IncontinencePopulation-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study
Introduction
The term lower urinary tract symptoms (LUTS) was introduced in 1994 [1] and consists of storage, voiding, and postmicturition symptoms [2]. Many adults experience LUTS, and the prevalence of these symptoms increases with age [3]. Individuals with LUTS often experience urinary incontinence (UI) or overactive bladder (OAB) symptoms. OAB is a subset of storage LUTS currently defined by the International Continence Society (ICS) as urgency, with or without urgency UI (UUI), usually with frequency and nocturia [2]. LUTS, including UI and OAB, have detrimental effects on health-related quality of life [4], [5], [6].
Several population-based studies have estimated the prevalence of UI or subsets of LUTS [7], [8], [9], [10], [11], but prevalence estimates differ based on type of UI and country surveyed. Many of these studies were also limited by gender, examining UI in women and LUTS in men. Relatively few published prevalence surveys in the general population have assessed the prevalence of OAB, and these have used different definitions of OAB [6], [12], [13], [14], [15]. To date, no large population-based study has evaluated the prevalence of all LUTS using the definitions recently approved by the ICS [2]. Therefore, the aim of this study was to estimate the population-based prevalence of UI, OAB, and other LUTS among men and women aged ≥ 18 yr using the current ICS (2002) definitions.
Section snippets
Methods
This was a population-based, cross-sectional telephone survey of adults aged ≥ 18 yr in five countries: Canada, Germany, Italy, Sweden, and the United Kingdom. All interviews were conducted using a computer-assisted telephone interview (CATI) system. All interviewers underwent standardised training and regular quality-control checks. Ethics committee approval was obtained according to national regulations in each country.
Participants
A total of 58,139 individuals were contacted to participate in the study, and 19,165 agreed (33% response rate). Individuals were interviewed between April 2005 and December 2005. Demographics for the survey participants and for the general population within the five countries surveyed are summarised in Table 1. Respondents were predominantly white (95.6%), about 26.6% had a university education or higher, and 58.5% were currently married.
Prevalence of LUTS
Table 2 reports the prevalence of LUTS in the survey
Discussion
To date, the EPIC study is the largest of its kind to report population-based prevalence rates of LUTS including OAB and UI, and in five countries. To our knowledge, this is the first study published that evaluated these symptoms simultaneously using the 2002 ICS definitions. Our results demonstrate that LUTS are highly prevalent in men (62.5%) and women (66.6%) ≥40 yr of age in the countries surveyed and that the prevalence of LUTS increases with age. Approximately 1.4% of men and 1.8% of
Conclusions
This population-based survey confirms that LUTS are highly prevalent, and the prevalence of LUTS increases with age. The prevalence of LUTS was higher in the EPIC study, which used 2002 ICS definitions, than in many studies that estimated the prevalence of “moderate to severe” LUTS, defined as a score of at least 8 on the IPSS. Storage symptoms are more prevalent than voiding or postmicturition LUTS, and nocturia was the most commonly reported symptom. Based on these results, it is anticipated
Conflict of interest statement
This study was sponsored by Pfizer Inc. D.I. is a paid consultant to Pfizer Inc. I.M. is a member of International Advisory Boards regarding lower urinary tract symptoms for Astellas Pharma, Novartis, and Pfizer Inc; an investigator in the STAR study sponsored by Astellas Pharma; a recipient of research grants for epidemiologic studies on lower urinary tract symptoms from Astellas Pharma and Pfizer Inc to the Department of Obstetrics and Gynecology; and a recipient of honoraria for lectures
Acknowledgements
The authors would like to acknowledge the invaluable expertise in statistical programming by Christer Eskvard and the editorial assistance of Linda Goldstein, PhD, from Complete Healthcare Communications, Inc, in the preparation of this manuscript. This study was funded by Pfizer Inc.
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