Prevalence and trends in urinary incontinence among women in the United States, 2005–2018

Abstract

BACKGROUND Women are disproportionally affected by urinary incontinence compared to men. Urinary incontinence results in physical and psychological adverse consequences and impaired quality of life and contributes to significant societal and economic burden. Previous studies reported high urinary incontinence burden in the US. However, the current prevalence and recent trends in urinary incontinence and its subtypes among US women have not been described. In addition, correlates of urinary incontinence among US women have not been systematically evaluated in the contemporary population. OBJECTIVES The purpose of this study is to determine the prevalence and trends in urinary incontinence among adult women in the United States from 2005 to 2018. Additionally, this study aims to investigate the relationship between urinary incontinence subtypes with several sociodemographic, lifestyle, health-related and gynecological factors. STUDY DESIGN We used data from the National Health and Nutrition Examination Survey, a nationally representative series of surveys that was designed to evaluate the health status of the United States population. Data on urinary incontinence from seven consecutive two-year cycles (2005-2006 to 2017-2018) were used for the purpose of this study. A total of 19,791 participants aged ≥ 20 years were included. Weighted prevalence estimates and 95% confidence intervals were calculated in each study cycle for stress, urgency, and mixed urinary incontinence. Multivariable-adjusted weighted logistic regression was used to investigate the temporal trends in urinary incontinence, in addition to determining the association between urinary incontinence subtypes with several participants' factors. RESULTS In the 2017-2018 cycle, stress urinary incontinence was the most prevalent subtype: 45.9% (95% confidence interval (CI): 42.1 to 49.7%), followed by urgency urinary incontinence: 31.1% (95% CI: 28.6 to 33.6%) and mixed urinary incontinence: 18.1% (95% CI: 15.7 to 20.5%). The prevalences of urgency and mixed urinary incontinence were higher in women 60 years and older (urgency: 49.5%, 95% CI: 43.9 to 55.2%; mixed: 31.4%, 95% CI: 26.2 to 36.6%) than those 40-59 years (urgency: 27.9%, 95% CI: 23.6 to 32.1%; mixed: 15.9%, 95% CI: 12.9 to 19.0%) and those 20-39 years (urgency: 17.6%, 95% CI: 13.8 to 21.5%; mixed: 8.3%, 95% CI: 5.4 to 11.3%). The overall prevalence of stress and mixed urinary incontinence was stable throughout 2005 to 2018 (both p trend = 0.3), with increases in mixed urinary incontinence among women 60 years and older (p=0.001). The prevalence of urgency urinary incontinence increased significantly, particularly among women 60 years and older (both p=0.002). Age, obesity, smoking, comorbidities, and postmenopausal hormone therapy were associated with higher prevalence of all types of urinary incontinence. Black women were less likely to report stress urinary incontinence, but more likely to report urgency urinary incontinence. CONCLUSIONS While the estimated overall prevalence of stress and mixed urinary incontinence remained stable from 2005 to 2018, the prevalence of urgency and mixed urinary incontinence increased significantly among women aged 60 years and older. All subtypes of urinary incontinence were higher among women with obesity, comorbidities, those who used postmenopausal hormone therapy, and smokers.