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Cited by 24Pelvic floor disorders treatmentsUrinary Bladder and Prostate ResearchAging, Health, and Disability

Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women

Open access
Greer, Joy A., Xu, Rengyi, Propert, Kathleen J., Arya, Lily A.·2015·Neurourology and Urodynamics
DOI 10.1002/nau.22615PMC PMC4205203
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Abstract

AIMS: Disability, an individual's reduced capacity to perform physical tasks encountered in daily routine, is associated with urinary incontinence in the elderly. Our objective was to determine if urinary incontinence is associated with disability in community-dwelling women 40 years and older. METHODS: Cross-sectional study among US women ≥40 years (n = 4,458) from National Health and Nutrition Examination Surveys 2005-2010. We estimated the age-stratified weighted prevalence and factors independently associated with disability (Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), mobility, and functional limitations) in women with and without urinary incontinence while controlling for confounders of the association between disability and urinary incontinence. RESULTS: The weighted prevalence of all disabilities was higher in women with urinary incontinence than women without urinary incontinence across most decades of life with the greatest difference in the prevalence of mobility disabilities: 40-49 years (12.1% vs. 7.0%), 50-59 years (17.0% vs. 9.2%), 60-69 years (28.3% vs. 19.8%), and 70+ years (43.8% vs. 33.0%, all P < 0.05). On multivariable analysis, after controlling for the confounding effect of age, co-morbidities, and income-poverty ratio, urinary incontinence was weakly associated with disabilities. The adjusted odds ratio (95% confidence interval) of disabilities for urinary incontinence was ADL 1.96 (1.07, 3.58), IADL 1.18 (0.78, 1.78), mobility 1.26 (1.01, 1.56), and functional limitations 1.36 (1.07, 1.73). CONCLUSIONS: Urinary incontinence is weakly associated with disabilities and cannot be implicated as a cause of disability in community dwelling women.

Integrity signals

Registry

Crossref · 10.1002/nau.22615

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Adjusted odds of ADL disability for UI were 1.96 (95% CI 1.07, 3.58).

    “The adjusted odds ratio (95% confidence interval) of disabilities for urinary incontinence was ADL 1.96 (1.07, 3.58), IADL 1.18 (0.78, 1.78), mobility 1.26 (1.01, 1.56) and functional limitations 1.36 (1.07, 1.73).”
    Quote in the paperSubstantial claim
  • Findingown data

    Univariable odds of ADL disability for women with UI were 3.71 (95% CI 1.95, 7.05).

    “On univariable analysis, the odds (95% CI) of disability in ADLs, IADLs, mobility, and functional limitations for women with urinary incontinence were 3.71 (1.95, 7.05), 1.75 (1.21, 2.53), 2.13 (1.76, 2.57), and 2.13 (1.76, 2.58), respectively.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Univariable odds of mobility disability for women with UI were 2.13 (95% CI 1.76, 2.57).

    “On univariable analysis, the odds (95% CI) of disability in ADLs, IADLs, mobility, and functional limitations for women with urinary incontinence were 3.71 (1.95, 7.05), 1.75 (1.21, 2.53), 2.13 (1.76, 2.57), and 2.13 (1.76, 2.58), respectively.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Adjusted odds of IADL disability for UI were 1.18 (95% CI 0.78, 1.78).

    “The adjusted odds ratio (95% confidence interval) of disabilities for urinary incontinence was ADL 1.96 (1.07, 3.58), IADL 1.18 (0.78, 1.78), mobility 1.26 (1.01, 1.56) and functional limitations 1.36 (1.07, 1.73).”
    Quote in the paperSubstantial claim
  • Findingown data

    This study shows coexisting comorbidities are common in women with UI.

    “Our study also shows that coexisting co-morbidities are common in women with urinary incontinence.”
    Quote in the paperSubstantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    Although UI is likely not a cause of disability in community-dwelling women, this study shows high prevalence of mobility and functional-limitation disabilities in women with UI, especially ages 40 to 59.

