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Prevalence and trends in urinary incontinence among women in the United States, 2005–2018

Published:March 13, 2021DOI:https://doi.org/10.1016/j.ajog.2021.03.016

      Background

      Women are disproportionately affected by urinary incontinence compared with men. Urinary incontinence results in physical and psychological adverse consequences and impaired quality of life and contributes to significant societal and economic burden. Previous studies reported high urinary incontinence burden in the United States. However, the current prevalence and recent trends in urinary incontinence and its subtypes among US women have not been described. In addition, correlates of urinary incontinence among US women have not been systematically evaluated in the contemporary population.

      Objective

      The purpose of this study was to determine the prevalence and trends in urinary incontinence among adult women in the United States from 2005 to 2018. In addition, this study aimed to investigate the relationship of urinary incontinence subtypes with several sociodemographic, lifestyle, health-related, and gynecologic factors.

      Study Design

      We used data from the National Health and Nutrition Examination Survey, a nationally representative series of surveys that was designed to evaluate the health status of the US population. Data on urinary incontinence from 7 consecutive 2-year cycles (2005–2006 to 2017–2018) were used for this study. A total of 19,791 participants aged ≥20 years were included. Weighted prevalence estimates and 95% confidence intervals were calculated in each study cycle for stress, urgency, and mixed urinary incontinence. Multivariate-adjusted weighted logistic regression was used to investigate the temporal trends in urinary incontinence, in addition to determining the association between urinary incontinence subtypes with several participants’ factors.

      Results

      In the 2017–2018 cycle, stress urinary incontinence was the most prevalent subtype (45.9%; 95% confidence interval, 42.1–49.7), followed by urgency urinary incontinence (31.1%; 95% confidence interval, 28.6–33.6) and mixed urinary incontinence (18.1%; 95% confidence interval, 15.7–20.5). The prevalence rates of urgency and mixed urinary incontinence were higher in women aged 60 years and older (urgency, 49.5% [95% confidence interval, 43.9–55.2]; mixed, 31.4% [95% confidence interval, 26.2–36.6]) than in those aged 40 to 59 years (urgency, 27.9% [95% confidence interval, 23.6–32.1]; mixed, 15.9% [95% confidence interval, 12.9–19.0]) and those aged 20 to 39 years (urgency, 17.6% [95% confidence interval, 13.8–21.5]; mixed, 8.3% [95% confidence interval, 5.4–11.3]). The overall prevalence of stress and mixed urinary incontinence was stable throughout 2005 to 2018 (both Ptrend=.3), with increases in mixed urinary incontinence among women aged 60 years and older (P=.001). The prevalence of urgency urinary incontinence significantly increased, particularly among women aged 60 years and older (both P=.002). Age, obesity, smoking, comorbidities, and postmenopausal hormone therapy were associated with higher prevalence of all types of urinary incontinence. Black women were less likely to report stress urinary incontinence but more likely to report urgency urinary incontinence.

      Conclusion

      Although the estimated overall prevalence of stress and mixed urinary incontinence remained stable from 2005 to 2018, the prevalence of urgency and mixed urinary incontinence significantly increased among women aged 60 years and older. All subtypes of urinary incontinence were higher among women with obesity and comorbidities, those who used postmenopausal hormone therapy, and those who smoke.

