title: Predictors of care seeking in women with urinary incontinence.
abstract: OBJECTIVE
  To determine predictors of health care utilization in women with urinary incontinence (UI) from the population to specialty care.
  
  
  METHODS
  The General Longitudinal Overactive Bladder Evaluation-UI is a population-based study on the natural history of UI in women ≥40 years of age. Prevalence of UI was estimated using the Bladder Health Survey (BHS). Survey data were linked with electronic health records (EHRs) to examine factors associated with a clinical UI diagnosis using logistic regression. Risk factors analyzed included: UI symptoms, subtypes, bother, severity, duration, and effect on quality of life, and demographic and other health characteristics. All statistical tests were two-sided with a P-value < 0.05 being significant.
  
  
  RESULTS
  The overall prevalence of any UI based on responses to the BHS was 1,618/4,064 (40%). Of the 1,618 women with UI, there were only 398 (25%) women with EHR (clinical) diagnosis of UI. Women with UI versus those without UI were more likely to be have a BMI >25 kg/m(2) (70% vs. 58%), more likely to be parous (91% vs. 87%) and college educated (54% vs. 46%), P < 0.001. After adjusting for confounders in the model, variables significantly associated with clinical UI diagnosis included: older age (OR = 1.96), higher parity (> 1 birth) (OR = 1.76), higher urgency UI (OR = 1.08), adaptive behavior (OR = 1.2), and UI bother scores (OR = 1.01), as well as more frequent outpatient visits (OR = 1.03), P < 0.05.
  
  
  CONCLUSIONS
  UI is a highly prevalent condition with only a minority of women seeking care. Factors associated with health care utilization include older age, parity (1+), number of doctor visits, urgency UI subtype, UI bother, and impact on behavior.
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA. vminassian@partners.org
authors.forename: Vatche A
authors.initials: VA
authors.lastname: Minassian
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Yan
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Lichtenfeld
authors.forename: Haiyan
authors.initials: H
authors.lastname: Sun
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011795:Surveys and Questionnaires; D053201:Urinary Bladder, Overactive / Q000453:epidemiology* / Q000628:therapy*; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000628:therapy*