Biomedical subjects

S J Jacobsen

Publications and source records attributed to S J Jacobsen.

At least 55 records · Page 3Linked to original sources

PubMed1999

Trends in prostatectomy for benign prostatic hyperplasia among black and white men in the United States: 1980 to 1994.

OBJECTIVES: To estimate the annual rate of discharge for prostatectomy for benign prostatic hyperplasia (BPH) in black and white men from 1980 to 1994 using the National Hospital Discharge Survey. METHODS: Overall and race-, age-, and year-specific utilization rates were estimated for the civilian population in the United States. Length of stay was calculated for each discharge, and the results were plotted over time. An expected number of discharges based on the rates observed in 1980 was estimated to determine the impact of decreased prostatectomy rates on the number of procedures that would have been expected in this aging population. RESULTS: Discharge rates for whites were within a narrow range (233.2 to 274.5 per 100,000) from 1980 through 1990 and then displayed a monotonic decline after 1991 to 131.3 per 100,000 in 1994. Rates for blacks were 10% to 24% lower from 1980 to 1991; the decline in discharge rates began in 1993 for blacks, and by 1994 the racial gap had closed. Length of stay decreased throughout the period but length of stay averaged 30% longer for blacks throughout. On the basis of the observed rates of 1980, there were more than 140,000 fewer prostatectomies performed for BPH in 1994 than would have been expected owing to the aging of the population. CONCLUSIONS: These data demonstrate that the black/white differences in prostatectomy for BPH that were observed in the 1980s have disappeared in recent years. Furthermore, rates have declined dramatically in all age- and race-specific groups. Further work is needed to determine whether this convergence in discharge rates is due to equalization of access to medical care or to differences in utilization of alternative therapies.

Black or African American↗

PubMed1999

Decline of sexual function with age in Japanese men compared with American men--results of two community-based studies.

OBJECTIVES: To investigate the self-reported sexual function of Japanese men aged 40 to 79 years in a community-based study and compare the results to a similarly conducted study in Olmsted County, Minnesota. METHODS: Two hundred eighty-nine Japanese and 2115 American men from the community were queried about ability to have erections when stimulated, sexual drive, and satisfaction with sexual activity using a self-administered questionnaire. RESULTS: Both Japanese and American men showed an age-related decline in erectile function, sexual libido, and sexual satisfaction. In particular, 71% of Japanese men aged 70 to 79 years reported having erections only a little of the time or less when sexually stimulated, and 80% perceived sexual drive once per month or less during the past month. Although more Japanese than American men reported erectile dysfunction and decreased libido, there were no striking differences in self-reported sexual satisfaction between the studies. However, cultural and perceptual differences could play a role in these results, despite attempts to ensure linguistic equivalency in the questionnaires. CONCLUSIONS: Although erectile dysfunction and decreased libido were noted by a greater proportion of Japanese than American men, the self-reported degree of satisfaction was comparable between the studies. Perceptions of elderly male sexual function and its impact on health-related quality of life may differ among races, sites, and countries.

Adult↗

PubMed1999

Use of echocardiography in the management of congestive heart failure in the community.

OBJECTIVES: We evaluated the use and the impact of echocardiography in patients receiving an initial diagnosis of congestive heart failure in Olmsted County, Minnesota, in 1991. BACKGROUND: The American College of Cardiology/American Heart Association clinical practice guidelines recommend echocardiography in all patients with suspected congestive heart failure. No data are available on use and impact of echocardiography in management of congestive heart failure in a community. METHODS: The medical records linkage system of the Rochester Epidemiology Project was used to identify all 216 patients who satisfied the Framingham criteria for congestive heart failure. Of these, 137 (63%) underwent echocardiography within 3 weeks before or after the episode of congestive heart failure (Echo group), and the other 79 patients constitute the No-Echo group. RESULTS: The No-Echo group patients were older (p=0.022), were more likely to be female (p=0.072), had milder symptoms (p=0.001) and were less often hospitalized at diagnosis (p=0.001). Fewer patients in the No-Echo group were treated with angiotensin-converting enzyme inhibitors (p=0.001). Advanced age (> or = 80 years), lower New York Heart Association functional class, absence of a fourth heart sound on examination, absence of cardiomegaly or signs of congestive heart failure on chest radiography and absence of known valve disease were independently related to the decision not to obtain an echocardiogram. Survival after adjustment for age, functional class and gender was lower in the No-Echo group than the Echo group (risk ratio=0.607, p=0.017). CONCLUSIONS: The underuse of echocardiography appears to be associated with poorer survival and underuse of angiotensin-converting enzyme inhibitor therapy.

