American Journal of Epidemiology Advance Access originally published online on June 9, 2008
American Journal of Epidemiology 2008 168(2):234-235; doi:10.1093/aje/kwn153
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LETTERS TO THE EDITOR |
THE AUTHORS REPLY
1 New England Research Institutes, Watertown, MA 02111
2 The University of Virginia Health System, Charlottesville, VA 22908
(e-mail: stennstedt{at}neriscience.com)
We thank McGrother et al. (1) for their interest in our paper (2). In their letter, McGrother et al. have compared findings from the Leicestershire Medical Research Council (MRC) Incontinence Study and the Boston Area Community Health (BACH) Survey, noting both consistencies and inconsistencies. As found in the BACH sample, they have reported a cross-sectional relation between coronary heart disease (angina and myocardial infarction) and urine leakage. However, in contrast to these findings about women from the Leicestershire MRC Incontinence Study (3), the relation between heart disease and incontinence varied by gender and race/ethnic group in the BACH sample. This association is significant (p < 0.05) in multivariate models for White men (odds ratio = 4.26, 95 percent confidence interval: 1.30, 13.97) and Black women (odds ratio = 2.52, 95 percent confidence interval: 1.15, 5.53), with odds ratios greater than 1 for Black men and Hispanic women and odds ratios less than 1 for Hispanic men and White women (2). In bivariate analyses, the prevalence of urine leakage is higher in those with heart disease for Black men and women and White men and women but not for Hispanics. In this regard, the results of these two studies appear less consistent. However, the findings from the two studies underscore the importance of further epidemiologic and clinical attention to this relation of urine leakage and heart disease.
The authors also note the apparent inconsistency in findings regarding the association of lifestyle factors and urinary incontinence. The recommended bivariate analyses were conducted in preliminary analysis to inform the construction of the multivariate models. In terms of physical activity, weekly urine leakage was less frequent at higher physical activity levels for all groups, but significant only for Black men (p = 0.046) and Black women (p = 0.025). This relation was not observed in the multivariate models. Although it is certainly possible that lifestyle factors preceded comorbid conditions as suggested by McGrother et al. (1), it is equally possible that comorbid conditions affected the reports of current physical activity and other lifestyle factors. The longitudinal data currently being collected will allow for a more thorough analysis of this association and potential causality.
A forthcoming BACH analysis of the cross-sectional association of various lifestyle factors (physical activity, diet including carbonated beverages as well as caffeinated and decaffeinated tea and coffee, alcohol intake, smoking), obesity, and urine leakage should provide data for useful comparison of results from the Leicestershire MRC Incontinence Study and other studies reporting similar relations (e.g., Norwegian Epidemiology of Incontinence in the County of Nord-Trøndelag (EPINCONT) (4) and Study of Women's Health Across the Nation (SWAN) (5)). The ongoing follow-up at 5 years will allow us to investigate the natural history (progression or remission) of urine leakage over time and temporal relations with comorbid conditions and lifestyle factors in this highly diverse population. Collectively, data from the BACH Survey and other studies can be used to generate hypotheses for clinical studies and to inform development of both treatment and preventive interventions for both men and women.
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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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- McGrother CW, Donaldson MMK, Thompson JR. 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." (Letter). Am J Epidemiol (2008) 168:234.
[Free Full Text] - 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] - 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] - 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]
- Waetjen EL, Liao S, Johnson WO, et al. Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data. Am J Epidemiol (2007) 165:309–18.
[Abstract/Free Full Text]
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