PREVALENCE AND SEVERITY OF URINARYINCONTINENCE AMONG WOMEN IN DENMARK AND GERMANY: A CROSS NATIONALSURVEY.
L. SCHREIBER PEDERSEN1,G. LOSE 1, M. HOYBYE 2, S. ELSNER 3,A. WALDMANN 3, M. RUDNICKI 4;
1Departmentof Gynecology and Obstetrics, Herlev Gentofte Univ. Hosp., Herlev,Denmark, 2Institute for clinical medicine, Electivesurgery center, Silkeborg Hosp., Silkeborg, Denmark, 3Institutefor Social Medicine and Epidemiology, Univ. of Luebeck, Luebeck,Germany, 4Department of Obstetrics and Gynecology, OdenseUniv. Hosp., Odense, Denmark.
Introduction: Urinaryincontinence (UI) is a prevalent condition that interferes withwomen’s health-related quality of life. Earlier studies demonstratea wide variability in crude prevalence rates ranging from 16.1% to68.8% (1), due to heterogeneity in methodology, definition of UI andthe populations included, making studies difficult to compare. Truecomparison of female UI prevalence is possible when using across-national approach, but only a minority of studies uses thismethod (2,3). Thus further studies are needed to assess and comparethe prevalence of UI between countries, using standardized, reliableand validated questionnaires, with focus on avoiding selection biasand obtaining a high response rate.
Objective: We aimed todetermine and compare the prevalence and severity of UI andassociated risk factors in Germany and Denmark by using the samemethodology and definition and comparable populations.
Methods:The study was a postal cross-national survey conducted in Germany andDenmark, including 8000 randomly selected women aged 18+ years. UIwas defined as any complaint of involuntary loss of urine, accordingto the 2002 IUGA/ICS terminology. The questionnaire containedsocio-demographic questions and the ICIQ-UI short form. With thisstudy, being a part of a multicenter project, the questionnaire alsocontained questions regarding help-seeking behavior and the I-QOLquestionnaire. The ICIQ-UI SF was used to assess prevalence of UI andsubtypes within the latest four weeks. The ICIQ-score was used toassess UI severity. Height and weight was self-reported.
Results:The response rate in Germany and Denmark was 46.2% and 66.6%(p<0.001). Mean age of the participating women in Germany were50.3 (range 18-96 years), and did not differ from the participatingwomen in Denmark (mean age 51.9 years, range 18-101 years). InGermany 48.3% of the participating women had experienced UI “atleast sometimes” within the latest four weeks, which were similarto the Danish participating women’s prevalence rate at 46.4%.Stress urinary incontinence (SUI) dominated among younger women inboth countries, and urgency urinary incontinence (UUI) and mixedurinary incontinence (MUI) among women 80+ years in Germany andDenmark respectively. The mean total ICIQ-score increasedsignificantly across all age groups (p<0.001), with the highestscore among the 80+ women (10; 95% CI 8.7-11.1). Women with MUIreported a higher mean total ICIQ-score in all age groups, comparedto women with SUI and UUI (p<0.001). The prevalence of UIincreased with enhancing BMI (body mass index; in kg/m²) reaching apeak of 67.3% of women with BMI>35. SUI was the most prevalentsubtype of UI in women with BMI<35, and MUI in the group of womenwith BMI>35. The prevalence of UUI did not change significantlybetween the BMI categories. Risk factors analyses revealed that UIwas significantly associated with age (highest impact), BMI, vaginaldelivery (but independent of the number of vaginal deliveries),chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM),and having at least one co-morbidity (lowest impact). SUI wassignificantly associated with age (highest impact), vaginaldeliveries, DM and BMI (lowest impact). UUI was significantlyassociated with age (highest impact) and having at least oneco-morbidity (lowest impact). For MUI age and obesity had similarimpact as a risk factor, followed by having at least one co-morbidityand COPD respectively.
Conclusions: This study revealedthat urinary incontinence is very prevalent among the femalepopulation aged 18+ years in Germany and Denmark, with age andobesity as prominent risk factors. The difference in response ratesmay reflect various attitudes in the two population's liabilitytowards answering a questionnaire, but their response to questionsconcerning UI seemed unaffected by this, since the prevalence rateswere similar.
References: 1. Urol Int. 2013;90(1):1-9. 2.Eur Urol. 2006;50(6):1306-15. 3. BJU Int. 2004;93:324-30.