Division of Urology, University of Toronto, Toronto, Ontario, Canada.
Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Urol. 2020 Mar;203(3):591-597. doi: 10.1097/JU.0000000000000574. Epub 2019 Oct 3.
Previous studies have shown an association between urinary incontinence and increased mortality independently of demographics and health status. However, they do not account for the effect of frailty as a state of vulnerability. We evaluated whether there is an association between urinary incontinence and mortality and, if so, whether adjustment for a frailty index would affect the association.
We performed a cross-sectional study in a nationally representative sample of 2,282 community dwelling individuals 50 years old or older who were surveyed between 2003 and 2006. The study primary outcome was overall survival as reported on December 31, 2011. We used design adjusted Cox proportional hazards regression models to estimate the hazard of mortality associated with urinary incontinence. We adjusted the models for demographics and a validated 45-item frailty index incorporating an accumulation of deficits in the domains of health and independence.
Of the individuals 23% reported having urinary incontinence at least a few times per week. Stress urinary incontinence and urge urinary incontinence were associated with a 13.3% (95% CI 7.2-19.7) and 18.4% (95% CI 8.3-29.4) increase in the frailty index, respectively. Without controlling for frailty individuals with urinary incontinence were at higher risk for death (HR 1.39, 95% CI 1.13-1.72). When adjusted for the frailty index, the association between urinary incontinence and mortality was no longer significant (HR 1.10, 95% CI 0.89-1.36).
The association between urinary incontinence and mortality can be understood based on increased frailty in incontinent individuals. Urinary incontinence itself is not independently associated with mortality. In clinical practice these findings underscore the importance of screening for frailty in addition to urinary incontinence.
先前的研究表明，尿失禁与死亡率之间存在关联，这种关联独立于人口统计学因素和健康状况。然而，这些研究并未考虑脆弱性作为一种易损状态的影响。我们评估了尿失禁与死亡率之间是否存在关联，如果存在，那么调整虚弱指数是否会影响这种关联。
我们对 2003 年至 2006 年间接受调查的 2282 名年龄在 50 岁或以上的社区居民进行了一项全国代表性样本的横断面研究。该研究的主要结局是截至 2011 年 12 月 31 日的总体生存率。我们使用设计调整的 Cox 比例风险回归模型来估计与尿失禁相关的死亡率风险。我们调整了模型，以适应人口统计学因素和一个包含健康和独立领域缺陷积累的 45 项验证虚弱指数。
在这些人中，有 23%的人报告每周至少有几次尿失禁。压力性尿失禁和急迫性尿失禁分别与虚弱指数增加 13.3%（95%可信区间 7.2-19.7）和 18.4%（95%可信区间 8.3-29.4）相关。在不控制脆弱性的情况下，有尿失禁的个体死亡风险更高（风险比 1.39，95%可信区间 1.13-1.72）。当调整虚弱指数时，尿失禁与死亡率之间的关联不再显著（风险比 1.10，95%可信区间 0.89-1.36）。
尿失禁与死亡率之间的关联可以通过尿失禁患者的脆弱性增加来解释。尿失禁本身与死亡率无关。在临床实践中，这些发现强调了在筛查尿失禁的基础上筛查脆弱性的重要性。