    “Even though urinary incontinence is likely not a cause of disability in community dwelling women, our study does show that the prevalence of disabilities in mobility and functional limitations is high in women with urinary incontinence especially in the age group of 40 to 59 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this study, the number of comorbidities was associated with both UI and disabilities.

    “In our study also, the number of co-morbidities emerged as an important variable that was associated with both urinary incontinence and disabilities.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among 4,458 women, those with UI were significantly more likely to have higher BMI and two or more comorbidities than those without UI.

    “Women with urinary incontinence were significantly more likely to have a higher BMI and two or more co-morbidities than women without urinary incontinence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In this study, comorbidity-disability odds ratios ranged from 3.41 to 7.09, while UI-disability odds ratios ranged from 1.12 to 1.90.

    “The odds ratio of the association between co-morbidities and disabilities ranged from 3.41 to 7.09 while the odds ratios of disabilities and urinary incontinence ranged from 1.12 and 1.90.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After adjustment for age, comorbidities, race, BMI, pelvic organ prolapse, hysterectomy, and income-poverty ratio, the UI-disability association weakened, with odds ratios from 1.12 to 1.90.

    “After controlling for confounding variables including age, co-morbidities, race, BMI, pelvic organ prolapse, hysterectomy, and income-poverty ratio, the association between UI and disability decreased with odds ratios ranging from 1.12 to 1.90 (Table III).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In women with UI versus without UI, weighted mobility disability prevalence was higher in each decade: 40-49 12.1% vs 7.0%, 50-59 17.0% vs 9.2%, 60-69 28.3% vs 19.8%, and 70+ 43.8% vs 33.0%, all P<.05.

    “The weighted prevalence of all disabilities was higher in women with urinary incontinence than women without urinary incontinence across most decades of life with the greatest difference in the prevalence of mobility disabilities: 40–49 years (12.1% versus 7.0%), 50–59 years (17.0% versus 9.2%), 60–69 years (28.3% versus 19.8%), and 70+ years (43.8% versus 33.0%, all P < .05).”
    • Also stated in: § Results · plain
      “The greatest difference in the prevalence of disabilities was noted for mobility disability; the weighted prevalence of mobility disability was significantly higher for women with UI than women without UI across all decades of life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    UI was not significantly associated with mobility or IADL disability, and its association with ADL disability and functional limitations was weak.

    “UI was not significantly associated with mobility disability or IADL disability and the strength of the association between UI and ADL disabilities and functional limitations was weak.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Increasing age and number of comorbidities remained significantly associated with higher odds of disability, while higher income-poverty ratio was protective.

    “Variables that remained significantly associated with disability were increasing age and number of co-morbidities (increased odds of disabilities), and higher income-poverty ratio (protective effect).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a prospective study of older adults with mean age 79, worsening ADL, IADL, and physical performance were linked to higher risk of new urinary incontinence.

    “Tinetti et al. showed that in elderly adults with a mean age of 79 years, functional decline and disability as measured by worsening ADL, IADL, and physical performance measures were prospectively associated with an increased risk of developing incident urinary incontinence.(3)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Tinetti et al.

      Not checked in the free run.

    • cites [3] Tinetti, 1995, Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    UI was measured with the validated 2-item Incontinence Severity Index, which correlates well with pad-weight volume and bladder-diary frequency.

    “Urinary incontinence was defined using the validated 2-item Incontinence Severity Index (included on the NHANES Kidney and Incontinence Questionnaire), which correlates well with incontinence volume based on pad weights and incontinence frequency obtained on bladder diaries.(8)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Sandvik, 2000, A severity index for epidemiological surveys of female urinary incontinence: Comparison with 48-hour pad-weighing tests, Neurourol Urodyn source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Low physical activity is an important risk factor for disability.

    “low levels of physical activity are an important risk factor for disability (3)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Tinetti, 1995, Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In adults over 65, worsening urinary incontinence independently predicts falls, fractures, and functional dependence.

    “Conversely, worsening urinary incontinence has been shown to be an independent predictor of falls, fractures and functional dependence in the elderly over age of 65 years.(4)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Brown, 2000, Urinary incontinence: Does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group, J Am Geriatr Soc source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Symptomatic pelvic organ prolapse was defined by a positive response to a vaginal bulge question; this response correlates with examination findings but has higher specificity than sensitivity and underreports true prevalence.

