Rural vs. urban disparities in association with lower urinary tract symptoms and benign prostatic hyperplasia in ageing men, NHANES 2001–2008

• Published in: International journal of clinical practice (Esher) Vol. 69; no. 11; pp. 1316 - 1325
• Main Authors: Egan, K. B., Suh, M., Rosen, R. C., Burnett, A. L., Ni, X., Wong, D. G., McVary, K. T.
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.11.2015
• Subjects: Adult; Aged; Aging; Alcohols; Analgesics; Antidepressants; Benign; Calcium; Calcium channel blockers; Commuting; Demographics; Health insurance; Health Status Disparities; Humans; Hyperplasia; Hypertension; Logistic Models; Lower Urinary Tract Symptoms - epidemiology; Male; Mens health; Middle Aged; Prevalence; Prostate; Prostate cancer; Prostatic Hyperplasia - epidemiology; Proton pump inhibitors; Quality of Life; Risk Factors; Rural areas; Rural Population - statistics & numerical data; Socioeconomic Factors; United States - epidemiology; Urban Population - statistics & numerical data; Urbanization; Urinary tract; Urogenital system
• ISSN: 1368-5031; 1742-1241
• DOI: 10.1111/ijcp.12709

Summary Objective 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. Methods 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. Results 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). Conclusion Rural/urban status was not associated with significantly increased adjusted odds of either recognised or unrecognised LUTS/BPH.