Urinary Incontinence Epidemiology and Care Seeking

 描述（由申请人提供）：尿失禁（UI）是一种在所有年龄段的女性中常见的身体，情感和经济负担。然而，只有少数女性，即使是那些症状严重的女性，会与他们的医疗保健提供者讨论UI。该项目的目标是提供数据，以告知有关UI护理寻求和管理的决策，以减少UI负担的长期目标。我们的具体目标是利用护士健康研究（NHS，NHSII）中超过140，000名年龄在37 - 91岁之间的女性长达16年的UI详细数据。第一个目标是解决缺乏跟踪UI自然史的数据;提高自然史知识将有助于促进妇女和临床医生之间关于UI症状的预期过程和预防或管理时间的讨论。我们将跟踪UI频率、严重程度和亚型的变化，通过每2至4年一次的问卷调查收集，最长可达16年。单独分析将考虑老年和年轻女性的自然病史。该项目的第二个目的是评估UI寻求护理的潜在决定因素，这可以帮助提供者瞄准并告知不讨论其症状的妇女。我们将专门评估UI特性的关系（例如，更高的严重性、更麻烦、混合的UI子类型、更长的持续时间）和独立的健康因素（例如，更多的共病，更差的健康相关生活质量）与自我报告的讨论UI与医疗保健提供者。作为补充，我们还将评估潜在的决定因素与UI识别的关系，由供应商利用链接的医疗保险和NHS数据。最后，关于治疗可能性或关于如何治疗不同UI亚型的信息还不可能确定，因为它需要UI、UI特征和所用治疗的联合知识。因此，在第三个目标中，我们将利用联系的NHS 和医疗保险索赔数据，以检查利用医疗和手术治疗UI，包括哪些患者接受（和不接受）治疗，以及如何处理UI亚型。这些数据可以帮助识别可能从治疗讨论中受益的患者，并帮助提供者了解治疗指南。总体而言，该提案的三个目标与优化UI护理和减轻其负担具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.