    “A positive response correlates with the presence of a vaginal bulge on examination(12) however the question has higher specificity than sensitivity for pelvic organ prolapse based on exam.(12)”
    • Also stated in: § Study Population · plain
      “Prolapse estimates using this question underreport the true prevalence of prolapse on examination.(13)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] Barber, 2006, Responsiveness of the pelvic floor distress inventory (PFDI) and pelvic floor impact questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse, Am J Obstet Gynecol source

      Not checked in the free run.

    • cites [13] Handa, 2011, Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth, Obstet Gynecol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies suggest women with stress or urge incontinence are less likely than continent women to engage in recreational exercise and everyday activities such as walking, shopping, and house-cleaning.

    “Prior studies suggest that women with stress and urge incontinence are less likely to participate in recreational exercise (5) and everyday physical activities such as walking, shopping, and house-cleaning than continent women.(6)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Nygaard, 2005, Is urinary incontinence a barrier to exercise in women, Obstet Gynecol source

      Not checked in the free run.

    • cites [6] Fultz, 2004, Does urinary incontinence affect middle-aged and older women's time use and activity patterns, Obstet Gynecol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Disabilities are commonly present in women with UI and have been associated with worse surgical outcomes.

    “Disabilities, however, are commonly present in women with urinary incontinence and have been associated with worse outcomes following surgery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    UI is weakly associated with disabilities and cannot be implicated as a cause of disability in community-dwelling women.

    “Urinary incontinence is weakly associated with disabilities and cannot be implicated as a cause of disability in community dwelling women.”
    • Also stated in: § Conclusions · plain
      “In summary, urinary incontinence is weakly associated with disabilities and cannot be implicated as a cause of disability in community dwelling women.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Logistic regression was used to estimate odds of each disability type for UI while adjusting for potential confounders.

    “We performed logistic regression to determine the odds of each type of disability for urinary incontinence while controlling for potential confounding variables.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This study shows that disability prevalence is high in younger ambulatory community-dwelling women with UI but is not directly related to UI.

    “Our study shows that the prevalence of disability in younger ambulatory community-dwelling women with UI is high but not directly related to urinary incontinence.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Kafri et al. previously found lower-limb functional limitations, such as walking long distances and climbing, to be associated with UI, but whether UI causes or results from such disability in community-dwelling women remains unknown.

    “Kafri et al. (18) have previously shown that limitations in lower limb function, such as walking long distances and climbing, are associated with the presence of urinary incontinence, but whether urinary incontinence is the cause or the result of such disability in community dwelling women is not known.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Kafri et al.

      Not checked in the free run.

    • cites [18] Kafri, 2012, Self-report function and disability: A comparison between women with and without urinary incontinence, Disabil Rehabil source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Following Grimes and Schultz, odds ratios were considered clinically significant only if greater than 3.5 or 4.

    “In accordance with recommendations of Grimes and Schultz (23), we considered odds ratios to be clinically significant only if they were greater than 3.5 or 4.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Grimes and Schultz

      Not checked in the free run.

    • cites [23] Grimes, 2012, False alarms and pseudo-epidemics: The limitations of observational epidemiology, Obstet Gynecol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies have shown comorbidities increase disability risk.

    “prior studies have already shown that co-morbidities increase the risk of disability.(1, 24, 25)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Fried, 2004, Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care, J Gerontol A Biol Sci Med Sci source

      Not checked in the free run.

    • cites [24] Fried, 1998, Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study, JAMA source

      Not checked in the free run.

    • cites [25] Verbrugge, 1989, Comorbidity and its impact on disability, Milbank Q source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Urgency to reach the toilet can lead to falls and fractures, followed by reduced physical activity, functional decline, and disability.

    “Conversely, urgency to reach the toilet can result in increased falls and fractures with subsequent reduced physical activity, functional decline and disability.(4, 15)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Brown, 2000, Urinary incontinence: Does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group, J Am Geriatr Soc source

      Not checked in the free run.

