title: Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men.
abstract: BACKGROUND
  Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission.
  
  
  METHODS
  In community-dwelling US men aged ≥65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000-2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model.
  
  
  RESULTS
  We identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0-3.8), poor mental health (OR=1.9, 95% CI: 1.1-3.4), BMI≥25.0 kg m(-2) (OR=1.7, 95% CI: 1.0-2.8), hypertension (OR=1.5, 95% CI: 1.0-2.4) and back pain (OR=1.5, 95% CI: 1.0-2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1-4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2-0.9).
  
  
  CONCLUSIONS
  Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.
authors.affiliation: 1] Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA [2] Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland, OR, USA [3] Department of Medicine, Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Marshall
authors.affiliation: Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA.
authors.forename: K F
authors.initials: KF
authors.lastname: Holton
authors.affiliation: 1] Division of Urology, University of California San Diego, La Jolla, CA, USA [2] Moores Cancer Center, University of California San Diego, La Jolla, CA, USA [3] Department of Surgery, San Diego Veterans Affairs Medical Center, La Jolla, CA, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Parsons
authors.affiliation: 1] Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland, OR, USA [2] Biostatistics Design Program, Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, OR, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Lapidus
authors.affiliation: 1] Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland, OR, USA [2] Biostatistics Design Program, Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, OR, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ramsey
authors.affiliation: Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Barrett-Connor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D011469:Prostatic Diseases / Q000150:complications; D011788:Quality of Life; D012307:Risk Factors