Urinary Incontinence Epidemiology and Care Seeking

 描述(由申请人提供)：尿失禁(UI)是一种身体上、情感上和经济上的负担，在所有年龄段的女性中都很常见。然而，只有少数女性，即使是那些症状严重的女性，也会与她们的医疗保健提供者讨论UI。这个项目的目标是提供数据，为有关尿失禁护理寻求和管理的决策提供信息，长期目标是减轻尿失禁负担。我们的具体目标是利用护士健康研究(NHS，NHSII)中年龄在37-91岁的140,000名女性长达16年的UI详细数据。第一个目标是解决缺乏跟踪尿路感染自然病史的数据的问题；提高对自然病史的了解将有助于促进妇女和临床医生之间就尿路感染症状的预期过程以及预防或处理的时机进行讨论。我们将跟踪UI频率、严重性和亚型的变化，这些变化是通过每隔2到4年进行一次的问卷收集的，最长可达16年。单独的分析将考虑老年女性和年轻女性的自然历史。该项目的第二个目标是评估寻求治疗尿失禁的潜在决定因素，这可以帮助提供者瞄准并告知不讨论其症状的女性。我们将具体评估尿失禁特征(例如，更严重、更麻烦、混合尿失禁亚型、持续时间更长)和独立健康因素(例如，更多合并发病、更差的健康相关生活质量)与自我报告的与医疗保健提供者关于尿失禁的讨论的关系。作为补充，我们还将评估潜在决定因素与提供者利用关联的Medicare和NHS数据进行UI识别的关系。最后，关于治疗可能性的信息，或关于如何治疗不同的UI亚型的信息，还不可能确定，因为它需要关于UI、UI特征和所用治疗的联合知识。因此，在第三个目标中，我们将利用关联的NHS 联邦医疗保险声称使用数据来检查尿崩症的内科和外科治疗的利用情况，包括哪些患者接受(和不接受)治疗，以及尿崩症亚型是如何治疗的。这些数据可以帮助识别可能从治疗讨论中受益的患者，并帮助向提供者通报治疗指南。总体而言，这项建议的三个目标与优化UI的护理和减轻其负担有直接的临床相关性。

 DESCRIPTION (provided by applicant): Urinary incontinence (UI) is a physically, emotionally, and economically burdensome condition that is common among women of all ages. Yet, only a minority of women, even those with severe symptoms, discusses UI with their healthcare provider. The goal of this project is to provide data to inform decisions about UI care seeking and management, with the long-term aim of reducing UI burden. Our specific aims leverage detailed data on UI over up to 16 years among >140,000 women, aged 37-91 years, in the Nurses' Health Studies (NHS, NHSII). The first aim addresses the lack of data tracking UI natural history; improved knowledge of natural history will help facilitate discussions between women and clinicians about the expected course of UI symptoms and timing of prevention or management. We will track changes in UI frequency, severity, and subtype, collected via questionnaires administered every 2 to 4 years, over up to 16 years. Separate analyses will consider natural history within older and younger women. The second aim of this project is to evaluate potential determinants of care seeking for UI, which could help providers target and inform women who do not discuss their symptoms. We will specifically evaluate relations of UI characteristics (e.g., higher severity, more bother, mixed UI subtype, longer duration) and independent health factors (e.g., more co-morbidity, worse health- related quality of life) with self-reported discussions about UI with healthcare providers. In complement, we will also evaluate relations of potential determinants with UI identification by providers utilizing linked Medicare and NHS data. Finally, information on treatment likelihood, or on how different UI subtypes are treated, has not been possible to determine, since it requires joint knowledge of UI, UI characteristics, and treatments utilized. Thus, in the third aim we will leverage linked NHS and Medicare claims data to examine utilization of medical and surgical treatments for UI, including which patients receive (and don't receive) treatment, and how UI subtypes are treated. These data could help identify patients who might benefit from treatment discussions and help inform providers on treatment guidelines. Overall, the three aims of this proposal have direct clinical relevance to optimizing care for UI and reducing its burden.