Adult↗

PubMed1999

Prevalence of combined fecal and urinary incontinence: a community-based study.

OBJECTIVE: To assess the prevalence of combined fecal and urinary incontinence. DESIGN: A cross-sectional, community-based study. SETTING: Olmsted County, Minnesota. PARTICIPANTS: Men (n = 778) and women (n = 762), aged 50 years or older, selected randomly from the population. MEASUREMENTS: Participants completed a previously validated self-administered questionnaire that assessed the occurrence of fecal and urinary incontinence in the previous year. RESULTS: The age-adjusted prevalence of incontinence was 11.1% (95% Confidence Interval (CI), 8.8-13.5) in men and 15.2% (95% CI, 12.5-17.9) in women for fecal incontinence; 25.6% (95% CI, 22.5-28.8) in men and 48.4% (95% CI, 44.7-52.2) in women for urinary incontinence; and 5.9% (95% CI, 4.1-7.6) in men and 9.4% (95% CI, 7.1-11.6) in women for combined urinary and fecal incontinence. The prevalence of fecal incontinence increased with age in men but not in women, from 8.4% among men in their fifties to 18.2% among men in their eighties (P for trend = .001). For women, the prevalence increased from 13.1% among 50-year-old women to 20.7% among women 80 years or older (P for trend = .5). Among persons with fecal incontinence, the prevalence of concurrent urinary incontinence was 51.1% among men and 59.6% among women (P = .001 and P = .003, respectively). Cross-sectionally, the age-adjusted, relative odds of fecal incontinence among persons with urinary incontinence was greater in men than in women (Odds Ratio (OR) = 3.0; 95% CI, 1.9-4.8 in men and OR = 1.8; 95% CI, 1.2-2.7 in women, P = .04). CONCLUSIONS: These findings suggest that persons with one form of incontinence are likely to have the other form as well. Despite the higher prevalence of urinary and fecal incontinence among women, the association between fecal incontinence and urinary incontinence was stronger among men than women. This finding, and the significant association between fecal incontinence and age observed in men but not in women, suggest that the etiologies may be more closely linked in men than in women.

Age Distribution↗

PubMed1999

Association of health-related quality of life and benign prostatic enlargement.

OBJECTIVE: To investigate the association of benign prostatic enlargement and health-related quality of life (HRQoL) assessed by validated questionnaires. METHOD: Randomly selected men (n = 471) aged 40-79 years from Olmsted County, Minn. (USA) without prior prostate surgery or prostate cancer had a full urologic workup, including transrectal ultrasonography, in addition to completing questionnaires soliciting information about urinary symptom frequency, bother, degree of interference with daily activities and other measures of HRQoL. RESULTS: Disease-specific HRQoL was worse in older men, and men with more severe symptoms. Age-adjusted mean scores for symptom severity, bother and activity interference were about 50% worse for men with enlarged prostates (volume > 40 cm3). After adjusting for age, men with enlarged prostates were nearly 3 times (95% CI 1.6, 5.1) as likely to have moderate to severe symptoms, and about twice as likely to have bother (odds ratio 2.4; 95% CI 1.3, 4.2) or activity interference (odds ratio 1.8; 95% CI 1. 0, 3.2) relative to men with smaller prostates. CONCLUSION: HRQoL measures are worse in men who are older and, after adjusting for age, in men with increased urinary symptom frequency and enlarged prostate. The broader spectrum of patients provided by the community-based random sampling allows elucidation of these important relationships.