      Key words

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      References

        • Bardsley A.
        An overview of urinary incontinence.
        Br J Nurs. 2016; 25: S14-S21
        • Melville J.L.
        • Katon W.
        • Delaney K.
        • Newton K.
        Urinary incontinence in US women: a population-based study.
        Arch Intern Med. 2005; 165: 537-542
        • Chong E.C.
        • Khan A.A.
        • Anger J.T.
        The financial burden of stress urinary incontinence among women in the United States.
        Curr Urol Rep. 2011; 12: 358-362
        • Aoki Y.
        • Brown H.W.
        • Brubaker L.
        • Cornu J.N.
        • Daly J.O.
        • Cartwright R.
        Urinary incontinence in women.
        Nat Rev Dis Primers. 2017; 3: 17042
        • Schreiber Pedersen L.
        • Lose G.
        • Høybye M.T.
        • Elsner S.
        • Waldmann A.
        • Rudnicki M.
        Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark.
        Acta Obstet Gynecol Scand. 2017; 96: 939-948
        • Brown J.S.
        • Vittinghoff E.
        • Lin F.
        • Nyberg L.M.
        • Kusek J.W.
        • Kanaya A.M.
        Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001-2002.
        Diabetes Care. 2006; 29: 1307-1312
        • Haylen B.T.
        • Ridder D.
        • Freeman R.M.
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.
        Neurourol Urodyn. 2010; 29: 4-20
        • Swanson J.G.
        • Kaczorowski J.
        • Skelly J.
        • Finkelstein M.
        Urinary incontinence: common problem among women over 45.
        Can Fam Phys. 2005; 5: 84-85
        • Milsom I.
        • Gyhagen M.
        The prevalence of urinary incontinence.
        Climacteric. 2019; 22: 217-222
        • Bedretdinova D.
        • Fritel X.
        • Panjo H.
        • Ringa V.
        Prevalence of female urinary incontinence in the general population according to different definitions and study designs.
        Eur Urol. 2016; 69: 256-264
        • Dooley Y.
        • Kenton K.
        • Cao G.
        • et al.
        Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey.
        J Urol. 2008; 179: 656-661
        • Markland A.D.
        • Richter H.E.
        • Fwu C.W.
        • Eggers P.
        • Kusek J.W.
        Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008.
        J Urol. 2011; 186: 589-593
        • Patel K.
        • Hargreaves M.K.
        • Liu J.
        • et al.
        Relationship between smoking and obesity among women.
        Am J Health Behav. 2011; 35: 627-636
        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • Mcdowell M.A.
        • Tabak C.J.
        • Flegal K.M.
        Prevalence of overweight and obesity in the United States, 1999-2004.
        JAMA. 2006; 295: 1549-1555
        • Curtin L.R.
        • Mohadjer L.K.
        • Dohrmann S.M.
        • et al.
        The national health and nutrition examination survey: sample design, 1999-2006.
        Vital Health Stat 2. 2012; 155: 1-39
        • Cao C.
        • Yang L.
        • Xu T.
        • et al.
        Trends in sexual activity and associations with all-cause and cause-specific mortality among US adults.
        J Sex Med. 2020; 17: 1903-1913
        • Yang L.
        • Cao C.
        • Kantor E.D.
        • et al.
        Trends in sedentary behavior among the US population, 2001-2016.
        JAMA. 2019; 321: 1587-1597
        • Centers for Disease Control and Prevention
        NHANES response rates and population totals.
        (Available at:)
        • Cao C.
        • Hu L.
        • Xu T.
        • et al.
        Prevalence, correlates and misperception of depression symptoms in the United States, NHANES 2015-2018.
        J Affect Disord. 2020; 269: 51-57
        • Aune D.
        • Mahamat-Saleh Y.
        • Norat T.
        • Riboli E.
        Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose-response meta-analysis of prospective studies.
        BJOG. 2019; 126: 1424-1433
        • Menacker F.
        • Hamilton B.E.
        Recent trends in cesarean delivery in the United States.
        NCHS. 2010; 35: 1-8
        • Osterman M.J.K.
        • Martin J.A.
        Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006-2012.
        Natl Vital Stat Rep. 2014; 63: 1-11
        • Linde J.M.
        • Nijman R.J.M.
        • Trzpis M.
        • Broens P.M.A.
        Urinary incontinence in the Netherlands: prevalence and associated risk factors in adults.
        Neurourol Urodyn. 2017; 36: 1519-1528
        • Tähtinen R.M.
        • Cartwright R.
        • Vernooij R.W.M.
        • et al.
        Long-term risks of stress and urgency urinary incontinence after different vaginal delivery modes.
        Am J Obstet Gynecol. 2019; 220: 181.e1-181.e8
        • Merriam A.A.
        • Ananth C.V.
        • Wright J.D.
        • Siddiq Z.
        • D’Alton M.E.
        • Friedman A.M.
        Trends in operative vaginal delivery, 2005-2013: a population-based study.
        BJOG. 2017; 124: 1365-1372
        • Wesnes S.L.
        • Lose G.
        Preventing urinary incontinence during pregnancy and postpartum: a review.
        Int Urogynecol J. 2013; 24: 889-899
        • Dumoulin C.
        • Hay-Smith J.
        • Mac Habee-Seguin G.
        • Mercier J.
        Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis.
        Neurourol Urodyn. 2013; 34: 300-308
        • Mobley D.
        • Baum N.
        Smoking: its impact on urologic health.
        Rev Urol. 2015; 17: 220-225
        • Stewart W.F.
        • Van Rooyen J.B.
        • Cundiff G.W.
        • et al.
        Prevalence and burden of overactive bladder in the United States.
        World J Urol. 2003; 20: 327-336
        • Anger J.T.
        • Saigal C.S.
        • Litwin M.S.
        • Urologic Diseases of America Project
        The prevalence of urinary incontinence among community dwelling adult women: results from the National Health and Nutrition Examination Survey.
        J Urol. 2006; 175: 601-604
        • Thom D.H.
        • van den Eeden S.K.
        • Ragins A.I.
        • et al.
        Differences in prevalence of urinary incontinence by race/ethnicity.
        J Urol. 2006; 175: 259-264
        • Lee J.A.
        • Johns T.S.
        • Melamed M.L.
        • et al.
        Associations between socioeconomic status and urge urinary incontinence: an analysis of NHANES 2005 to 2016.
        J Urol. 2020; 203: 379-384
        • Govender Y.
        • Gabriel I.
        • Minassian V.
        • Fichorova R.
        The current evidence on the association between the urinary microbiome and urinary incontinence in women.
        Front Cell Infect Microbiol. 2019; 9: 133
        • Micussi M.T.
        • Freitas R.P.
        • Angelo P.H.
        • Soares E.M.
        • Lemos T.M.
        • Maranhão T.M.
        Evaluation of the relationship between the pelvic floor muscles and insulin resistance.
        Diabetes Metab Syndr Obes. 2015; 8: 409-413
        • Kirss F.
        • Lang K.
        • Toompere K.
        • Veerus P.
        Prevalence and risk factors of urinary incontinence among Estonian postmenopausal women.
        Springerplus. 2013; 2: 524
        • Townsend M.K.
        • Curhan G.C.
        • Resnick N.M.
        • Grodstein F.
        Postmenopausal hormone therapy and incident urinary incontinence in middle-aged women.
        Am J Obstet Gynecol. 2009; 200: 86.e1-86.e5