Obesity, Unhealthy Lifestyle, Old Age and Poverty
Linked to Urinary Problems
Study found the vast majority of men and women have
urinary problems
May 15, 2008 - People who are obese and have unhealthy lifestyles,
as well as older people from a lower economic status, are more likely to
suffer from a larger number of urinary problems, according to a study of
more than 5,000 men and women in Boston. The study included people
between the ages of 30 and 70 and found the vast majority of men and
women have urinary problems.
According to the Boston Area Community Health
Survey (BACH), other health issues that increase the risk of multiple
lower urinary tract symptoms include diabetes, high blood pressure and
heart disease.
Women who have had hysterectomies and other
gynecological surgery also face an elevated risk, as do men who have
undergone prostate or bladder surgery.
Researchers hope the results will help clinicians
to understand why problems occur and how they can be managed more
effectively.
The study, which received funding from the National
Institute of Diabetes, Digestive and Kidney Diseases – part of the USA’s
National Institutes of Health - looked at the urological symptoms of
5,506 residents in Boston, Massachusetts.
All were aged between 30 and
70 and 42 per cent were male. 34 per cent were white, 32 per cent were
black and 34 per cent were Hispanic.
All the participants took part in detailed
one-to-one interviews, which included urological symptoms, other medical
conditions, physical characteristics such as weight and waist
circumference, education, income and behavioral and psychosocial
factors.
By carrying out a statistical analysis of the
results, the researchers were able to group the participants with
urological symptoms into distinct patterns or clusters, four for the
women and five for the men. Using this method enabled the team to
examine the relationship between complex urological problems and other
health conditions or lifestyle factors.
“The cluster analysis method is highly objective
and makes no assumptions about which men or women are more likely to
suffer from these common conditions” explains Dr Raymond C Rosen, Senior
Scientist at the New England Research Institutes in Massachusetts.
“These results will hopefully aid our understanding
of why urological problems occur and how we can manage these conditions
more effectively”.
Three-quarters of the women who took part in the
survey reported at least one of the 14 urological symptoms included in
the study.
Key female findings included:
● Four female clusters were identified.
● The majority of the women who reported
symptoms (54 per cent) fell into Cluster One which was characterized by
storage problems, such as needing to go to the toilet frequently and
getting up to go during the night. They had fewer overall symptoms than
the women in the other clusters.
● Symptoms increased in number and severity
until they reached Cluster Four, where women had the highest number of
urological symptoms. Eight per cent of women fell into this cluster.
● The women who experienced symptoms had a
higher Body Mass Index than the women who didn’t and this peaked in
Cluster Four, where the average BMI was 34.5 and just under 65 per cent
were obese.
● Women in Cluster Four were four times more
likely to suffer from diabetes than women who reported no urological
symptoms.
● On average, symptomatic women were older than
women who didn’t report any symptoms and average ages in the more
symptomatic clusters were higher.
● A woman’s social economic status was much more
likely to predict her level of urology symptoms then her race. For
example, women in Cluster Four were more likely have a low social
economic status.
Just over two-thirds of the men who took part in
the study (69 per cent) reported urological symptoms.
Key male findings included:
● Five male clusters were identified.
● Half of the men were assigned to Cluster One,
which covered storage problems and included the male participants with
the fewest number of symptoms. The number of symptoms increased in
Clusters Two, Three and Four.
● Eight per cent of the symptomatic men fell
into the highest category, Cluster Five, with an average of 10 symptoms
per person.
● There was a significant increase in age across
the groups – the average age of the men with no symptoms was 44,
compared with 59 in Cluster Five.
● The researchers also noticed significant
racial differences. Cluster Four had the lowest percentage of black and
Hispanic men and Hispanic men were also under-represented in Cluster
Five.
● 40 per cent of the men in Cluster Five came
from the lowest social economic status group.
● Men were much more likely to find themselves
in Cluster Five if they had a sedentary lifestyle, with 54 per cent
recording the lowest levels of physical activity, compared with 20 per
cent for men with no symptoms.
● Men in Clusters Three to Five reported
significantly higher levels of diabetes, blood pressure and heart
problems. For example, 40 per cent of men in Cluster Five reported
problems with cardiovascular disease, compared with less then 20 per
cent in Cluster One.
● 43 per cent of the men in Cluster Five were
medically obese.
● There were no significant differences in
smoking or alcohol consumption across the clusters, apart from the fact
that Cluster Five contained a higher percentage of men who didn’t drink
(41 per cent). 26 per cent of men with no symptoms abstained, as did 25
to 30 per cent of the men in the other clusters.
“The findings of the BACH survey are very useful
for clinicians and health promotion experts as they provide evidence of
a wide range of factors that influence lower urinary tract symptoms,
such as age, other illnesses, lifestyle, economic status and race” says
Dr Rosen.
“They underline the importance of clinicians
carrying out a thorough urological assessment of patients who fall into
these high risk groups.”
“And they also provide a useful basis for future
research into this highly complex area.”
The study is published in the May issue of the
UK-based urology journal BJU International.
Editor's Notes:
The BACH Survey was carried out by investigators
from the New England Research Institutes, led by Dr John B McKinlay.
Their findings are summarized in two papers in BJU International – on
the male and female studies - written in collaboration with urology
experts from Cornell University in New York and the University of Texas
and medical researchers from Pfizer Inc.
Cluster analysis and lower urinary tract symptoms
in men: findings from the Boston Area Community Health Survey. Cinar et
al. BJU International. 101 1247-1256. (May 2008) Do urological symptoms
cluster among women? Results from the Boston Area Community Health
Survey. Hall et al. BJU International. 101, 1257-1266 (May 2008).
Established in 1929, BJU International is
published 23 times a year by Wiley-Blackwell and edited by Professor
John Fitzpatrick from Mater Misericordiae University Hospital and
University College Dublin, Ireland. It provides its international
readership with invaluable practical information on all aspects of
urology, including original and investigative articles and illustrated
surgery.
www.bjui.org
About Wiley-Blackwell. Wiley-Blackwell was formed
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