Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction
TL;DR: Study Type – Symptom prevalence (prospective cohort) and Cause of Death – Causes of Death and Mortality (Prospective cohort).
Abstract: Study Type – Symptom prevalence (prospective cohort)
Level of Evidence 1b
What’s known on the subject? and What does the study add?
Few prevalence studies used current ICS LUTS symptom definitions and to our knowledge no studies exist that estimate total worldwide prevalence of reported LUTS symptoms One of the primary goals of this analysis was to estimate current and future worldwide prevalence of LUTS among adults Our estimation model suggests that LUTS are highly prevalent worldwide, with an increasing burden predicted over time
OBJECTIVE
• To estimate and predict worldwide and regional prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI) and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) in 2008, 2013 and 2018 based on current International Continence Society symptom definitions in adults aged ≥20 years
PATIENTS AND METHODS
• Numbers and prevalence of individuals affected by each condition were calculated with an estimation model using gender- and age-stratified prevalence data from the EPIC study along with gender- and age-stratified worldwide and regional population estimates from the US Census Bureau International Data Base
RESULTS
• An estimated 452%, 107%, 82% and 215% of the 2008 worldwide population (43 billion) was affected by at least one LUTS, OAB, UI and LUTS/BOO, respectively By 2018, an estimated 23 billion individuals will be affected by at least one LUTS (184% increase), 546 million by OAB (201%), 423 million by UI (216%) and 11 billion by LUTS/BOO (185%)
• The regional burden of these conditions is estimated to be greatest in Asia, with numbers of affected individuals expected to increase most in the developing regions of Africa (301–311% increase across conditions, 2008–2018), South America (205–247%) and Asia (197–244%)
CONCLUSIONS
• This model suggests that LUTS, OAB, UI and LUTS/BOO are highly prevalent conditions worldwide Numbers of affected individuals are projected to increase with time, with the greatest increase in burden anticipated in developing regions
• There are important worldwide public-health and clinical management implications to be considered over the next decade to effectively prevent and manage these conditions
Citations
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Cites background from "Worldwide prevalence estimates of l..."
...Overactive bladder syndrome (OAB) affects >400 million people worldwide [1]....
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TL;DR: Current evidence demonstrates that the substantial economic burden of UUI to patients and society is demonstrated and will increase markedly as the population ages.
296 citations
Cites background or methods or result from "Worldwide prevalence estimates of l..."
...United Kingdom: In the total UK EpiLUTS population of 3517 men and 3983 women aged 40 yr, the prevalence of UUI was 11.7% for men and 29.0% for women....
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...6%, respectively, from 2008 to 2018, based on EPIC study prevalence data for adults aged 18 yr [11]....
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...Sweden: In the total Swedish EpiLUTS population of 1207 men and 1293 women aged 40 yr, the prevalence of UUI was 10.9% for men and 30.5% for women....
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...United States: In the total US EpiLUTS population of 9416 men and 10 584 women aged 40 yr, the prevalence of UUI was 14.2% for men and 30.8% for women....
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...These differences may result from many sociocultural and environmental factors that can affect bladder health and LUTS prevalence, in addition to genetic factors [25]....
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TL;DR: UUI in the United States is associated with a substantial economic burden from both a societal and patient perspective, and studies evaluating the impact of interventions that reduce the frequency of UUI episodes on the overall economic burden are warranted.
Abstract: BACKGROUND: The International Continence Society (ICS) identifies several urinary incontinence (UI) subtypes: urgency urinary incontinence (UUI), stress UI (SUI), and mixed UI (MUI). UUI is a common symptom of overactive bladder (OAB) syndrome. Based on the current ICS definition of OAB, all patients with UUI have OAB, whereas not all patients with OAB have UUI. Because UUI is a chronic condition that is expected to increase in prevalence as the population of elderly individuals grows, it is important to understand its economic burden on society and patients and its cost components. OBJECTIVE: To summarize the published English language medical literature on estimates of the economic burden of UUI in the United States from a societal and patient perspective, including direct costs (diagnosis, treatment, routine care [including incontinence pads], and UUI-associated comorbidities/complications); indirect costs (lost wages by patients and caregivers and lost work productivity due to absenteeism and presente...
223 citations
Cites background from "Worldwide prevalence estimates of l..."
...Because the prevalence of UUI increases with age and the number of individuals aged ≥ 65 years will increase over the next decade, the prevalence rates of UUI alone and MUI are also expected to increase.(16) The most recent analysis of direct costs for OAB plus UUI among adults aged ≥ 25 years estimated an annual national cost of $82....
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...6% in 2018.(16) Although variability exists in published prevalence rates, the overall evidence indicates that UUI is a common and chronic condition that affects millions of U....
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TL;DR: The prevalence of urinary incontinence is strongly related to the age of the woman and thus, due to the increase in mean life expectancy, the overall prevalence of UI in women is expected to increase in the future.
Abstract: The reported prevalence of urinary incontinence (UI) among women varies widely in different studies due to the use of different definitions, the heterogenicity of different study populations, and p...
