Risk Factors for Urinary Incontinence in Women

描述（由申请人提供）：这是最后一次重新提交的竞争性更新，以检查尿失禁的风险因素。中年和老年妇女的估计表明，30-40%有尿失禁（UI）;在60岁以上的人中，12%报告每天发生漏尿。UI的成本约为200亿美元/年，其中大部分负担（例如，卫生巾、额外洗涤/干洗），包括收入有限的老年妇女。在第一个资助期内，我们开始在护士健康研究和护士健康研究II中对237，000名妇女的UI患病率和发病率进行研究。我们研究了UI的描述性流行病学，注意到不同种族/民族的患病率存在显著差异，并检测了UI发展的几个重要风险因素，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。具体而言，我们建议仔细研究不同种族/民族之间UI发生率、UI类型和UI进展的差异;这对于更好地理解UI的病因和更好地解决临床和公共卫生实践中的UI至关重要（例如，针对高/低风险患者）。此外，我们建议专门探讨2型糖尿病女性患者UI发展的风险因素-确定该组的风险因素可能对越来越多的糖尿病女性患者预防UI具有广泛的意义。鉴于最近有趣的证据表明，使用绝经后激素治疗可能会增加发展UI的风险，我们还提出了新的和详细的分析之间的关系口服避孕药和UI绝经前妇女。最后，我们建议在老年妇女中开展饮食和尿失禁的研究;经常建议失禁妇女减少某些食物，如咖啡因和酸性水果/蔬菜。然而，建议减少水果/蔬菜等健康食物的摄入量，特别是老年妇女，可能对公众健康有害，而且几乎没有流行病学数据支持这种建议。凭借多年来对饮食的广泛信息，我们在解决这些问题方面具有独特的优势。护士健康研究和护士健康研究II的数据收集方法是相同的，包括分别自1976年和1989年以来两年一次的问卷调查，要求提供有关健康和生活方式的广泛信息。两个队列的随访率仍然很高。总的来说，这是一个令人兴奋和独特的机会，可以显着扩大有关失禁风险因素的知识范围，这是女性常见的疾病。通过利用以前收集的数据，我们可以以非常低的成本实现这些目标。公共卫生相关性：中年和老年妇女的估计表明，30-40%有尿失禁（UI）;在60岁以上的人中，12%的人每天都会出现漏尿。在这一竞争性更新中，我们建议利用护士健康研究和护士健康研究II来探讨种族/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.