Johnson T M, Kincade J E, Bernard S L, Busby-Whitehead J, Hertz-Picciotto I, DeFriese G H
Cecil G. Sheps Center for Health Services Research, Division of General Medicine and Clinical Epidemiology, School of Medicine, The University of Carolina at Chapel Hill, USA.
J Am Geriatr Soc. 1998 Jun;46(6):693-9. doi: 10.1111/j.1532-5415.1998.tb03802.x.
To assess whether urinary incontinence (UI) and its severity are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors.
A cross-sectional analysis using multivariate logistic regression.
Subjects were from the 1990-1991 National Survey of Self-Care and Aging (N = 3485), a random sampling in geographic clusters of community-dwelling Medicare beneficiaries 65 years of age or older in the contiguous United States.
The responses to an interviewer-administered questionnaire regarding urinary incontinence, Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, need for proxy response to the survey, and number of medical conditions.
Unadjusted analysis showed the presence of urinary incontinence to be associated with poor self-rated health (OR 2.7, 2.1-3.3). With gender, number of comorbid conditions, race, IADL impairment, and interaction terms of incontinence/race and incontinence/IADL in the final model, UI was associated with poor self-rated health in certain subgroups. White subjects with no IADL impairment and mild-moderate incontinence had an OR of 2.0 (95% CI 1.5-2.9) and those with severe incontinence had an OR of 4.5 (95% CI 2.4-8.4) of rating their health as poor, whereas those with no IADL impairment and no incontinence were the referent group. For those with a lot of difficulty performing one or more IADL activity, the association of UI and poor self-rated health was weak. For non-white subjects, there was no association, or a very weak association, of UI and poor self-rated health.
In this national sample, urinary incontinence was independently and positively associated with poor self-rated health after adjustment for age, comorbidity, and frailty for most community-dwelling older adults. This association between UI and poor self-rated health was weaker and statistically insignificant when IADL impairment was present or in non-white subjects. Further research is indicated to better understand the impact of urinary incontinence in specific cultural settings.
在全国范围内社区居住的老年人样本中，评估尿失禁（UI）及其严重程度是否与自我健康评价不佳相关，以及在控制了因功能状态、合并症和人口统计学因素导致的混杂因素后，这种关系是否仍然存在。
使用多变量逻辑回归的横断面分析。
研究对象来自1990 - 1991年全国自我护理与老龄化调查（N = 3485），该调查在美国本土对65岁及以上社区居住的医疗保险受益人的地理集群进行随机抽样。
对访员管理的问卷的回答，内容涉及尿失禁、日常生活基本活动（BADL）、日常生活工具性活动（IADL）、日常生活移动活动（MADL）、年龄、性别、居住地点、种族、教育程度、是否需要他人代答问卷以及疾病数量。
未经调整的分析表明，存在尿失禁与自我健康评价不佳相关（比值比2.7，2.1 - 3.3）。在最终模型中纳入性别、合并症数量、种族、IADL功能受损情况以及尿失禁/种族和尿失禁/IADL的交互项后，尿失禁在某些亚组中与自我健康评价不佳相关。没有IADL功能受损且有轻度至中度尿失禁的白人受试者将自己的健康评为不佳的比值比为2.0（95%可信区间1.5 - 2.9），而有严重尿失禁的白人受试者这一比值比为4.5（95%可信区间2.4 - 8.4），没有IADL功能受损且没有尿失禁的受试者作为参照组。对于在一项或多项IADL活动中存在很大困难的人，尿失禁与自我健康评价不佳之间的关联较弱。对于非白人受试者，尿失禁与自我健康评价不佳之间没有关联或关联非常弱。
在这个全国性样本中，对于大多数社区居住的老年人，在调整年龄、合并症和虚弱程度后，尿失禁与自我健康评价不佳独立且呈正相关。当存在IADL功能受损或在非白人受试者中，尿失禁与自我健康评价不佳之间的这种关联较弱且无统计学意义。需要进一步研究以更好地了解尿失禁在特定文化背景下的影响。