    • cites [15] Miles, 2001, New-onset incontinence and markers of frailty: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, J Gerontol A Biol Sci Med Sci source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The findings suggest that comorbidities, not UI, explain the high disability prevalence in younger ambulatory community-dwelling women, and UI cannot be considered a cause of disability in these women.

    “These findings suggest that the presence of co-morbidities rather than urinary incontinence explains the observed high prevalence of disabilities in younger ambulatory community-dwelling women and urinary incontinence cannot be implicated as a cause of disability in these women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Disability was self-reported via questionnaires, and prior studies support the reliability of self-reported disability instruments.

    “Disability was self-reported using questionnaires, and prior studies support the reliability of self-reported instruments to measure disability.(22)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Kehoe, 1994, Comparing self-reported and physician-reported medical history, Am J Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The cross-sectional design prevents determining a causal UI-disability relationship or treatment effects.

    “Our study is limited by its cross-sectional design that does not allow us to determine a causal relationship between urinary incontinence and disability or the effect of treatment of urinary incontinence.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Disability was measured with the Physical Function Questionnaire and classified into four categories following Seeman et al. for NHANES.

    “Disability was measured using The Physical Function Questionnaire and classified into four categories per Seeman et al for the NHANES population.(2)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Seeman, 2010, Disability trends among older Americans: National Health and Nutrition Examination Surveys, 1988-1994 and 1999-2004, Am J Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Large-database analyses can increase the chance of finding an association by chance.

    “Analyses of large databases can also increase the probability to finding an association by chance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Prior studies disagree on which specific comorbidities are linked to UI, but a greater number of comorbidities is associated with worsening incontinence.

    “These studies show that while there is lack of consistency across studies as to which specific co-morbidities are associated with urinary incontinence, increasing number of co-morbidities is associated with worsening incontinence.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [16] Melville, 2005, Urinary incontinence in US women: A population-based study, Arch Intern Med source

      Not checked in the free run.

    • cites [17] Tennstedt, 2008, Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults, Am J Epidemiol source

      Not checked in the free run.

28 of 28

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Many older women with pelvic floor disorders, especially those with urinary and fecal incontinence, have limited mobility, which increases their dependence on caregivers to travel to providers' offices.

    “Many older women with pelvic floor disorders, especially those with urinary and fecal incontinence, also suffer from limited mobility, thus increasing their dependence on caregivers to travel to their providers’ office.13,14”

    From Willingness of women with pelvic floor disorders to use mobile technology to communicate with their health care providers (2019) · cites this paper as [14]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting conclusions about adjusted mobility disability

    Major

    The abstract reports a mobility-disability odds ratio whose 95% confidence interval excludes 1, indicating statistical significance under the paper's P<0.05 criterion. The Results section instead says urinary incontinence was not significantly associated with mobility disability.

1 of 1

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Authors
Greer, J. A., Xu, R., Propert, K. J., & Arya, L. A.
Affiliations
  • Naval Medical Center Portsmouth (US)
  • University of Pennsylvania (US)
Corresponding author
Greer, Joy A.
ORCID
Venue
Neurourology and Urodynamics
Publisher
Wiley
Published
2014-04-21
Volume
34
Issue
6
Pages
539-543
ISSN
0733-2467 (ISSN-L)
DOI
10.1002/nau.22615
PMC
PMC4205203
OpenAlex
W1948084483
Cited by
24
References
24
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 6 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 1
FWCI
0.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Neurourology and Urodynamics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Center for Advancing Translational Sciences (UL1TR000003)
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
Keywords
urinary incontinence, disability, community-dwelling women, activities of daily living, instrumental activities of daily living, mobility impairment, functional limitations, older women, prevalence, comorbidities
MeSH terms
Activities of Daily Living, Adult, Age Factors, Aged, Cross-Sectional Studies, Disability Evaluation, Female, Health Surveys, Humans, Income, Middle Aged, Nutrition Surveys, Poverty, Socioeconomic Factors, United States, Urinary Incontinence, Prevalence, Mobility Limitation, Young Adult

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