Risk Factors for Urinary Incontinence in Women

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DESCRIPTION (provided by applicant): This is the final resubmission of a competing renewal to examine risk factors for urinary incontinence. Estimates in middle-aged and older women indicate that 30-40% have urinary incontinence (UI); in those over 60 years, 12% report daily episodes of leaking urine. The costs of UI are approximately $20 billion/year, with much of that burden (e.g., pads, extra washing/dry cleaning) paid for by individuals, including older women on limited incomes. In the first funding period, we began studies of UI prevalence and incidence among 237,000 women in the Nurses' Health Study and Nurses' Health Study II. We examined the descriptive epidemiology of UI, noting significant differences in prevalence by race/ethnicity, and detected several important risk factors for UI development, including type 2 diabetes and use of exogenous hormones. In this revision, we propose to extend our research on key previous findings. Specifically, we propose to carefully investigate differences in UI incidence, UI type, and UI progression across racial/ethnic groups; this will be critical to better understanding the etiology of UI and better addressing UI in clinical and public health practice (e.g., targeting high/low risk patients). In addition, we propose to specifically explore risk factors for UI development in women with type 2 diabetes - identifying risk factors in this group could have broad implications for the prevention of UI among the growing number of women with diabetes. Given interesting recent evidence that use of postmenopausal hormone therapy may increase risk of developing UI, we also propose novel and detailed analyses of the relation between oral contraceptives and UI in premenopausal women. Finally, we propose to initiate research on diet and UI in older women; women with incontinence are often given advice to reduce certain foods, such as caffeine, and acidic fruit/vegetables. Yet, recommending lower intake of healthy foods such as fruit/vegetables, especially in older women, may be harmful to the public health, and there are virtually no epidemiologic data supporting such recommendations. With extensive information on diet over many years, we are uniquely positioned to address these issues. Data collection methods in the Nurses' Health Study and Nurses' Health Study II are identical, including biennial questionnaires requesting extensive information on health and lifestyle since 1976, and 1989, respectively. Follow-up remains high in both cohorts. Overall, this is an exciting and unique opportunity to significantly expand the scope of knowledge regarding risk factors for incontinence, a common condition in women. By taking advantage of the previously collected data, we can accomplish these goals at extremely modest cost. PUBLIC HEALTH RELEVANCE: Estimates in middle-aged and older women indicate that 30-40% have urinary incontinence (UI); in those over 60 years, 12% experience daily episodes of leaking urine. In this competing renewal, we propose to take advantage of the Nurses' Health Study and Nurses' Health Study II to explore the relations of race/ethnicity, type 2 diabetes, exogenous hormones, and diet to urinary incontinence in women aged 37-88 years.