title: Comparison of lower urinary tract symptom severity and associated bother between community-dwelling black and white men: the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men's Health Study.
abstract: OBJECTIVE
  To determine the magnitude of racial disparity in lower urinary tract symptom (LUTS) severity and bother by combining two large comparable epidemiologic studies of community-dwelling white and black men, thereby avoiding many of the referral biases present in previous studies. Prior studies evaluating racial differences in benign prostatic hyperplasia have been hampered by selection bias, because nearly all have used surgical treatment as a marker for benign prostatic hyperplasia.
  
  
  METHODS
  Data from the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men's Health Study were combined for a total study sample of 2480 men. We examined LUTS severity and associated bother as measured by the self-administered American Urological Association Symptom Index and Symptom Problem Index.
  
  
  RESULTS
  Overall 34% of white men reported moderate/severe LUTS compared with 41% of black men (P <0.001). These patterns were consistent across age and persisted after adjustment for age and other sociodemographic factors. The relationship between LUTS severity and bother differed by race in that black men reported less bother for each unit increase in LUTS (P <0.001).
  
  
  CONCLUSIONS
  In contrast to studies based on clinical populations, our community-based study demonstrated greater LUTS severity in black men compared with white men but black men reported less bother for any given level of LUTS severity. Although these findings suggest a racial disparity in benign prostatic hyperplasia, additional studies of anatomic, physiologic, and molecular factors may clarify whether these racial differences are real or due to sociocultural differences in reporting symptom morbidity.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Sarma
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Rosebud O
authors.initials: RO
authors.lastname: Roberts
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Girman
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lieber
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cooney
authors.forename: David
authors.initials: D
authors.lastname: Schottenfeld
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015982:Bias; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000453:epidemiology; D011788:Quality of Life; D012720:Severity of Illness Index; D014551:Urinary Tract / Q000473:pathology*; D014570:Urologic Diseases / Q000175:diagnosis* / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*