Cluster analysis of multiple chronic conditions associated with urinary incontinence among women in the USA

• Published in: BJU international Vol. 122; no. 6; pp. 1041 - 1048
• Main Authors: Markland, Alayne D., Vaughan, Camille P., Okosun, Ike S., Goode, Patricia S., Burgio, Kathryn L., Johnson, Theodore M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2018
• Subjects: Adipose tissue; Adult; Age; Aged; Asthma; Asthma - complications; Asthma - epidemiology; Asthma - physiopathology; Cardiovascular diseases; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; chronic disease; Chronic illnesses; Cluster Analysis; comorbidity; Cross-Sectional Studies; epidemiology; Female; Humans; Hysterectomy; Middle Aged; Minority & ethnic groups; Multiple Chronic Conditions; Prevalence; Quality of Life; Severity of Illness Index; United States - epidemiology; Urinary incontinence; Urinary Incontinence - epidemiology; Urinary Incontinence - etiology; Urinary Incontinence - physiopathology; Women's Health; United States; United States > US; epidemiology; comorbidity; multiple chronic conditions; urinary incontinence; chronic disease
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.14246

Objective To identify patterns of prevalent chronic medical conditions among women with urinary incontinence (UI). Materials and Methods We combined cross‐sectional data from the 2005–2006 to 2011–2012 US National Health and Nutrition Examination Surveys, and identified 3 800 women with UI and data on 12 chronic conditions. Types of UI included stress UI (SUI), urgency UI (UUI), and mixed stress and urgency UI (MUI). We categorized UI as mild, moderate or severe using validated measures. We performed a two‐step cluster analysis to identify patterns between clusters for UI type and severity. We explored associations between clusters by UI subtype and severity, controlling for age, education, race/ethnicity, parity, hysterectomy status and adiposity in weighted regression analyses. Results Eleven percent of women with UI had no chronic conditions. Among women with UI who had at least one additional condition, four distinct clusters were identified: (i) cardiovascular disease (CVD) risk‐younger; (ii) asthma‐predominant; (iii) CVD risk‐older; and (iv) multiple chronic conditions (MCC). In comparison to women with UI and no chronic diseases, women in the CVD risk‐younger (age 46.7 ± 15.8 years) cluster reported the highest rate of SUI and mild UI severity. In the asthma‐predominant cluster (age 51.5 ± 10.2 years), women had more SUI and MUI and more moderate UI severity. Women in the CVD risk‐older cluster (age 57.9 ± 13.4 years) had the highest rate of UUI, along with more severe UI. Women in the MCC cluster (age 61.0 ± 14.8 years) had the highest rates of MUI and the highest rate of moderate/severe UI. Conclusions Women with UI rarely have no additional chronic conditions. Four patterns of chronic conditions emerged with differences by UI type and severity. Identification of women with mild UI and modifiable conditions may inform future prevention efforts.