Adult↗

PubMed1999

Sex differences in the epidemiology and outcomes of heart disease: population-based trends.

We examined trends in heart disease (HD) mortality and the delivery of cardiac in Olmsted County, MN. Between 1979 and 1994, women experienced 51% of the total number of HD (ICD9 codes 390-398,402,404-429) deaths (3095). Age-adjusted HD mortality rate declined from 123 per 100,000 (95%CI 102, 144) in 1979 to 81 (67,95) in 1994. The risk ratio (RR) of HD death in 1994 compared to 1979 was 0.69 for women vs 0.53 for men (P = 0.06). This equates to a decline in HD mortality of 2.5%/y in women and 4.2%/y in men. The decline in HD mortality was less pronounced in older age groups (P < 0.001), reflecting a shift of the burden of HD towards women and the elderly. Compared to men, there was less use of stress tests among women, of cardiology visits after stress testing, and of cardiac procedures among women presenting to the emergency room with unstable angina. Further studies are needed to examine causal links between these trends.

Delivery of Health Care↗

PubMed1999

Potential effect of authorization bias on medical record research.

OBJECTIVE: To analyze the influence of recent changes in Minnesota statutes that generally require prior authorization for use of medical records for research from patients who received medical care after Jan. 1, 1997. MATERIAL AND METHODS: In this Mayo Clinic Institutional Review Board-approved study, we obtained a stratified random sample of patients encountered at Mayo Clinic Rochester during the period 1994 through 1996 and estimated the proportion willing to provide the general authorization. On the basis of data from administrative files, we then compared demographic, diagnostic, and utilization characteristics for patients who provided authorization and those who did not. RESULTS: Overall, 3.2% (95% confidence interval, 2.4 to 4.0%) of the study subjects declined authorization. If patients not responding to requests for authorization were also considered to have refused, the overall refusal rate would be 20.7% (95% confidence interval, 18.5 to 22.9%). Women were somewhat more likely to refuse authorization than were men (4.0% versus 2.4%; P = 0.067), and patients younger than 60 years were more likely to refuse than were older patients (5.4% versus 1.2%; P<0.001). Patients residing more than 120 miles from Rochester were much less likely to decline authorization than were local residents (2.1% versus 5.8%; P = 0.001). Patients with prior diagnoses that might be considered more sensitive such as mental disorders, infectious diseases, and reproductive problems also were more likely to refuse authorization. CONCLUSION: These data demonstrate that laws requiring written authorization for research use of the medical record could result in substantial biases in etiologic and outcome studies, the direction and magnitude of which may vary from topic to topic. Clinicians should be prepared to enter the discussion to help inform patients and legislators of the potential hazards of laws that restrict access to medical records for research purposes.

Adult↗

PubMed1999

Trends in heart disease deaths in Olmsted County, Minnesota, 1979-1994.

BACKGROUND: Although age-adjusted heart disease mortality has declined since the 1960s, this decline may not have applied equally to all subgroups. OBJECTIVE: To examine recent trends in heart disease mortality, specifically in women and in the elderly. METHODS: Age- and sex-specific heart disease mortality (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 390-398, 402, 404-429) in Olmsted County, Minnesota, between 1979 and 1994 were studied. RESULTS: The total number of heart disease deaths was 3095; 1578 (51%) occurred in women and 1984 (64%) in persons aged 75 years or older. Most heart disease deaths (77%) were coronary disease deaths (ICD-9-CM codes 410-414). Age-adjusted heart disease mortality rates declined from 123 per 100,000 (95% confidence interval [CI], 102-144/100,000) in 1979 to 81 per 100,000 (95% CI, 67-95/100,000) in 1994. Poisson regression analyses indicated that the trends differed according to sex and age. For women, the relative risk (RR) of heart disease death in 1994 compared with 1979 was 0.69 vs 0.53 for men (P = .06). This equates to a decline in heart disease mortality of 2.5% per year in women or 32% over the period and 4.2% per year in men or 47% over the period. The decline was less pronounced as age increased (P < .001). For 60-year-old women, the RR for 1994 compared with 1979 was 0.59, whereas for 80-year-old women, the RR for 1994 compared with 1979 was 0.76. For men, the RR for 1994 compared with 1979 was 0.60 for 80-year-old men vs 0.46 for 60-year-old men. CONCLUSIONS: Between 1979 and 1994, in Olmsted County, the decline in heart disease mortality was of lesser magnitude in women and in the elderly, emphasizing the importance of age- and sex-specific trends to characterize time patterns in heart disease deaths to target preventive measures.

