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Alison J. Huang, MD, MPhil; Jeanette S. Brown, MD; Alka M. Kanaya, MD; Jennifer M. Creasman, MSPH; Arona I. Ragins, MS; Stephen K. Van Den Eeden, PhD; David H. Thom, MD, PhD

Arch Intern Med. 2006;166:2000-2006.

Objective  To identify the factors associated with greater quality-of-life impact, treatment seeking, and use of treatments for urinary incontinence in ethnically diverse older women.

Methods  Cross-sectional analysis of a population-based cohort of 2109 middle-aged and older women who were randomly selected from age and race/ethnicity strata. Data were collected by self-report questionnaires and in-person interviews. Multivariable logistic regression was used to identify predictors of high quality-of-life impact (Incontinence Impact Questionnaire [IIQ] score 75th percentile), treatment seeking, and use of treatments for incontinence.

Results  More than one fourth (n = 603) of the study participants (including 96 black [16%], 123 Latina [20%], 65 Asian [11%], and 309 white [51%] women) reported weekly incontinence. After clinical severity and other factors were adjusted for, women were more likely to experience high quality-of-life impact if they had nighttime incontinence (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3-4.9), coital incontinence (OR, 1.9; 95% CI, 1.1-3.3), or comorbid fecal incontinence (OR, 2.2; 95% CI, 1.2-4.2). Predictors of treatment seeking included older age (OR, 1.6 per 10 years; 95% CI, 1.2-2.0); higher IIQ score (OR, 4.6 for highest IIQ quartile vs lowest IIQ quartile; 95% CI, 2.5-8.4), and higher household income (OR, 2.6 for income $100 000/y vs <$20 000/y; 95% CI, 1.0-2.7).

Conclusions  Clinicians seeking to evaluate the impact of incontinence on women's lives should assess not only the clinical severity of their symptoms but also the specific context in which symptoms occur. The prevalence of treatment seeking for incontinence is low across all ethnic groups, even when women have clinically severe symptoms and access to a health provider.

Author Affiliations: General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, Calif (Dr Huang); Departments of Medicine (Drs Huang and Kanaya), Obstetrics, Gynecology, & Reproductive Sciences (Dr Brown), Urology (Dr Brown), Epidemiology & Biostatistics (Dr Brown and Ms Creasman), and Family & Community Medicine (Dr Thom), University of California, San Francisco; and Division of Research, Kaiser Permanente, Oakland, Calif (Ms Ragins and Dr Van Den Eeden).

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