-5.
  25. Hannestad YS, Rortveit G, Sandvik H, et al. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol (2000) 53:1150-7.
  26. Anger JT, Saigal CS, Litwin MS, et al. The prevalence of urinary incontinence among community dwelling adult women: results from the National Health and Nutrition Examination Survey. J Urol (2006) 175:601-4.
  27. Melville JL, Katon W, Delaney K, et al. Urinary incontinence in US women: a population-based study. Arch Intern Med (2005) 165:537-42.
  28. Nygaard I, Turvey C, Burns TL, et al. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol (2003) 101:149-56.
  29. Sampselle CM, Harlow SD, Skurnick J, et al. Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Obstet Gynecol (2002) 100:1230-8.
  30. Grodstein F, Fretts R, Lifford K, et al. Association of age, race, and obstetric history with urinary symptoms among women in the Nurses' Health Study. Am J Obstet Gynecol (2003) 189:428-34.
  31. Samuelsson E, Victor A, Svardsudd K. Determinants of urinary incontinence in a population of young and middle-aged women. Acta Obstet Gynecol Scand (2000) 79:208-15.
  32. Peacock LM, Wiskind AK, Wall LL. Clinical features of urinary incontinence and urogenital prolapse in a black inner-city population. Am J Obstet Gynecol (1994) 171:1464-9.
  33. Sandvik H, Hunskaar S, Vanvik A, et al. Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol (1995) 48:339-43.
  34. Mattox TF, Bhatia NN. The prevalence of urinary incontinence or prolapse among white and Hispanic women. Am J Obstet Gynecol (1996) 174:646-8.
  35. Howard D, Delancey JO, Tunn R, et al. Racial differences in the structure and function of the stress urinary continence mechanism. Obstet Gynecol (2000) 95:713-17.
  36. Teo RE, Yisa S, Mayne C, et al. A comparison of urodynamic diagnoses and detrusor muscle function in white and South Indian Asian women. J Urol (2005) 174:184-6.
  37. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn (2002) 21:167-78.
  38. Brading A, Pessina F, Esposito L, et al. Effects of metabolic stress and ischaemia on the bladder, and the relationship with bladder overactivity. Scand J Urol Nephrol Suppl (2004) 215:84-92.
  39. Shenfeld OZ, Meir KS, Yutkin V, et al. Do atherosclerosis and chronic bladder ischemia really play a role in detrusor dysfunction of old age? Urology (2005) 65:181-4.
  40. Jackson RA, Vittinghoff E, Kanaya AM, et al. Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study. Obstet Gynecol (2004) 104:301-7.
  41. Turner-Stokes L, Frank AO. Urinary incontinence among patients with arthritisa neglected disability. J R Soc Med (1992) 85:389-93.
  42. Adams C, Lorish C, Cushing C, et al. Anatomical urinary stress incontinence in women with rheumatoid arthritis: its frequency and coping strategies. Arthritis Care Res (1994) 7:97-103.
  43. Brown JS, Seeley DG, Fong J, et al. Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol (1996) 87:715-21.
  44. Mommsen S, Foldspang A. Body mass index and adult female urinary incontinence. World J Urol (1994) 12:319-22.
  45. Wingate L, Wingate MB, Hassanein R. The relation between overweight and urinary incontinence in postmenopausal women: a case control study. J North Am Menopause Soc (1994) 1:199-203.
  46. Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet (2005) 366:1640-9.
  47. Grady D, Brown JS, Vittinghoff E, et al. Postmenopausal hormones and incontinence: The Heart and Estrogen/Progestin Replacement Study. Obstet Gynecol (2001) 97:116-20.
  48. Steinauer JE, Waetjen LE, Vittinghoff E, et al. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol (2005) 106:940-5.
  49. Hendrix SL, Cochrane BB, Nygaard IE, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA (2005) 293:935-48.
  50. Stach-Lempinen B, Hakala AL, Laippala P, et al. Severe depression determines quality of life in urinary incontinent women. Neurourol Urodyn (2003) 22:563-8.
  51. Sandvik H, Seim A, Vanvik A, et al. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn (2000) 19:137-45.
  52. Rohr G, Christensen K, Ulstrup K, et al. Reproducibility and validity of simple questions to identify urinary incontinence in elderly women. Acta Obstet Gynecol Scand (2004) 83:969-72.
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Author Information

Sharon L. Tennstedt,1 Carol L. Link,1 William D. Steers,2 John B. McKinlay1

1 New England Research Institutes, Watertown, MA
2 University of Virginia Health System, Charlottesville, VA

Competing Interests: none declared.

Am J Epidemiol.  2008;167(4):390-399.  ©2008 Oxford University Press

 
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