Age Distribution↗

PubMed1999

Prostatic central zone volume, lower urinary tract symptom severity and peak urinary flow rates in community dwelling men.

PURPOSE: Previous studies have suggested that central zone prostatic volume may be more strongly correlated with lower urinary tract symptom severity and peak urinary flow rates than total prostatic volume. We determine whether prostatic central zone volume and central zone index volume correlate better with these measures than total prostate volume in an age stratified, community based random sample of healthy white men. MATERIALS AND METHODS: A cohort of 474 men were randomly selected from the 2,115 community dwelling men, 40 to 79 years old, who participated in the Olmsted County study of urinary symptoms and health status among men. All men had undergone transrectal ultrasound of the prostate. The total prostate and hypoechoic central zone volumes were caliper measured by 1 operator on static ultrasounds from baseline. Volumes were calculated with the prolate ellipsoid formula. The operator was blinded to clinical information and outcome. The associations between total prostate volume and central zone index (central zone volume/total volume), and American Urological Association (AUA) symptom index and peak urinary flow rates, respectively, were quantified with the Spearman rank correlation coefficient and least squares regression models. RESULTS: There was a moderately strong correlation between patient age and central zone volume (rs 0.54, p <0.001), total prostate volume (rs 0.45, p <0.001) and central zone index (rs 0.38, p <0.001). The AUA symptom index and peak flow rates correlated less strongly with central zone volume (rs 0.17, p = 0.001 and rs -0.20, p <0.001, respectively) and total volume (rs 0.16, p <0.001 and rs -0.16, p <0.001, respectively). Central zone index weakly correlated with AUA symptom index (rs 0.08, p = 0.103) and peak urinary flow rate (rs -0.08, p = 0.0823). In regression models predicting AUA symptom index and peak flow rates central zone volume added little information after accounting for age and total prostatic volume in predicting AUA symptom index (p = 0.55) and peak flow rate (p = 0.84). CONCLUSIONS: Central zone volume measured from static images optimized for total prostate volume no more closely correlated with lower urinary tract symptom severity or peak urinary flow rates than total prostate volume. Thus, the potentially greater imprecision in measuring central zone volume may not be offset by gains in strength of association with lower urinary tract symptom severity or peak urinary flow rates.

Adult↗

PubMed1999

Distribution of post-void residual urine volume in randomly selected men.

PURPOSE: We describe the distribution of post-void residual urine volume and its relationship to other urological measurements in a random sample of men. MATERIALS AND METHODS: Post-void residual was measured by transabdominal ultrasonography after voiding and prostate volume was measured by transrectal ultrasonography in 477 randomly selected community dwelling white men as part of a baseline urological evaluation. Symptoms were characterized with the American Urological Association symptom index. Acute urinary retention cases with catheterization in the subsequent 3 to 4 years were identified through chart review. RESULTS: The distribution of post-void residual was highly skewed with a median of 9.5 ml., and 25th and 75th percentiles equal to 2.5 and 35.4, respectively. There was a significant correlation of post-void residual with prostate volume (rs = 0.24, p <0.001). The odds of post-void residual greater than 50 ml. were 2.5 times greater for men with prostate volume greater than 30 ml. than those with smaller prostates. In regression analyses post-void residual did not appear to be associated with the American Urological Association symptom index, age or peak urinary flow rate. Men with enlarged prostate volume or post-void residual greater than 50 ml. at baseline were about 3 times as likely to have subsequent acute urinary retention with catheterization during 3 to 4 years of followup. CONCLUSIONS: These results suggest little variation in the distribution of post-void residual urine volume across age groups or levels of urinary symptoms and peak urinary flow rate. However, a somewhat stronger relationship was found between residual urine and prostate volume.

