Risk Factors for Urinary Incontinence in Women

描述(由申请人提供)：这是竞争更新检查尿失禁风险因素的最后一次重新提交。据估计，30-40%的中老年女性有尿失禁(UI)；在60岁以上的女性中，12%的人报告每天发生尿漏。尿布的成本约为200亿美元/年，其中大部分负担(例如，垫子、额外的洗涤/干洗)由个人支付，包括收入有限的老年妇女。在第一个资助期间，我们在护士健康研究和护士健康研究II中开始了对237,000名妇女尿失禁患病率和发病率的研究。我们检查了尿失禁的描述性流行病学，注意到不同种族/民族在患病率上的显著差异，并发现了几个导致尿失禁发生的重要风险因素，包括2型糖尿病和外源性激素的使用。在这次修订中，我们建议扩展我们对先前关键发现的研究。具体地说，我们建议仔细调查尿失禁发生率、尿失禁类型和尿失禁进展在种族/民族之间的差异；这将是更好地理解尿失禁的病因并在临床和公共卫生实践中更好地处理尿失禁(例如，针对高/低风险患者)的关键。此外，我们建议专门探索2型糖尿病女性尿失禁发生的危险因素--确定这一组中的危险因素可能对预防越来越多的女性糖尿病患者发生尿失禁具有广泛的意义。考虑到最近有趣的证据表明，使用绝经后激素治疗可能会增加发生尿失禁的风险，我们还提出了对绝经前妇女口服避孕药和尿失禁之间关系的新颖和详细的分析。最后，我们建议启动对老年女性饮食和尿失禁的研究；大小便失禁的女性经常被建议减少某些食物，如咖啡因和酸性水果/蔬菜。然而，建议减少水果/蔬菜等健康食品的摄入量，特别是在老年妇女中，可能会损害公众健康，而且几乎没有流行病学数据支持这种建议。凭借多年来有关饮食的广泛信息，我们在解决这些问题方面处于独特的地位。《护士健康研究》和《护士健康研究II》的数据收集方法相同，分别包括两年一次的问卷调查，要求提供自1976年以来的健康和生活方式方面的广泛信息，以及。在两个队列中，随访率仍然很高。总体而言，这是一个令人兴奋和独特的机会，可以显著扩大有关大小便失禁风险因素的知识范围，大小便失禁是一种常见的女性疾病。通过利用之前收集的数据，我们可以以极低的成本实现这些目标。公共卫生相关性：据估计，30-40%的中老年妇女患有尿失禁；在60岁以上的妇女中，12%的人每天都有漏尿的经历。在这次竞争性的更新中，我们建议利用护士健康研究和护士健康研究II来探索种族/民族、2型糖尿病、外源性激素和饮食与37-88岁女性尿失禁的关系。

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.