Department of Urology, University of California, San Francisco, San Francisco, CA.
Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
Urology. 2014 Feb;83(2):312-9. doi: 10.1016/j.urology.2013.08.047. Epub 2013 Oct 19.
To determine the prevalence and correlates of lower urinary tract symptoms (LUTS) among returned Iraq and Afghanistan veterans; in particular its association with mental health diagnoses and medication use.
We performed a retrospective cohort study of Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs health care. Mental health diagnoses were defined by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes from medical records. LUTS was defined by ICD-9-CM code, use of prescription medication for LUTS, or procedure for LUTS. We determined the independent association of mental health diagnoses and LUTS after adjusting for sociodemographic and military service characteristics, comorbidities, and medications.
Of 519,189 veterans, 88% were men and the mean age was 31.8 years (standard deviation ± 9.3). The overall prevalence of LUTS was 2.2% (11,237/519,189). Veterans with post-traumatic stress disorder (PTSD) were significantly more likely to have a LUTS diagnosis, prescription, or related procedure (3.5%) compared with veterans with no mental health diagnoses (1.3%) or a mental health diagnosis other than PTSD (3.1%, P <.001). In adjusted models, LUTS was significantly more common in veterans with PTSD with and without other mental health disorders vs those without mental health disorders (adjusted relative risk [ARR] = 2.04, 95% confidence interval [CI] = 1.94-2.15) and in veterans prescribed opioids (ARR = 2.46, 95% CI = 2.36-2.56).
In this study of young returned veterans, mental health diagnoses and prescription for opioids were independently associated with increased risk of receiving a diagnosis, treatment, or procedure for LUTS. Provider awareness may improve the detection and treatment of LUTS, and improve patient care and quality of life.
确定伊拉克和阿富汗退伍军人中下尿路症状（LUTS）的患病率和相关因素；特别是其与心理健康诊断和药物使用的关系。
我们对新使用美国退伍军人事务部医疗保健的伊拉克和阿富汗退伍军人进行了回顾性队列研究。通过医疗记录中的国际疾病分类，第 9 修订版，临床修正（ICD-9-CM）代码来定义心理健康诊断。LUTS 通过 ICD-9-CM 代码、LUTS 的处方药使用或 LUTS 的程序来定义。在调整了社会人口统计学和兵役特征、合并症和药物使用后，我们确定了心理健康诊断和 LUTS 之间的独立关联。
在 519,189 名退伍军人中，88%为男性，平均年龄为 31.8 岁（标准差±9.3）。LUTS 的总体患病率为 2.2%（11,237/519,189）。与无心理健康诊断（1.3%）或心理健康诊断非 PTSD（3.1%）的退伍军人相比，患有创伤后应激障碍（PTSD）的退伍军人更有可能被诊断出患有 LUTS、开具处方或进行相关治疗（3.5%，P<.001）。在调整模型中，与无心理健康障碍的退伍军人相比，患有 PTSD 或伴有其他心理健康障碍的退伍军人的 LUTS 更为常见（调整后的相对风险 [ARR] = 2.04，95%置信区间 [CI] = 1.94-2.15），以及服用阿片类药物的退伍军人（ARR = 2.46，95% CI = 2.36-2.56）。
在这项对年轻退伍军人的研究中，心理健康诊断和阿片类药物的处方与 LUTS 诊断、治疗或程序的风险增加独立相关。提高提供者的认识可能会提高 LUTS 的检出率和治疗率，改善患者的护理和生活质量。