Adult↗

PubMed1999

Longitudinal prostate growth rates during 5 years in randomly selected community men 40 to 79 years old.

PURPOSE: We estimate the rate of prostate growth in randomly selected healthy community dwelling men. MATERIALS AND METHODS: Prostate volume in an age stratified random sample of 631 white male residents of Olmsted County, Minnesota 40 to 79 years old without prior prostate surgery or prostate cancer was measured up to 4 times by transrectal ultrasound during a followup period of almost 7 years. RESULTS: Estimated prostate growth rates increased with increasing age. However, the estimated average annual change was 1.6% across all age groups. Estimated prostate growth rates were high depending on baseline prostate volume with higher growth rates for men with larger prostates. CONCLUSIONS: While there is wide variability in prostate growth rates on an individual level, prostate volume appears to increase steadily at about 1.6% per year in randomly selected community men.

Adult↗

PubMed1999

Highly sensitive automated chemiluminometric assay for measuring free human glandular kallikrein-2.

BACKGROUND: Human glandular kallikrein (hK2) is a serine protease that has 79% amino acid identity with prostate-specific antigen (PSA). Both free hK2 and hK2 complexed to alpha1-antichymotrypsin (ACT) are present in the blood in low concentrations. We wished to measure hK2 in serum with limited contribution from hK2-ACT for the results. METHODS: We developed an automated assay for hK2 with use of a select pair of monoclonal antibodies. The prototype assay was implemented on a Beckman Coulter ACCESS(R) analyzer. RESULTS: The detection limit of the assay was 1.5 ng/L, the "functional sensitivity" (day-to-day CV <15%) was <4 ng/L, cross-reactivity with PSA and PSA-ACT was negligible, and cross-reactivity with hK2-ACT was 2%. After surgical removal of prostate glands, serum hK2 was <7 ng/L and was <15 ng/L in most healthy women. The median serum concentration of hK2 in healthy men without prostate cancer was 26 ng/L. The median concentration of hK2 was 72 ng/L for men having prostate cancer with lower Gleason scores compared with 116 ng/L for men with more advanced cancer. The concentration of hK2 correlated weakly with PSA, with the mean hK2 concentrations generally 30- to 80-fold lower than PSA concentrations. CONCLUSION: The availability of a robust, high sensitivity automated assay for hK2 should facilitate further investigations of the role of hK2 measurements in the management of patients with prostate disease.

Adult↗

PubMed1999

Treatment for benign prostatic hyperplasia among community dwelling men: the Olmsted County study of urinary symptoms and health status.

PURPOSE: We describe treatments for benign prostatic hyperplasia (BPH) among men participating in the Olmsted County study of urinary symptoms and health status among men during 10,000 person-years of followup. MATERIALS AND METHODS: A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire to assess symptom severity and voided into a portable urometer. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume and measurement of serum prostate specific antigen. Followup included retrospective review of community medical records and completion of a biennial questionnaire to determine the occurrence of medical and surgical treatment for BPH in the subsequent 6 years. RESULTS: During more than 10,000 person-years of followup 167 men were treated, yielding an overall incidence of 16.0/1,000 person-years. There was a strong age related increase in risk of any treatment from 3.3/1,000 person-years for men 40 to 49 years old to more than 30/1,000 person-years for those 70 years old or older. Men with moderate to severe symptoms (American Urological Association symptom index greater than 7), depressed peak urinary flow rates (less than 12 ml. per second), enlarged prostate (greater than 30 ml.) or elevated serum prostate specific antigen (1.4 ng./ml. or greater) had about 4 times the risk of BPH treatment than those who did not. After adjustment for all measures simultaneously an enlarged prostate (hazard ratio 2.3, 95% confidence interval [CI] 1.1, 4.7), depressed peak flow rate (hazard ratio 2.7, 95% CI 1.4, 5.3) and moderate to severe symptoms (hazard ratio 5.3, 95% CI 2.5, 11.1) at baseline each independently predicted subsequent treatment. CONCLUSIONS: While repeat contact and availability of urological measurements during the study period may have influenced treatment decisions in this cohort, the data demonstrate that treatment is common in elderly men with nearly 1 in 4 receiving treatment in the eighth decade of life. Furthermore, these data suggest that men with moderate to severe lower urinary tract symptoms, impaired flow rates or enlarged prostates are more likely to undergo treatment, with increases in risk of similar magnitude to those associated with adverse outcomes, such as acute urinary retention.

