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The association of urinary incontinence with poor self-rated health
T M Johnson1, J E Kincade, S L Bernard
1Cecil G. Sheps Center for Health Services Research, Division of General Medicine and Clinical Epidemiology, School of Medicine, The University of Carolina at Chapel Hill, USA.
Objectives:
To assess whether urinary incontinence (UI) and its severity are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors.
Design:
A cross-sectional analysis using multivariate logistic regression.
Setting:
Subjects were from the 1990-1991 National Survey of Self-Care and Aging (N = 3485), a random sampling in geographic clusters of community-dwelling Medicare beneficiaries 65 years of age or older in the contiguous United States.
Measures:
The responses to an interviewer-administered questionnaire regarding urinary incontinence, Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, need for proxy response to the survey, and number of medical conditions.
Results:
Unadjusted analysis showed the presence of urinary incontinence to be associated with poor self-rated health (OR 2.7, 2.1-3.3). With gender, number of comorbid conditions, race, IADL impairment, and interaction terms of incontinence/race and incontinence/IADL in the final model, UI was associated with poor self-rated health in certain subgroups. White subjects with no IADL impairment and mild-moderate incontinence had an OR of 2.0 (95% CI 1.5-2.9) and those with severe incontinence had an OR of 4.5 (95% CI 2.4-8.4) of rating their health as poor, whereas those with no IADL impairment and no incontinence were the referent group. For those with a lot of difficulty performing one or more IADL activity, the association of UI and poor self-rated health was weak. For non-white subjects, there was no association, or a very weak association, of UI and poor self-rated health.
Conclusion:
In this national sample, urinary incontinence was independently and positively associated with poor self-rated health after adjustment for age, comorbidity, and frailty for most community-dwelling older adults. This association between UI and poor self-rated health was weaker and statistically insignificant when IADL impairment was present or in non-white subjects. Further research is indicated to better understand the impact of urinary incontinence in specific cultural settings.