Urge Urinary Incontinence: Risk Factors and Health-Related Quality of Life in the Black Women’s Health Study

INTRODUCTION: Black women in the United States are reported to have a higher prevalence of urge urinary incontinence (UUI) compared to other racial/ethnic groups. The etiology of this observed difference is poorly understood. Additionally, the impact of UUI on health-related quality of life (HRQOL) is not well explored in this population. OBJECTIVE: To evaluate the risk factors associated with UUI in the Black Women’s Health Study (BWHS) and its association with HRQOL. METHODS: In 2011, the BWHS administered follow-up surveys to all participants who inquired about their experiences with urinary incontinence (UI) in the previous year. UI severity was measured by the Sandvik severity index. Using this cross-sectional data, we assessed demographic and lifestyle risk factors associated with UUI. We further assessed its association with HRQOL using the Patient Reported Outcomes Measurement System Global Heath (PROMIS-10) questionnaires by comparing women without urinary incontinence to women with UUI and across severity of UUI. For PROMIS T scores the minimal clinically important difference (MCID) is generally considered to be a 3- to 5-point difference. To assess the associations between risk factors with UUI, logistic regression models were used. Odds ratio (ORs) with associated 95% confidence intervals (CIs) and p values were reported. To assess the associations between UUI and PROMIS-10 scores, linear regression models were used. Mean differences (Betas), 95% CI, and p values were reported. Two-sided p-values less than 0.05 were considered statistically significant. Clinical significances (on PROMIS-10) were assessed by comparing the mean differences in (PROMIS-10) between UUI groups with the recommended MCID. RESULTS: A total of 25,233 women were included in this analysis. The prevalence of UUI in the BWHS was 16.7%. In univariate analysis, increasing age, increasing BMI, greater than 1 birth, postmenopausal status, current smoking, type II diabetes, menopausal status, depression, HRT, OC use, hypertension, hyperlipidemia, deep venous thrombosis, stroke, and endometriosis were associated with higher odds of experiencing UUI. Hours per week of physical activity and oral contraceptive use in the last 2 years were associated with decreased odds of experiencing UUI. Years of education, insurance status, and history of hysterectomy were not observed to be associated with UUI. Global physical health (GPH) (47.7 vs 50.8; p<0.01) and Global mental health (GMH) (48.3 vs 50.8; p<0.01) were lower when comparing women with UUI and without UI. PROMIS-10 scores were similar in women with mild and moderate UUI. Women with severe incontinence had the greatest mean difference in both GPH (−6.2 (−6.7, −5.7); <0.001) and GMH (−4.0 (−4.5, −3.5); <0.001) compared to women without UI. CONCLUSIONS: In this study, hours of physical activity per week and OC use in the last 2 years were associated with decreased odds of experiencing UUI. It appears that HRQOL is impacted the most in women with severe UUI with minimal difference in women that have mild or moderate UUI. Further research on modifiable risk factors aimed at reducing UUI may in turn improve quality of life (Tables 1 and 2).