Adult↗

PubMed1999

Decline in prostate cancer mortality from 1980 to 1997, and an update on incidence trends in Olmsted County, Minnesota.

PURPOSE: We describe trends in prostate cancer mortality from 1980 to 1997, before and after the introduction of serum prostate specific antigen (PSA) testing to the community medical practice, and provide an update on trends in incidence since 1992. MATERIALS AND METHODS: All men with a diagnosis of prostate cancer who died between 1980 and 1997 were identified and parts 1 and 2 of the death certificates were reviewed for a diagnosis of prostate cancer. In addition, all men with biopsy proved prostate cancer diagnosed between 1983 and 1995 were identified. The complete medical records of incident cases of prostate cancer were reviewed for signs and symptoms at diagnosis and for the first treatment received. RESULTS: Age adjusted, community mortality rates from prostate cancer increased from 25.8/100,000 men in 1980 to 1984 to a peak of 34/100,000 in 1989 to 1992, and have since declined to 19.4/100,000 in 1993 to 1997 (22% decline in mortality, 95% confidence interval 49% decline to 17% increase). The overall age adjusted incidence rates which peaked at 209/100,000 person-years in 1992 as previously reported declined to 108/100,000 in 1993 and 132/100,000 in 1995. A similar pattern was observed for organ confined cancers. However, incidence rates for regional or distant disease were suggestive of a continuing downward trend from 1989 to 1992 compared to 1993 to 1995 (12% decline per year, p = 0.07). CONCLUSIONS: These data demonstrate that despite the increase in prostate cancer mortality rates in the mid to late 1980s, mortality rates in 1993 to 1997 are lower than in the years before serum PSA testing. While chance cannot be ruled out, the data suggest that increased screening for prostate cancer, particularly through PSA testing, may have led to declines in mortality from prostate cancer.

Aged↗

PubMed1998

Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991.

BACKGROUND: Data are limited regarding the classification and prognosis of patients with congestive heart failure (CHF) in the community. METHODS AND RESULTS: Using the resources of the Rochester Epidemiology Project, we evaluated all patients receiving a first diagnosis of CHF in Olmsted County, Minnesota, in 1991 (n=216). Among these patients, 88% were >/=65 years and 49% were >/=80 years of age. The prognosis of patients with a new diagnosis of CHF was poor; survival was 86+/-2% at 3 months, 76+/-3% at 1 year, and 35+/-3% at 5 years. Of the 216 patients, 137 (63%) had an assessment of ejection fraction. In these patients, systolic function was preserved (ejection fraction >/=50%) in 59 (43%) and reduced (ejection fraction <50%) in 78 (57%). Survival adjusted for age, sex, NYHA class, and coronary artery disease was not significantly different between patients with preserved and those with reduced systolic function (relative risk, 0.80; P=0.369). ACE inhibitors were used in only 44% of the total population with CHF. CONCLUSIONS: The present study reports the clinical characteristics and natural history of CHF as it presents in the community in the vasodilator era. CHF is a disease of the "very elderly," frequently occurs in the setting of normal ejection fraction, and has a poor prognosis, regardless of the level of systolic function. Diagnostic and therapeutic methods are underused in the community.

Age Distribution↗

PubMed1998

Levonorgestrel contraceptive implants in female patients 14 to 21 years old.

