Familial risk of urinary incontinence in women: population based cross sectional study
http://www.100md.com
《英国医生杂志》
1 Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway, 2 Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen
Correspondence to Y S Hannestad Yngvild.hannestad@isf.uib.no
Abstract
A genetic predisposition may play a part in the development of urinary incontinence in women, a common condition which is often chronic and burdensome.1 2 We investigated the familial risk of urinary incontinence in the daughters, granddaughters, and sisters of incontinent women.
Methods
We recruited 8771 of 13 501 (65.0%) mothers and 2866 of 4456 (64.3%) older sisters who were surveyed for the Nord-Tr?ndelag health survey during 1995-7 (figure). We were able to follow up 68.6% (6021 of 8771) of the mothers (cohort 1, mothers to daughters) and 73.4% (2104 of 2866) of the sisters (cohort 2, sisters to sisters). Table 1 lists the characteristics of the two cohorts.
Table 1 Characteristics of two cohorts of women. Values are numbers (percentages) of women unless stated otherwise
Daughters of mothers with any type of urinary incontinence had a 1.3-fold risk of being incontinent (table 2). The risk for having the same type of incontinence as the mother was slightly higher (urge incontinence was not statistically significant). The relative risk of severe urinary incontinence in the daughters of mothers with severe incontinence was 1.9. The risks were highest for severe stress incontinence and severe mixed incontinence. We could not calculate risk estimates for severe urge incontinence because of small population numbers.
Table 2 Observed risks of incontinence in daughters of mothers with incontinence. Risks relate to daughters whose mothers were continent
When we could investigate urinary incontinence in both the daughters and the granddaughters of mothers (322 families), we found no increased risk in the granddaughters if only the mothers were incontinent. When both mothers and daughters had urinary incontinence, however, the risk for incontinence in granddaughters was 2.4 (95% confidence interval 1.1 to 4.3). We were unable to estimate risks according to type of incontinence because too few women could be followed through the three generations.
Female siblings had a 1.6-fold increased risk of urinary incontinence if their older sisters were incontinent (table 3). This risk was not significantly different from that between mothers and daughters (1.3-fold risk; P = 0.07). The risks for stress and mixed incontinence in female siblings of older sisters with similar symptoms were 1.8-fold and 1.7-fold, respectively. Too few sisters had severe or urge incontinence to estimate the risk of these symptoms.
Table 3 Observed risks of incontinence in younger sisters of older sisters with incontinence (risks relate to younger sisters whose older sisters were continent)
Discussion
Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J 2000;11: 301-19.
Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc 1998;46: 473-80.
Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol 2000;53: 1150-7.
Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn 2000;19: 137-45.
McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 2003;157: 940-3.
Elia G, Bergman J, Dye TD. Familial incidence of urinary incontinence. Am J Obstet Gynecol 2002;187: 53-5.
Mushkat Y, Bukovsky I, Langer R. Female urinary stress incontinence—does it have familial prevalence? Am J Obstet Gynecol 1996;174: 617-9.
Rekers H, Drogendijk AC, Valkenburg H, Riphagen F. Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences. Eur J Obstet Gynecol Reprod Biol 1992;43: 229-34.
Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Scand J Prim Health Care 2002;20: 102-7.
Schulman C, Claes H, Matthijs J. Urinary incontinence in Belgium: a population-based epidemiological survey. Eur Urol 1997;32: 315-20.
Zhang J, Yu KF. What's the relative risk?: a method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998;280: 1690-1.
Sandvik H, Hunskaar S, Vanvik A, Bratt H, Seim A, Hermstad R. Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol 1995;48: 339-43.
Jensen JK, Nielsen FJ, Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol 1994;83: 904-10.
FitzGerald MP, Brubaker L. Urinary incontinence symptom scores and urodynamic diagnoses. Neurourol Urodyn 2002;21: 30-5.
Thom DH, van den Eeden SK, Brown JS. Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life. Obstet Gynecol 1997;90: 983-9.
Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 2001;98: 1004-10.
Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003;348: 900-7.
Mommsen S, Foldspang A. Body mass index and adult female urinary incontinence. World J Urol 1994;12: 319-22.
Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003;110: 247-54.(Yngvild S Hannestad, post)
Correspondence to Y S Hannestad Yngvild.hannestad@isf.uib.no
Abstract
A genetic predisposition may play a part in the development of urinary incontinence in women, a common condition which is often chronic and burdensome.1 2 We investigated the familial risk of urinary incontinence in the daughters, granddaughters, and sisters of incontinent women.
Methods
We recruited 8771 of 13 501 (65.0%) mothers and 2866 of 4456 (64.3%) older sisters who were surveyed for the Nord-Tr?ndelag health survey during 1995-7 (figure). We were able to follow up 68.6% (6021 of 8771) of the mothers (cohort 1, mothers to daughters) and 73.4% (2104 of 2866) of the sisters (cohort 2, sisters to sisters). Table 1 lists the characteristics of the two cohorts.
Table 1 Characteristics of two cohorts of women. Values are numbers (percentages) of women unless stated otherwise
Daughters of mothers with any type of urinary incontinence had a 1.3-fold risk of being incontinent (table 2). The risk for having the same type of incontinence as the mother was slightly higher (urge incontinence was not statistically significant). The relative risk of severe urinary incontinence in the daughters of mothers with severe incontinence was 1.9. The risks were highest for severe stress incontinence and severe mixed incontinence. We could not calculate risk estimates for severe urge incontinence because of small population numbers.
Table 2 Observed risks of incontinence in daughters of mothers with incontinence. Risks relate to daughters whose mothers were continent
When we could investigate urinary incontinence in both the daughters and the granddaughters of mothers (322 families), we found no increased risk in the granddaughters if only the mothers were incontinent. When both mothers and daughters had urinary incontinence, however, the risk for incontinence in granddaughters was 2.4 (95% confidence interval 1.1 to 4.3). We were unable to estimate risks according to type of incontinence because too few women could be followed through the three generations.
Female siblings had a 1.6-fold increased risk of urinary incontinence if their older sisters were incontinent (table 3). This risk was not significantly different from that between mothers and daughters (1.3-fold risk; P = 0.07). The risks for stress and mixed incontinence in female siblings of older sisters with similar symptoms were 1.8-fold and 1.7-fold, respectively. Too few sisters had severe or urge incontinence to estimate the risk of these symptoms.
Table 3 Observed risks of incontinence in younger sisters of older sisters with incontinence (risks relate to younger sisters whose older sisters were continent)
Discussion
Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J 2000;11: 301-19.
Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc 1998;46: 473-80.
Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol 2000;53: 1150-7.
Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn 2000;19: 137-45.
McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 2003;157: 940-3.
Elia G, Bergman J, Dye TD. Familial incidence of urinary incontinence. Am J Obstet Gynecol 2002;187: 53-5.
Mushkat Y, Bukovsky I, Langer R. Female urinary stress incontinence—does it have familial prevalence? Am J Obstet Gynecol 1996;174: 617-9.
Rekers H, Drogendijk AC, Valkenburg H, Riphagen F. Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences. Eur J Obstet Gynecol Reprod Biol 1992;43: 229-34.
Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Scand J Prim Health Care 2002;20: 102-7.
Schulman C, Claes H, Matthijs J. Urinary incontinence in Belgium: a population-based epidemiological survey. Eur Urol 1997;32: 315-20.
Zhang J, Yu KF. What's the relative risk?: a method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998;280: 1690-1.
Sandvik H, Hunskaar S, Vanvik A, Bratt H, Seim A, Hermstad R. Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol 1995;48: 339-43.
Jensen JK, Nielsen FJ, Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol 1994;83: 904-10.
FitzGerald MP, Brubaker L. Urinary incontinence symptom scores and urodynamic diagnoses. Neurourol Urodyn 2002;21: 30-5.
Thom DH, van den Eeden SK, Brown JS. Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life. Obstet Gynecol 1997;90: 983-9.
Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 2001;98: 1004-10.
Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003;348: 900-7.
Mommsen S, Foldspang A. Body mass index and adult female urinary incontinence. World J Urol 1994;12: 319-22.
Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003;110: 247-54.(Yngvild S Hannestad, post)