162 citations
Cites background from "Worldwide prevalence estimates of l..."
...Irwin et al.2 have published data estimating the current and future worldwide prevalence of lower urinary tract symptoms....
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...Irwin et al.(2) have published data estimating the current and future worldwide prevalence of lower urinary tract symptoms....
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References
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TL;DR: The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International ContinenceSociety.
4,293 citations
TL;DR: The EPIC study is the largest population-based survey to assess prevalence rates of OAB, UI, and other LUTS in five countries and is the first study to evaluate these symptoms simultaneously using the 2002 ICS definitions.
2,275 citations
TL;DR: The NOBLE studies do not support the commonly held notion that women are considerably more likely than men to have urgency-related bladder control problems, and overactive bladder, with and without urge incontinence, has a clinically significant impact on quality-of-life, quality- of-sleep, and mental health, in both men and women.
Abstract: Context: the National Overactive BLadder Evaluation (NOBLE) Program was initiated to better understand the prevalence and burden of overactive bladder in a broad spectrum of the United States population. Objective: to estimate the prevalence of overactive bladder with and without urge incontinence in the US, assess variation in prevalence by sex and other factors, and measure individual burden. Design: US national telephone survey using a clinically validated interview and a follow-up nested study comparing overactive bladder cases to sex- and age-matched controls. Setting: noninstitutionalized US adult population. Participants: a sample of 5,204 adults ≥18 years of age and representative of the US population by sex, age, and geographical region. Main outcome measures: prevalence of overactive bladder with and without urge incontinence and risk factors for overactive bladder in the US. In the nested case-control study, SF-36, CES-D, and MOS sleep scores were used to assess impact. Results: the overall prevalence of overactive bladder was similar between men (16.0%) and women (16.9%), but sex-specific prevalence differed substantially by severity of symptoms. In women, prevalence of urge incontinence increased with age from 2.0% to 19% with a marked increase after 44 years of age, and in men, increased with age from 0.3% to 8.9% with a marked increase after 64 years of age. Across all age groups, overactive bladder without urge incontinence was more common in men than in women. Overactive bladder with and without urge incontinence was associated with clinically and significantly lower SF-36 quality-of-life scores, higher CES-D depression scores, and poorer quality of sleep than matched controls. Conclusions: the NOBLE studies do not support the commonly held notion that women are considerably more likely than men to have urgency-related bladder control problems. The overall prevalence of overactive bladder does not differ by sex; however, the severity and nature of symptom expression does differ. Sex-specific anatomic differences may increase the probability that overactive bladder is expressed as urge incontinence among women compared with men. Nonetheless, overactive bladder, with and without incontinence, has a clinically significant impact on quality-of-life, quality-of-sleep, and mental health, in both men and women.
2,017 citations
TL;DR: The prevalence of chronic and debilitating symptoms of the overactive bladder are determined as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions.
Abstract: Objective To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions.
Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged 40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms.
Results In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged 40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment.
Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.
1,544 citations
TL;DR: To examine the effect overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) on health‐related quality of life (HRQoL) in a population sample, as OAB often occurs in conjunction with many other LUTS.
Abstract: OBJECTIVES
To examine the effect overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in a population sample, as OAB often occurs in conjunction with many other LUTS.
SUBJECTS AND METHODS
A nested case-control analysis was performed on men and women with (cases) and without (controls) OAB, from the EPIC study. OAB was assessed using 2002 International Continence Society definitions. Based on their responses to questions about LUTS, cases were classified into five groups; continent OAB, OAB with incontinence, OAB + postmicturition, OAB + voiding, and OAB + postmicturition + voiding. Both cases and controls were asked questions about symptom bother (OAB-q), generic QoL (EQ-5D), work productivity (Work Productivity and Activity Impairment, WPAI), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sexual satisfaction, and erectile dysfunction (men only) using the Massachusetts Male Aging Study. Cases answered additional condition-specific questions HRQoL (OAB-q short form), Patient Perception of Bladder Condition and work productivity related to a specific health problem (WPAI-SHP). General linear models were used to evaluate group differences.
RESULTS
Of the EPIC participants, 1434 identified OAB cases were matched by age, gender and country, with 1434 participants designated as controls. Cases and controls were primarily Caucasian (96.2% and 96.7%, respectively), and most (65%) were female; the mean age was 53.8 and 53.7 years, respectively. Comorbid conditions differed significantly by case/control status, with cases reporting significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were significant differences between the cases and controls in all reported LUTS. The OAB + postmicturition + voiding group reported significantly greater symptom bother, worse HRQoL, higher rates of depression and decreased enjoyment of sexual activity, than the other subgroups.
CONCLUSION
OAB has a substantial, multidimensional impact on patients; OAB with additional LUTS has a greater impact. The diagnosis and treatment of OAB should be considered in conjunction with other LUTS, to maximize treatment options and optimize patient outcomes.
719 citations