OBJECTIVE: To determine which factors are associated with duration of use of a levonorgestrel implant (Norplant) for contraception in adolescents and young adults. DESIGN: We retrospectively studied 144 young women (14 to 21 years of age) who chose a levonorgestrel contraceptive implant at Mayo Clinic Rochester between April 1990 and December 1993. MATERIAL AND METHODS: The following information was obtained at the time of insertion of the implant and from any follow-up visits: demographics, prior contraceptive experiences, frequency and management of complications, complications noted at removal of the implant, and subsequent contraceptive choice. The duration of use was examined. RESULTS: Of the 144 young women who underwent insertion of a Norplant system, 75 telephoned or made a medical appointment because of implant-related side effects. During the follow-up period, 64 patients had the Norplant system removed. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83 % and for at least 24 months was 63 %. Duration of Norplant use was not found to differ with respect to age, prior contraceptive use, or timing of insertion, but it was significantly shorter among those with a prior pregnancy than in those who had never been pregnant. CONCLUSION: These findings suggest that a group of young women who are likely to continue use of a contraceptive implant (with or without treatment for side effects) are those who have never been pregnant.

Adolescent↗

PubMed1998

Natural history of prostatism: high American Urological Association Symptom scores among community-dwelling men and women with urinary incontinence.

OBJECTIVES: The American Urological Association Symptom Index (AUASI) has been reported to be nonspecific for benign prostatic hyperplasia. Comparable scores occur in patients with lower urinary tract symptoms of varying etiology, and even among women. The purpose of this study was to determine the association between the AUASI and urinary incontinence among community-dwelling men and women. METHODS: In 1994, a randomly selected cohort of 1540 men and women aged 50 years or older from Olmsted County, Minnesota completed a self-administered questionnaire that assessed urinary symptom severity (AUASI score) and estimated the prevalence of urinary incontinence in the previous 12 months. The association between moderate to severe urinary symptom (AUASI score greater than 7) and urinary incontinence was investigated using multiple logistic regression, with adjustments for gender and age. RESULTS: Mean and median AUASI scores increased with age, and were higher among those respondents with urinary incontinence and among men. All seven urologic items in the AUASI were more prevalent among respondents with urinary incontinence and among men. Nocturia was highly prevalent among respondents with and without urinary incontinence, but urgency, frequency, and weak urinary stream were more prevalent among respondents with incontinence than among respondents without incontinence. When urinary incontinence, gender, and age were considered simultaneously, the respondents with urinary incontinence (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 3.4, 5.5), men (OR = 1.9, 95% CI = 1.5, 2.5), and respondents 65 years or older (OR = 1.5, 95% CI = 1.2, 1.9) were more likely to have moderate to severe urinary symptoms. CONCLUSIONS: Our findings suggest that men and women with urinary incontinence and older men and women are significantly more likely to have moderate to severe urinary symptoms. These findings suggest that urinary incontinence may contribute to a high AUASI score in both sexes. Thus, these data indicate that the similarity in the distribution of the AUASI in men and women is, in part, an artifact introduced by the confounding effects of continence status.

Age Distribution↗

PubMed1998

Health-related quality of life associated with lower urinary tract symptoms in four countries.

OBJECTIVES: To describe health-related quality of life (HRQL) associated with lower urinary tract symptoms (LUTS) assessed by validated questionnaires in four countries. METHODS: More than 6000 men, recruited by using community- or population-based sampling in four countries, completed questionnaires soliciting information about urinary symptom frequency, bother, degree of interference with daily activities, and other measures of HRQL. RESULTS: In all countries, disease-specific HRQL worsened with increasing age. Adjusting for age, most disease-specific HRQL measures were significantly worse with increasing symptom severity. The correlation between symptoms and HRQL was strongest in countries with higher prevalence of symptoms, such as Japan or the United States, and less pronounced in countries with lower prevalence (France, Scotland), possibly reflecting the lower variability in scores. CONCLUSIONS: HRQL measures are worse in older men, and increased urinary symptom severity is associated with worse disease-specific HRQL in all countries, despite potential cross-cultural differences in disease prevalence, medication use, perceptions, or willingness to report symptoms or worse HRQL. This cross-cultural consistency suggests that an assessment of symptom bother or interference with daily activities may be useful in patient evaluation.

Adult↗