CARDIA-PLUS: A Life Course Investigation of Biopsychosocial Pathways to Bladder Health and Lower Urinary Tract Symptoms

项目总结/摘要 这项建议旨在研究四个相互关联的途径，心理社会和社会经济压力 可能导致膀胱健康状况较差（下尿路症状[LUTS]和症状的影响）， 女性和男性在整个生命过程中：情感，认知，行为和生理途径。的 拟议的工作利用了来自两个NIH计划的数据和智力资源，30年以上的冠状动脉 1985年开始的成人风险发展（CARDIA）队列研究和下尿路感染的预防 道症状（PLUS）研究联盟，于2015年启动。LUTS，包括膀胱过度活动症（OAB） 和尿失禁（UI），影响着数百万女性和男性的生活。预防LUTS一直是 由于缺乏利用生命过程数据的流行病学研究而受到阻碍。此外，很少有研究表明， 纳入了幸福的概念，并检查了促进和维持膀胱健康的因素， 被PLUS研究联盟称为“一种完整的身体，精神和社会福祉的状态...... 允许日常活动，适应短期的身体和环境压力，并允许最佳的良好- 是（例如，旅行、锻炼、社交、职业或其他活动）。该研究计划， 除了PLUS研究联盟的活动，利用现有的CARDIA数据，从妇女和男子， 膀胱健康和LUTS，并邀请从35岁招募的CARDIA参与者的子样本 检查（年龄53-65;资助2021-22）完成新的临床检查。分析将加强 可能促进膀胱健康或LUTS的个体途径的证据基础。它是假设 由于（1）抑郁症状（影响），（2） 认知受损，（3）行为因素（不良饮食、缺乏运动、吸烟），以及（4）生理因素 （体重增加、中心性肥胖、高血糖、高血压、炎症生物标志物和骨盆底肌肉） 弱点）。分析还将为心理社会和社会经济压力因素建立证据基础。是 假设压力源（不利的童年家庭环境，压力性生活事件，工作紧张， 压力、长期负担、歧视、经济困难、主观社会地位低）将与 膀胱健康状况较差/LUTS状态。最后，分析将检查是否个别途径介导 提出的压力源和膀胱健康状况差/LUTS状态之间的关联，以及是否有资源 支持削弱假设效果。显然有必要制定新的方法来改善这两方面的工作 预防和早期治疗LUTS。我们的研究结果可以为“上游”方法提供信息（例如，改善 特定的压力源被证明是风险因素，社会支持和关系的增强被证明是风险因素。 保护因素），以及“下游”方法（例如，抑郁症状的治疗;认知 训练练习;减肥;行为矫正，包括骨盆底练习）。

Project Summary/Abstract This proposal aims to examine four interrelated pathways by which psychosocial and socioeconomic stressors may lead to poorer bladder health (lower urinary tract symptoms [LUTS] and impact of symptoms) among women and men across the life course: affective, cognitive, behavioral, and physiological pathways. The proposed work leverages data and intellectual resources from two NIH initiatives, the 30+ year Coronary Artery Risk Development in Adults (CARDIA) cohort study, initiated in 1985, and the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, initiated in 2015. LUTS, including overactive bladder (OAB) and urinary incontinence (UI), affect the lives of millions of women and men. Prevention of LUTS has been hindered by a lack of epidemiologic research utilizing life course data. In addition, little research has incorporated the concept of well-being and examined factors that promote and maintain bladder health, defined by the PLUS Research Consortium as “a state of complete physical, mental, and social well-being…that permits daily activities, adapts to short-term physical and environmental stressors, and allows optimal well- being (e.g., travel, exercise, social, occupational, or other activities).” The proposed research, which extends beyond PLUS Research Consortium activities, utilizes existing CARDIA data from women and men with bladder health and LUTS and invites a subsample of CARDIA participants recruited from the Year 35 examination (ages 53-65; funded for 2021-22) to complete a new clinical examination. Analyses will strengthen the evidence base for individual pathways that may promote bladder health or LUTS. It is hypothesized that poorer bladder health/LUTS status will be observed as a result of (1) depressive symptoms (affect), (2) impaired cognition, (3) behavioral factors (poor diet, physical inactivity, smoking), and (4) physiological factors (weight gain, central adiposity, hyperglycemia, hypertension, inflammatory biomarkers, and pelvic floor muscle weakness). Analyses will also establish the evidence base for psychosocial and socioeconomic stressors. It is hypothesized that stressors (adverse childhood family environment, stressful life events, job strain, caregiving stress, chronic burden, discrimination, financial hardship, low subjective social standing) will be associated with poorer bladder health/LUTS status. Finally, analyses will examine whether individual pathways mediate proposed associations between stressors and poor bladder health/LUTS status, and whether resources for support weaken hypothesized effects. There is a clear need to develop new approaches to improve both prevention and early treatment of LUTS. Our findings may inform “upstream” approaches (e.g., amelioration of specific stressors shown to serve as risk factors, enhancement of social support and ties shown to serve as a protective factors), as well as “downstream” approaches (e.g., treatment of depressive symptoms; cognitive training exercises; weight loss; behavior modification, including pelvic floor exercises).