American Journal of Epidemiology Advance Access originally published online on June 9, 2008
American Journal of Epidemiology 2008 168(2):234; doi:10.1093/aje/kwn150
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LETTERS TO THE EDITOR |
RE: "PREVALENCE OF AND RISK FACTORS FOR URINE LEAKAGE IN A RACIALLY AND ETHNICALLY DIVERSE POPULATION OF ADULTS: THE BOSTON AREA COMMUNITY HEALTH (BACH) SURVEY"
Department of Health Sciences, University of Leicester, Leicester, Leicestershire LE1 6TP, United Kingdom
(e-mail: cm45{at}le.ac.uk)
We welcome the recent paper from the Boston Area Community Health (BACH) Survey (1) on the prevalence and risk factors for urinary incontinence in an ethnically diverse population of adults. In his invited commentary, Thom (2) stated that the association with coronary heart disease had not been reported previously as a risk factor for urinary incontinence. However, we would like to draw your attention to our study of comorbid factors in relation to the urinary symptom syndromes, overactive bladder and stress urinary incontinence. This cohort study investigated the associations of a range of comorbid indicators for hypothetical mechanisms, including diabetic, ischemic, neurogenic, myogenic, and immunologic, using a large (>12,500) representative sample of women in the United Kingdom aged 40 years or more (3). We demonstrated a cross-sectional relation for coronary heart disease (myocardial infarction and angina) with the outcomes of stress urinary incontinence and overactive bladder, as well as a prospective association with overactive bladder incident at 1-year follow-up. This is consistent with the findings of Tennstedt et al. (1), suggesting that evidence is building for a relation between heart disease and incontinence.
We also note the lack of association found with lifestyle factors. This is inconsistent with findings in our prospective studies in men (4) and women (5) and other studies that have shown associations with, for example, physical activity (6–8). One likely reason for this inconsistency is that, within the causal chain, lifestyle factors act before comorbidities. Therefore, inclusion of both within the current analysis is likely to underestimate any genuine lifestyle associations and to bias the results in favor of comorbid associations. For the purposes of comparing consistency, it would be preferable to see the results of a univariate age-adjusted analysis from the BACH Study, as well as the multivariate analysis, which depends on the particular confounding factors included in the model. Interactions between lifestyle factors may also distort the factors identified by using logistic regression and could usefully be checked by including interaction terms.
We look forward to seeing the prospective results from this interesting study.
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ACKNOWLEDGMENTS |
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Conflict of interest: none declared.
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References |
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 TOP References |
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- Tennstedt SL, Link CL, Steers WD, et al. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) Survey. Am J Epidemiol (2008) 167:390–9.
[Abstract/Free Full Text] - Thom DH. Invited commentary: the contribution of the BACH Survey to the epidemiology of urinary incontinence. Am J Epidemiol (2008) 167:400–3.
[Abstract/Free Full Text] - McGrother CW, Donaldson MMK, Hayward T, et al. Urinary storage symptoms and comorbidities: a prospective population cohort study in middle-aged and older women. Age Ageing (2006) 35:16–24.
[Abstract/Free Full Text] - Dallosso HM, Matthews RJ, McGrother CW, et al. The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men. Public Health Nutr (2004) 7:885–91.[Web of Science][Medline]
- Dallosso HM, McGrother CW, Matthews RJ, et al. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int (2003) 92:69–77.[CrossRef][Web of Science][Medline]
- Hannestad YS, Rortveit G, Daltveit AK, et al. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG (2003) 110:247–54.[Web of Science][Medline]
- Kikuchi A, Niu K, Ikeda Y, et al. Association between physical activity and urinary incontinence in a community-based elderly population aged 70 years and over. Eur Urol (2007) 52:868–75.[CrossRef][Web of Science][Medline]
- Danforth KN, Shah AD, Townsend MK, et al. Physical activity and urinary incontinence among healthy, older women. Obstet Gynecol (2007) 109:721–7.[CrossRef][Web of Science][Medline]
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  D. H. Thom THE AUTHOR OF THE INVITED COMMENTARY REPLIES Am. J. Epidemiol., July 15, 2008; 168(2): 235 - 236. [Full Text] [PDF]
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S. L. Tennstedt, C. L. Link, W. D. Steers, and J. B. McKinlay THE AUTHORS REPLY Am. J. Epidemiol., July 15, 2008; 168(2): 234 - 235. [Full Text] [PDF]
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