Egan K B, Suh M, Rosen R C, Burnett A L, Ni X, Wong D G, McVary K T
New England Research Institutes, Inc., Watertown, MA, USA.
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Int J Clin Pract. 2015 Nov;69(11):1316-25. doi: 10.1111/ijcp.12709. Epub 2015 Jul 28.
The objective of this study was to investigate rural/urban and socio-demographic disparities in lower urinary tract symptoms and benign prostatic hyperplasia (LUTS/BPH) in a nationally representative population of men.
Data on men age ≥40 years (N = 4,492) in the 2001-2008 National Health and Nutrition Examination Surveys were analysed. Self-report of physician-diagnosed enlarged prostate and/or BPH medication use defined recognised LUTS/BPH. Urinary symptoms without BPH diagnosis/medications defined unrecognised LUTS/BPH. Rural-Urban Commuting Area Codes assessed urbanisation. Unadjusted and multivariable associations (odds ratios (OR)) between LUTS/BPH and covariates were calculated using logistic regression.
Recognised and unrecognised LUTS/BPH weighted-prevalence estimates were 16.5% and 9.6%. There were no significant associations between LUTS/BPH and rural/urban status. Significant predisposing factors for increased adjusted odds of recognised and unrecognised LUTS/BPH included age, hypertension (OR=1.4;1.4), analgesic use (OR=1.4;1.4) and PSA level >4 ng/mL (OR=2.3;1.9) when adjusted for rural/urban status, race, education, income, alcohol, health insurance, health care and proton pump inhibitor (PPI) use (all p ≤ 0.1). Restricting to urban men only (N = 3,371), healthcare use (≥4visits/year) and PPI's increased adjusted odds of recognised LUTS/BPH (OR=2.0;1.6); no health insurance and <high school education decreased odds (OR=0.5;0.6) after adjusting for variables listed above, antidepressant and calcium channel blocker use (p ≤ 0.1). Also among urban men, adjusted odds of unrecognised LUTS/BPH increased for blacks (OR=1.9), Hispanic/Other (OR=1.9) and income<$34,999 (OR=1.6). Among rural men only (N = 1,121), adjusted odds of recognised and unrecognised LUTS/BPH increased for age, hypertension (OR=1.9;1.7) and analgesic use (OR=2.0;1.5) when adjusting for race, CRP, antidepressant and dyslipidaemic use (p ≤ 0.1).
Rural/urban status was not associated with significantly increased adjusted odds of either recognised or unrecognised LUTS/BPH.
本研究的目的是调查全国具有代表性的男性人群中，下尿路症状和良性前列腺增生（LUTS/BPH）在城乡及社会人口统计学方面的差异。
分析了2001 - 2008年国家健康与营养检查调查中年龄≥40岁男性（N = 4492）的数据。医生诊断的前列腺肿大和/或使用BPH药物的自我报告定义为已确诊的LUTS/BPH。无BPH诊断/用药的泌尿系统症状定义为未确诊的LUTS/BPH。城乡通勤区号用于评估城市化程度。使用逻辑回归计算LUTS/BPH与协变量之间的未调整和多变量关联（比值比（OR））。
已确诊和未确诊的LUTS/BPH加权患病率估计分别为16.5%和9.6%。LUTS/BPH与城乡状况之间无显著关联。在根据城乡状况、种族、教育程度、收入、饮酒、医疗保险、医疗保健和质子泵抑制剂（PPI）使用情况进行调整后（所有p≤0.1），已确诊和未确诊的LUTS/BPH调整后比值增加的显著诱发因素包括年龄、高血压（OR = 1.4；1.4）、使用镇痛药（OR = 1.4；1.4）和PSA水平>4 ng/mL（OR = 2.3；1.9）。仅针对城市男性（N = 3371），医疗保健使用（每年≥4次就诊）和PPI增加了已确诊LUTS/BPH调整后的比值（OR = 2.0；1.6）；在调整上述列出的变量、抗抑郁药和钙通道阻滞剂使用情况后（p≤0.1），无医疗保险和高中以下教育程度降低了比值（OR = 0.5；0.6）。同样在城市男性中，黑人（OR = 1.9）、西班牙裔/其他（OR = 1.9）和收入<$34,999（OR = 1.6）的未确诊LUTS/BPH调整后比值增加。仅在农村男性（N = 1121）中，在调整种族、CRP、抗抑郁药和血脂异常药物使用情况后（p≤0.1），年龄、高血压（OR = 1.9；1.7）和使用镇痛药（OR = 2.0；1.5）使已确诊和未确诊的LUTS/BPH调整后比值增加。
城乡状况与已确诊或未确诊的LUTS/BPH调整后比值显著增加无关。
