title: The iceberg of health care utilization in women with urinary incontinence.
abstract: OBJECTIVE
  The objective of the study was to estimate prevalence of urinary incontinence (UI) health care utilization in women from the population up to specialty care.
  
  
  METHODS
  The General Longitudinal Overactive Bladder Evaluation-UI (GLOBE-UI) is a population-based study on the natural history of UI in women  ≥  40 years of age. Prevalence of UI was estimated by using the Bladder Health Survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg.
  
  
  RESULTS
  A total sample of 7,059 women received the BHS. Of those, 3,316 (47 %) responded. Prevalence of UI was 1,366 (41 %). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91 vs 87 %), significantly more overweight or obese (74 vs 61 %), and more likely to have a college education or higher (54 vs 46 %), P < 0.01. Nine hundred fifty-eight (73 %) women with UI reported duration of more than 2 years and 72 % reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25 %) sought care, 313 (23 %) received some care, and 164 (12 %) received subspecialty care.
  
  
  CONCLUSIONS
  UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.
authors.affiliation: Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, 75 Francis Street, ASB1 3-Room 073, Boston, MA 02115, 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; D008875:Middle Aged; D010353:Patient Education as Topic; D010414:Pennsylvania / Q000453:epidemiology; D058007:Physicians, Primary Care; D015995:Prevalence; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000628:therapy*; D014932:Women's Health Services / Q000706:statistics & numerical data*